Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort

OBJECTIVE: We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm.METHODS: Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts.RESULTS: Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services.CONCLUSION: Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.</p

The Sneeuberg: A new centre of floristic endemism on the Great Escarpment, South Africa

The Sneeuberg mountain complex (Eastern Cape) comprises one of the most prominent sections of the Great Escarpment in southern Africa but until now has remained one of the botanically least known regions. The Sneeuberg is a discrete orographical entity, being delimited in the east by the Great Fish River valley, in the west by the Nelspoort Interval, to the south by the Plains of Camdeboo, and to the north by the Great Karoo pediplain. The highest peaks range from 2278 to 2504 m above sea level, and the summit plateaux range from 1800 to 2100 m. Following extensive literature review and a detailed collecting programme, the Sneeuberg is reported here as having a total flora of 1195 species of which 107 (9%) are alien species, 33 (2.8%) are endemic, and 13 (1.1%) near-endemic. Five species previously reported as Drakensberg Alpine Centre (DAC) endemics are now known to occur in the Sneeuberg (representing range extensions of some 300–500 km). One-hundred-and-five species (8.8%) are DAC near-endemics, with the Sneeuberg being the western limit for most of these. Ten species (0.8%) represent disjunctions across the Karoo Interval from the Cape Floristic Region (CFR) to the Sneeuberg. In all, some 23 significant range extensions, eight new species, and several rediscoveries are recorded. We conclude by recognising the Sneeuberg as a new centre of endemism along the Great Escarpment, with floristic affinities with the Albany Centre and the DAC, and links to the CFR

Epigenetic interactions with genetic and environmental risk factors for schizophrenia and bipolar disorder

DNA methylation has been proposed as a potential molecular mechanism linking environmental risk factors to the development of psychiatric disorders. This thesis presents a series of investigations designed to investigate epigenetic processes in the context of genetic and environmental risk factors for psychosis. These investigations were guided by the overall hypothesis that DNA methylation facilitates the gene-environment interactions which lead to the development of schizophrenia and bipolar disorder. The main empirical chapters demonstrate a new method to summarise the DNA methylation patterns associated with schizophrenia and investigate their i) interaction with genetic and environmental risk factors; ii) association with symptoms and brain structure, and iii) functional role in relation to gene expression. Participants were drawn from a clinical cohort for which deep phenotyping and multiple biological indices were available. Blood-derived DNA methylation was available for 171 participants (57 schizophrenia, 59 bipolar disorder, and 55 controls) from this cohort, subsets of which had genotype, magnetic resonance imaging, and ribonucleic acid (RNA)-seq data available. Study 1 presents a systematic review on DNA methylation of the glucocorticoid receptor gene in relation to trauma, psychopathology, RNA levels, and genotype. Inconsistencies in findings arising from this systematic review led to the adoption of an epigenome-wide approach to subsequent studies in this thesis. Study 2 thus sought to generate a poly-methylomic profile score (PMPS) to summarise the methylation patterns associated with schizophrenia. In Study 3, childhood trauma exposure and a polygenic risk score (PRS) were found to interact on this PMPS, and the PMPS was found to interact with the PRS on schizophrenia clinical status. However, Study 4 showed that PRSs and PMPSs were not associated with brain structure or symptoms. Finally, Study 5 showed that DNA methylation at some CpG sites comprising the PMPS were associated with the expression of corresponding genes. These findings emphasise that epigenetic processes must be considered in the context of underlying genetic risk and support the view that DNA methylation may provide biological insights into the pathophysiology of schizophrenia. Future research should investigate the biology underpinning intermediate phenotypes, rather than continuing to focus on heterogenous clinical disorders as if they are discrete biological entities

Familial clustering of birth risk for adverse childhood outcomes

Objective: To identify classes of children exposed to distinct clusters of perinatal and familial risk factors at the time of birth, and examine relationships between class membership and a variety of adverse outcomes in childhood. Design: A prospective longitudinal study of children (and their parents) born between 2002 and 2004 and who have been followed-up until 12–13 years of age. A combination of latent class analysis and logistic regression analyses were used. Results: Adverse developmental, social, and mental health outcomes in early and middle childhood were greatest for children with ‘pervasive familial risk’ (i.e., parental mental illness, parental criminality, and perinatal risk factors) at the time of birth; some associations were stronger among girls. Conclusion: Pervasive exposure to multiple risk factors in the pre- and perinatal period increases the risk of adverse outcomes in childhood. Future interventions should tailor strategies to address unique combinations of adverse risk exposures in vulnerable families.</p

Conditions of Birth and Early Childhood Developmental Risk for Mental Disorders

Distinct classes of children in the general population are at increased odds of later mental illness and other adverse outcomes according to patterns of early childhood developmental vulnerability. If certain risk factors known at the time of birth are reliably associated with membership in early childhood risk classes, then preventative interventions could be initiated in the earliest years of life. Associations between 14 factors known at the time of birth and membership in early childhood risk classes were examined in 66,464 children. Risk class membership was associated with maternal mental illness, parental criminal charges and being male; distinct patterns of association were shown for some conditions, for example, prenatal child protection notification was uniquely associated with misconduct risk'. These findings suggest that risk factors known at the time of birth could assist in very early detection of children who may benefit from early intervention in the first 2000 days.</p

Early childhood developmental vulnerability associated with parental mental disorder comorbidity

OBJECTIVES: Parental mental health has a profound influence on the mental health and well-being of their offspring. With comorbid mental disorders generally the rule rather than the exception, increased knowledge of the impact of parental mental disorder comorbidity on early child development may facilitate improved targeting and delivery of early intervention for vulnerable offspring.METHODS: Participants were 66,154 children and their parents in the New South Wales Child Development Study - a prospective, longitudinal, record-linkage study of a population cohort of children born in NSW between 2002 and 2004. Early childhood developmental vulnerability was assessed at age ~5 years using the Australian Early Development Census, and information on parental mental disorders was obtained from administrative health records. Binomial and multinomial logistic regression were used to assess the relationship between parental mental disorders and early childhood developmental vulnerability on emotional and behavioural domains, as well as membership of latent developmental risk classes reflecting particular classes of vulnerability.RESULTS: Multiple diagnoses of mental disorders in mothers and fathers were associated with an increased likelihood of early childhood emotional and behavioural developmental vulnerability in offspring, relative to parents without mental disorder. The likelihood of offspring vulnerability increased with the number of parental comorbidities, particularly maternal comorbidities.CONCLUSION: Early childhood developmental vulnerability was strongly associated with parental mental ill-health, with the strength of associations increasing in line with a greater number of mental disorder diagnoses among mothers and fathers. New and expectant parents diagnosed with multiple mental disorders should be prioritised for intervention, including attention to the developmental well-being of their offspring.</p

Cumulative comorbidity between neurodevelopmental, internalising, and externalising disorders in childhood: a network approach

Cumulative comorbidity of mental disorders is common, but the extent and patterns of comorbid psychopathology in childhood are not well established. The current study aimed to elucidate the emergent patterns of cumulative mental disorder comorbidity in children using network analysis of diagnoses recorded between birth and age 12 years. Participants were 90,269 children (mean age 12.7 years; 51.8% male) within the New South Wales Child Development Study (NSW-CDS)-a longitudinal record-linkage cohort study of Australian children born in NSW between 2002 and 2005. Binary indicators for eight types of mental disorder were derived from administrative health records. Patterns of conditional association between mental disorders were assessed utilising network analysis. Of 90,269 children, 2268 (2.5%) had at least one mental disorder by age 12 years; of the 2268 children who had at least one mental disorder by age 12 years, 461 (20.3%) were diagnosed with two or more different disorders out of the eight disorder types included in analyses. All disorders were either directly or indirectly interconnected, with childhood affective and emotional disorders and developmental disorders being most central to the network overall. Mental disorder nodes aggregated weakly (modularity = 0.185) into two communities, representative of internalising and externalising disorders, and neurodevelopmental and sleep disorders. Considerable sex differences in the structure of the mental disorder comorbidity networks were also observed. Developmental and childhood affective and emotional disorders appear to be key to mental disorder comorbidity in childhood, potentially reflecting that these disorders share symptoms in common with many other disorders.</p

Parental and community risk factors for childhood self-harm thoughts and behaviours

BACKGROUND: Childhood self-harm is rare but increasing in frequency. Little is known about risk factors specifically for self-harm in preteen children.METHODS: We examined self-harm thoughts and behaviours in children aged 3-14 years in association with parental and community-level risk factors, using a large general population-based record linkage sample (n = 74,479).RESULTS: Parental factors were strongly associated with childhood self-harm, with over three-quarters of children with self-harm having a parent with a history of mental disorder and/or criminal offending. Community-level factors (socioeconomic deprivation, remote or regional location, and neighbourhood crime rate) were not associated with childhood self-harm after adjustment for confounding factors.LIMITATIONS: Measures of self-harm thoughts and behaviours derived from administrative data likely underestimate the prevalence of self-harm in the population.CONCLUSIONS: Intergenerational transmission of risk factors is likely an important contributor to childhood self-harm.</p