Depression and blood pressure in high-risk children and adolescents: an investigation using two longitudinal cohorts

Objective: To examine the relationship between blood pressure and depressive disorder in children and adolescents at high risk for depression. Design: Multisample longitudinal design including a prospective longitudinal three-wave high-risk study of offspring of parents with recurrent depression and an on-going birth cohort for replication. Setting: Community-based studies. Participants: High-risk sample includes 281 families where children were aged 9-17 years at baseline and 10-19 years at the final data point. Replication cohort includes 4830 families where children were aged 11-14 years at baseline and 14-17 years at follow-up and a high-risk subsample of 612 offspring with mothers that had reported recurrent depression. Main outcome measures: The new-onset of Diagnostic and Statistical Manual of Mental Disorder, fourth edition defined depressive disorder in the offspring using established research diagnostic assessments-the Child and Adolescent Psychiatric Assessment in the high-risk sample and the Development and Wellbeing Assessment in the replication sample. Results: Blood pressure was standardised forage and gender to create SD scores and child's weight was statistically controlled in all analyses. In the high-risk sample, lower systolic blood pressure at wave 1 significantly predicted new-onset depressive disorder in children (OR=0.65, 95% CI 0.44 to 0.96; p=0.029) but diastolic blood pressure did not. Depressive disorder at wave 1 did not predict systolic blood pressure at wave 3. A significant association between lower systolic blood pressure and future depression was also found in the replication cohort in the second subset of high-risk children whose mothers had experienced recurrent depression in the past. Conclusions: Lower systolic blood pressure predicts new-onset depressive disorder in the offspring of parents with depression. Further studies are needed to investigate how this association arises

Psychoeducational interventions in adolescent depression: A systematic review

Background: Adolescent depression is common and leads to distress and impairment for individuals/families. Treatment/prevention guidelines stress the need for good information and evidence-based psychosocial interventions. There has been growing interest in psychoeducational interventions (PIs), which broadly deliver accurate information about health issues and self-management. Objective, methods: Systematic search of targeted PIs as part of prevention/management approaches for adolescent depression. Searches were undertaken independently in PubMed, PsycINFO, EMBASE, guidelines, reviews (including Cochrane), and reference lists. Key authors were contacted. No restrictions regarding publishing dates. Results: Fifteen studies were included: seven targeted adolescents with depression/depressive symptoms, eight targeted adolescents ‘at risk' e.g. with a family history of depression. Most involved family/group programmes; others included individual, school-based and online approaches. PIs may affect understanding of depression, identification of symptoms, communication, engagement, and mental health outcomes. Conclusion, practice implications: PIs can have a role in preventing/managing adolescent depression, as a first-line or adjunctive approach. The limited number of studies, heterogeneity in formats and evaluation, and inconsistent approach to defining PI, make it difficult to compare programmes and measure overall effectiveness. Further work needs to establish an agreed definition of PI, develop/evaluate PIs in line with frameworks for complex interventions, and analyse their active components

Childhood hyperactivity and mood problems at mid-life: evidence from a prospective birth cohort

Purpose Childhood hyperactivity leads to mental health problems, but it is not known whether there are long-term risks for adult mood problems in unselected population cohorts that extend to mid-life. Aims were to examine links between childhood hyperactivity and mood problems up to age 50 years and to consider confounding factors and gender differences in associations. Methods The National Child Development Study (NCDS) is a UK cohort of children born in 1958. Children with (N = 453) and without (N = 9192) pervasive and persistent hyperactivity were followed to age 50. Adult mood was assessed using the Malaise Inventory at ages 23, 33, 42, and 50 years and the CIS-R interview at 45 years. Results Childhood hyperactivity predicted low mood at all adult assessments (ES = 0.27–0.45), including after covariate adjustment (childhood adversity, emotional and behavioural problems, and attainment). Conclusion Hyperactivity has enduring risk effects on low mood throughout the life course that extend to middle age

General practitioner attitudes to the care of people with epilepsy: an examination of clustering within practices and prediction of patient-rated quality of care

BACKGROUND: There is wide variation in the quality of care provided by primary care practices to individuals with chronic illnesses. Individual doctor attitudes and interest have been demonstrated to influence patient outcomes in some instances. Given the trend towards larger practices and part-time working, continuity of care is likely to fall and thus practice-based rather than individual general practitioner attributes and attitudes are likely to become increasingly important. The aim in this paper was to examine the extent to which individual general practitioner (G.P.) attitudes to the care of people with epilepsy cluster within practices and predict patient-rated quality of care. METHODS: The sample consisted of 1255 people with active epilepsy (a recent seizure or on anti-convulsant medication for epilepsy) and 199 GPs from 82 general practices. Measures of GP attitudes (a 17-item GP attitudes questionnaire) and patient-rated quality of epilepsy care were obtained. 1210 individuals completed initial questionnaires and 975 patients filled in final questionnaires one year later. Responses were achieved from 64 practices (83% of total) and 115 GPs (60% of total). RESULTS: 2 main factors were found to underlie GP attitudes to the care of people with epilepsy and these demonstrated clustering within practices "epilepsy viewed as a primary care responsibility" (Eigenvalue 3.98, intra-class correlation coefficient (ICC) 0.40), and "medication skills"(Eigenvalue 2.74, ICC 0.35). GP-rated scores on "epilepsy care being a primary care responsibility" were a significant predictor of patient-rated quality of GP care (p = 0.031). Other contributory factors were seizure frequency (p = 0.044), and patient-rated "shared decision making" (p = 0.022). CONCLUSION: Specific general practitioner attitudes to the care of people with epilepsy cluster within practices and are significantly associated with patient-rated quality of epilepsy care. It is important to take these findings into consideration when planning primary care interventions to ensure people with epilepsy receive the benefits of available medical and surgical expertise

Examining the association between depression and seizures amongst adults with epilepsy : a longitudinal analysis

This programme of work examined the links between psychopathology and seizures for adults with epilepsy using longitudinal data from two datasets and employing state-of the-art analytic approaches to tease apart inter-relationships. In the first study, using path analysis to examine direction of effects, a bi-directional relationship between seizure frequency and depression scores was confirmed. That is, not only did seizure frequency influence depression scores longitudinally and concurrently, but that depression scores also influenced seizure frequency equivalently. The second study employed a latent variable structural equation modelling approach to examine moderation and mediation and prediction of change in variable scores over time. In this study although anxiety, perceived stress and depression all separately influenced changes in seizures (frequency and recency), depression mediated the relationship between both anxiety and stress with seizures. The third study used a latent growth curve approach to focus on patterns of change within individuals. Trajectories of change in depression scores for individuals over time were examined as well as factors predicting this variation. This study found that seizure recency was a significant predictor of the individual differences in baseline depression scores as well as of the changes in depression scores over time for individuals with epilepsy. The implications of these results are that both effective management of seizures and depression are essential for people with epilepsy. Given that the current focus of clinical management strategies for people with epilepsy is on seizure management, this research suggests the importance of also identifying and managing depression amongst people with epilepsy. Strategies to implement this would include increased awareness of the importance of depression amongst clinical staff, improved screening for depression amongst people with epilepsy (for example by using depression screening questionnaires such as the Hospital Anxiety and Depression Scale), implementing effective treatment (such as by using antidepressants or cognitive behaviour therapy) if depression is identified. Future aims would include confirming these findings using alternative designs, for example a randomised trial to investigate whether these links between depression and seizures arise because of a common antecedent factor or shared risk factors and examine whether other factors (such as gender) influence the relationships observed between depression and seizure outcomes.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Examining the association between depression and seizures amongst adults with epilepsy: A longitudinal analysis

This programme of work examined the links between psychopathology and seizures for adults with epilepsy using longitudinal data from two datasets and employing state-of the-art analytic approaches to tease apart inter-relationships. In the first study, using path analysis to examine direction of effects, a bi-directional relationship between seizure frequency and depression scores was confirmed. That is, not only did seizure frequency influence depression scores longitudinally and concurrently, but that depression scores also influenced seizure frequency equivalently. The second study employed a latent variable structural equation modelling approach to examine moderation and mediation and prediction of change in variable scores over time. In this study although anxiety, perceived stress and depression all separately influenced changes in seizures (frequency and recency), depression mediated the relationship between both anxiety and stress with seizures. The third study used a latent growth curve approach to focus on patterns of change within individuals. Trajectories of change in depression scores for individuals over time were examined as well as factors predicting this variation. This study found that seizure recency was a significant predictor of the individual differences in baseline depression scores as well as of the changes in depression scores over time for individuals with epilepsy. The implications of these results are that both effective management of seizures and depression are essential for people with epilepsy. Given that the current focus of clinical management strategies for people with epilepsy is on seizure management, this research suggests the importance of also identifying and managing depression amongst people with epilepsy. Strategies to implement this would include increased awareness of the importance of depression amongst clinical staff, improved screening for depression amongst people with epilepsy (for example by using depression screening questionnaires such as the Hospital Anxiety and Depression Scale), implementing effective treatment (such as by using antidepressants or cognitive behaviour therapy) if depression is identified. Future aims would include confirming these findings using alternative designs, for example a randomised trial to investigate whether these links between depression and seizures arise because of a common antecedent factor or shared risk factors and examine whether other factors (such as gender) influence the relationships observed between depression and seizure outcomes

Brief report: a comparison of child mental health inequalities in three UK population cohorts

There are substantial health disparities between children from low and higher income families. The study aimed to test changes in child mental health inequalities across three large UK population cohorts of 11-year old children assessed in 1999, 2004 and 2012 as part of the British Child and Adolescent Mental Health Surveys and Millennium Cohort Study. Child mental health was assessed using parent and teacher versions of the Strengths and Difficulties Questionnaire. There were substantial differences in parent and teacher reported symptom scores between children from low and higher income families in each cohort. Differences in parent reported symptoms increased over time (ES = 0.35 [95%CI = 0.20, 0.49] in 1999, ES = 0.39 [95%CI = 0.17, 0.61] in 2004, ES = 0.54 [95%CI = 0.49, 0.58] in 2012); cohort interaction: p = 0.01). This study found that marked child mental health inequalities exist. The mental health gap between advantaged and disadvantaged children has not reduced over the last 20 years and may be getting worse

The impact of schizophrenia and mood disorder risk alleles on emotional problems: investigating change from childhood to middle age

Previous studies find that both schizophrenia and mood disorder risk alleles contribute to adult depression and anxiety. Emotional problems (depression or anxiety) begin in childhood and show strong continuities into adult life; this suggests that symptoms are the manifestation of the same underlying liability across different ages. However, other findings suggest that there are developmental differences in the etiology of emotional problems at different ages. To our knowledge, no study has prospectively examined the impact of psychiatric risk alleles on emotional problems at different ages in the same individuals. Data were analyzed using regression-based analyses in a prospective, population-based UK cohort (the National Child Development Study). Schizophrenia and major depressive disorder (MDD) polygenic risk scores (PRS) were derived from published Psychiatric Genomics Consortium genome-wide association studies. Emotional problems were assessed prospectively at six time points from age 7 to 42 years. Schizophrenia PRS were associated with emotional problems from childhood [age 7, OR 1.09 (1.03–1.15), p = 0.003] to mid-life [age 42, OR 1.10 (1.05–1.17), p < 0.001], while MDD PRS were associated with emotional problems only in adulthood [age 42, OR 1.06 (1.00–1.11), p = 0.034; age 7, OR 1.03 (0.98–1.09), p = 0.228]. Our prospective investigation suggests that early (childhood) emotional problems in the general population share genetic risk with schizophrenia, while later (adult) emotional problems also share genetic risk with MDD. The results suggest that the genetic architecture of depression/anxiety is not static across development

Adult mood problems in children with neurodevelopmental problems: evidence from a prospective birth cohort followed to age 50

Purpose Specific child neurodevelopmental (ND) disorders such as ADHD and learning problems are associated with concurrent and future (up to early adulthood) mood problems. However, it is unclear whether findings generalise to population traits as well as diagnoses, to general as well as specific neurodevelopmental domains, and whether risk associations extend to later adulthood or diminish with age. Methods We used data from a UK cohort of children born in 1958, the National Child Development Study (NCDS). ND problems were assessed at ages 7 and 11 years with parent- and teacher ratings of restlessness, hyperactivity and motor co-ordination difficulties, and by individual tests of reading, arithmetic and general cognitive ability. Mood (depression/anxiety) problems were assessed using the Malaise symptom screen at 23, 33, 42, and 50 years. Factor analyses were conducted to assess whether the specific neurodevelopmental domains could be aggregated into a general “ND” latent factor as well as specific factors. Associations with mood outcomes were then tested. Results A bi-factor model with a general “ND” latent factor and specific “motor” and “cognition” factors fits the data well. The specific cognition and motor factor scores were associated with mood problems in early adulthood only. The “ND” factor demonstrated associations with mood problems at each adult follow-up (men - age 23 years: β = 0.17; age 33: β = 0.16; age 42: β = 0.14; age 50: β = 0.16; women - 23 years: β = 0.25; 33 years: β = 0.26; 42 years: β = 0.14; 50 years: β = 0.16; all ps  0.8). Conclusions Our results suggest that, in a population-based cohort, a general, childhood neurodevelopmental difficulty factor is stably associated with mood problems in adult life