Loss of parent in childhood and adult psychiatric disorder: the role of lack of adequate parental care

The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then described and basic results are reported. These indicate that, in a sample of women aged 18-65, loss of mother before the age of 17, either by death or by separation of one year or more, was associated with clinical depression in the year of interview. Loss of father by death was in no way associated with current depression, but separation from father showed a trend which, however, did not reach statistical significance. Control for other possible confounding factors did not change this patterning of results; these were further supported when psychiatric episodes earlier in adulthood were examined. Examination of the caregiving arrangements in childhood suggests that it is 'lack of care', defined in terms of neglect rather than simply hostile parental behaviour, which accounts for the raised rate of depression. Such 'lack of care' is more frequent after loss of mother than after loss of father.     

Stability and change in milder psychiatric disorder over 7 years in a birth cohort.

BACKGROUND: Relatively little is known regarding stability or change over time in milder psychiatric disorder identified in epidemiological studies. METHODS: Data were analysed on 2890 subjects from the 1946 British birth cohort study. Psychiatric disorder was identified at age 36 years using the Present State Examination Index of Definition and 7 years later at age 43 using a symptom scale, employing a threshold to give identical 6% prevalence of disorder. Predictors were derived from recent social data and information collected earlier in childhood and younger adulthood. RESULTS: Over 7 years, there was considerable movement between case and non-case status. Only 1.7% of the sample satisfied case criteria at both points. Approximately two-thirds of cases at age 36 had fallen below case levels at age 43 and two-thirds of cases at age 43 were new cases. Most onsets and remissions were between definite case and non-case levels, rather than around the threshold. The strongest predictors of onset and remission were recent demographic, social and life stress variables, and earlier reported nervous disorder, with contributions from parental social background, and life history variables in adolescence. CONCLUSIONS: There is considerable change over 7 years in milder psychiatric disorder, with around two-thirds of it episodic or fluctuating and one-third chronic. Recent social variables are strong predictors of change or chronicity, with some lasting contributions from childhood social setting and earlier life history.     

Tattoos, childhood sexual abuse and adult psychiatric disorder in women

Summary Background: Tattoos in women have been described in clinical samples as being associated with psychopathology, child sexual abuse (CSA), personality problems or alcohol abuse. Method: A random community study of New Zealand women being primarily investigated to assess the coping strategies of those reporting CSA gathered information about tattoos, and indicators of different types of psychosocial problems. Results: Women with tattoos were more likely to be younger, to drink more alcohol, to have more psychiatric symptoms and to show borderline personality features than were the non tattooed women. They were also more likely to report CSA. Conclusions: Tattoos in women are statistically linked to CSA, and to later psychopathology in some women.     

Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32

BACKGROUND: The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize them in future diagnostic systems. We tested whether risk factors for MDD and GAD are similar or different. METHOD: The representative 1972-73 Dunedin birth cohort of 1037 males and females was followed to age 32 with 96% retention. Adult GAD and MDD were diagnosed at ages 18, 21, 26, and 32 years, and juvenile anxiety/depression were also taken into account. Thirteen prospective risk measures indexed domains of family history, adverse family environment, childhood behavior, and adolescent self-esteem and personality traits. RESULTS: Co-morbid MDD+GAD was antedated by highly elevated risk factors broadly across all domains. MDD+GAD was further characterized by the earliest onset, most recurrence, and greatest use of mental health services and medication. Pure GAD had levels of risk factors similar to the elevated levels for co-morbid MDD+GAD; generally, pure MDD did not. Pure GAD had risks during childhood not shared by pure MDD, in domains of adverse family environment (low SES, somewhat more maltreatment) and childhood behavior (internalizing problems, conduct problems, somewhat more inhibited temperament). Pure MDD had risks not shared by pure GAD, in domains of family history (of depression) and personality (low positive emotionality). CONCLUSIONS: Specific antecedent risk factors for pure adult MDD versus GAD may suggest partly different etiological pathways. That GAD and co-morbid MDD+GAD share many risk markers suggests that the presence of GAD may signal a pathway toward relatively more severe internalizing disorder.     

Dietary iron intake during early pregnancy and birth outcomes in a cohort of British women

BACKGROUND Iron deficiency during pregnancy is associated with adverse birth outcomes, particularly, if present during early gestation. Iron supplements are widely recommended during pregnancy, but evidence of their benefit in relation to infant outcomes is not established. This study was performed in the UK, where iron supplements are not routinely recommended during pregnancy, to investigate the association between iron intake in pregnancy and size at birth. METHODS From a prospective cohort of 1274 pregnant women aged 18-45 years, dietary intake was reported in a 24-h recall administered by a research midwife at 12-week gestation. Dietary supplement intake was ascertained using dietary recall and three questionnaires in the first, second and third trimesters. RESULTS Of the cohort of pregnant women, 80% reported dietary iron intake below the UK Reference Nutrient Intake of 14.8 mg/day. Those reported taking iron-containing supplements in the first, second and third trimesters were 24, 15 and 8%, respectively. Women with dietary iron intake >14.8 mg/day were more likely to be older, have a higher socioeconomic profile and take supplements during the first trimester. Vegetarians were less likely to have low dietary iron intake [odds ratio = 0.5, 95% confidence interval (CI): 0.4, 0.8] and more likely to take supplements during the first and second trimesters. Total iron intake, but not iron intake from food only, was associated with birthweight centile (adjusted change = 2.5 centiles/10 mg increase in iron, 95% CI: 0.4, 4.6). This association was stronger in the high vitamin C intake group, but effect modification was not significant. CONCLUSION There was a positive relationship between total iron intake, from food and supplements, in early pregnancy and birthweight. Iron intake, both from diet and supplements, during the first trimester of pregnancy was higher in vegetarians and women with a better socioeconomic profile.     

Propensity to psychiatric and somatic ill-health: evidence from a birth cohort

BACKGROUND: Somatic and psychiatric morbidity may cluster because of reciprocal effects between them but also as a result of common underlying factors. METHODS: The data come from the 1946 MRC birth cohort (N = 5362). Clustering of 20 chronic medical conditions at the participants' 43rd year was analysed using multi-morbidity coefficients. Associations of somatic and psychiatric morbidity at 43 years, with temperament and behaviour, assessed from adolescence to early adulthood, and background variables like paternal social class, were examined using structural equation modelling. The focus was on whether links applied to both morbidity types or one only, and were direct or were indirect, mediated by prior morbidity. RESULTS: Reported chronic medical conditions clustered strongly. Somatic multi-morbidity and psychiatric ill-health at 43 years were associated with temperamental and behavioural features assessed between the subjects' 13th and 26th birthday, like neuroticism and aggression, as well as with external variables like parental death before the participants' 16th birthday. However, only neuroticism holds direct links with somatic as well as with psychiatric ill-health, 28% of the former and 52% of the latter association being independent of the simultaneous presence of the other morbidity type and of participants' health status 7 years earlier. CONCLUSIONS: Personality traits like neuroticism not only raise the risk of psychiatric disorder but also, irrespective of whether manifest psychiatric disorders have developed, of a broad spectrum of chronic somatic diseases. This suggests that clinicians and researchers should focus not only on the psychiatric disorders associated with such personality traits but also on their medical consequences.     

The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study

BACKGROUND: Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms. METHOD: A total of 5,362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years. RESULTS: Thirty-four (1.1%) of the 3,035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26-5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose-response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME. CONCLUSIONS: This temporal, dose-response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.     

Asthma onset and relapse in adult life: the British 1958 birth cohort study.

BACKGROUND: Few studies have investigated adult-onset wheezing because of difficulties identifying childhood asthma or wheeze retrospectively. OBJECTIVE: To investigate risk factors for the incidence and recurrence of wheezing illness in adulthood. METHODS: British children born during 1 week in 1958 (N = 18,558) were followed up periodically. Information on wheezing illness was obtained via parental interviews at ages 7, 11, and 16 years and via cohort member interviews at ages 23, 33, and 42 years. At ages 44 to 45 years a subset (N = 12,069) was targeted for biomedical survey, and total IgE and specific IgE responses to grass, cat, and dust mite were measured. RESULTS: Incidences of wheezing illness at ages 17 to 33 and 34 to 42 years were positively associated with atopy (any specific IgE -0.3 kU/L) and cigarette smoking. For ages 17 to 42 years, proportions of incident "asthma" and incident "wheeze without asthma" associated with atopy, adjusted for sex and smoking, were estimated to be 34% (95% confidence interval [CI], 26%-42%) and 5% (95% CI, 1%-9%), respectively, whereas proportions associated with cigarette smoking, adjusted for sex and atopy, were estimated to be 13% (95% CI, 0%-26%) and 34% (95% CI, 27%-40%), respectively. Among participants with no reported wheezing illness at ages 17 to 23 or 33 years, wheeze prevalence at the age of 42 years was positively associated with symptoms in childhood. CONCLUSIONS: Onset and relapse of wheezing illness in adult life seem to be similarly affected by atopy and cigarette smoking, although the nature of these effects may differ between asthma and wheeze without asthma. Children who apparently "outgrow" early wheezing illness remain at increased risk for relapse or recurrence during midlife.     

Staphylococcus aureus sensitization and allergic disease in early childhood: population-based birth cohort study

BACKGROUND: Staphylococcus aureus-secreted enterotoxins (SEs) may be involved in the pathophysiology of atopic diseases. OBJECTIVE: We investigated the role of SEs in allergic diseases during early childhood (using the mixture of SE-specific IgEs [SE-mix] as a marker). METHODS: Children (N = 510) were followed from birth to age 5 years (repeated questionnaires, IgE to inhalant and food allergens, lung function [spirometry, plethysmography], airway reactivity [dry air challenge]). We measured SE-mix specific IgE (SE-A, SE-C, toxic shock syndrome toxin 1) by using fluorescence immunoassay. RESULTS: We found no association between rhinitis and SE-mix sensitization. Children with eczema were more frequently SE-mix-sensitized than children without (17.4% vs 8.3%; P = .02). SE-mix sensitization rate increased significantly with increasing eczema severity (no eczema, mild, moderate/severe: 8.3%, 14.8%, 42.9%; P = .003) and remained independently associated with eczema in a multivariate model adjusting for total IgE (adjusted odds ratio, 2.19; 95% CI, 1.05-4.56; P = .04). SE-mix sensitization was associated with current wheeze in the univariate but not the multivariate model. Among wheeze phenotypes, persistent wheezers were most commonly sensitized to SE-mix (never, transient, late-onset, persistent: 8.5%, 3.8%, 7.7%, 17.6%; P = .05). Among wheezers, those SE-mix-sensitized had significantly higher airway reactivity compared with those nonsensitized (mean FEV(1) change, mL [95% CI]: -59 [-121, 3] vs 19 [-10.2, 48.9]; P = .04), with little difference after adjusting for atopy. CONCLUSION: We found differences in SE-mix IgE antibodies between healthy 5-year-old children and children with eczema and wheeze. The proportion of patients sensitized to SE-mix increases with increasing disease severity. CLINICAL IMPLICATIONS: Staphylococcal enterotoxins are potential modifiers of childhood wheeze and eczema.     

Breast cancer in relation to overnutrition

Summary Overnutrition and obesity, mainly due to intake of excess animal fat, have been associated with an increased risk of breast cancer by virtue of: (1) fat serving as a vehicle for fat-soluble environmental carcinogens, (2) fat-derived cocarcinogenic fatty acids and sterols, (3) hypercholesterolemia and increased ovarian and adrenocortical steroid synthesis (estrogens, androgens, cortisol), (4) decreased conversion of estrone to the antiestrogenic 2-hydroxyestrone, (5) increased conversion of androstenedione to the carcinogenic estrone (estradiol), and (6) depression of the immune response. However, the relevance of each of these mechanisms on the risk of breast cancer, remains unclear, despite many epidemiological, endocrinological, and immunological studies in humans and laboratory animals. Thus at present, the cause-effect relationship between overnutrition and breast cancer is not clear, nor is the interplay between nutritional, hormonal, and environmental risk factors of breast cancer understood. It seems that progress regarding overnutrition and risk of breast cancer can be achieved only when the various interrelated factors are evaluated in prospective studies with improved methods.     

Early life influences on adult leg and trunk length in the 1958 British birth cohort.

OBJECTIVES: Short leg length has been associated with increased disease risk. We investigated (1) whether taller childhood stature predicts longer adult leg than trunk length; (2) the effects of early life factors on adult leg/trunk length. METHODS: We used data from the 1958 British birth cohort on height in childhood and at 45 years, leg and trunk length at 45 years and early life factors (n approximately 5,900). RESULTS: For a SD increase in height at 7 years, adult leg length increased more than trunk length (2.5-2.8 cm vs. 1.9 cm). Parental height had a stronger association with adult than childhood height, and leg than trunk length. Prenatal factors were associated with leg (maternal smoking) and trunk length (birth order); birth weight had a similar effect on leg and trunk lengths. Large family size, overcrowding, and social housing were more strongly associated with leg than trunk length: deficits in adult height (0.4-0.8 cm) were mostly due to shorter legs. CONCLUSIONS: Socio-economic adversity in childhood is associated with delayed early growth, shorter adult leg length, and stature. Leg length is the height component most sensitive to early environment. Studies of early life and adult disease could usefully assess adult leg length in addition to height.     

Breastfeeding history and childhood allergic status in a prospective birth cohort.

BACKGROUND: Breastfeeding provides the best possible nutrition for newborns, but its role in the development of allergies is complex. OBJECTIVE: To examine the relationship between breastfeeding and early childhood skin sensitization. METHODS: In a birth cohort of 405 children from the Childhood Allergy Study, we used maternal report to classify children's duration of breastfeeding and whether they were breastfed only, formula fed only, or both. We examined the relationships between this information and childhood allergies as determined by skin prick testing for inhalant allergens at age 6 to 7 years. RESULTS: There was no association between duration of breastfeeding and risk of allergic sensitization. Overall, children who were breastfed only were 50% more likely to have allergic sensitization than those fed formula only (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1-2.1). Although the estimates are imprecise, this RR was higher for children born to mothers reporting a history of allergy (RR, 1.8; 95% CI, 1.0-3.0) than for those born to mothers with no allergic history (RR, 1.3; 95% CI, 0.9-2.1), for children in households without (RR, 1.6; 95% CI, 1.1-2.2) vs with (RR, 1.0; 95% CI, 0.3-4.0) multiple pets, and for those with an older sibling (RR, 2.0; 95% CI, 1.2-3.3) vs firstborns (RR, 1.3; 95% CI, 0.8-2.1). CONCLUSIONS: Breastfeeding without formula supplementation may be associated with an increased risk of childhood allergies. However, this association may vary with birth order, exposure to household pets, and maternal allergic history.     

Body mass index trajectories and age at menopause in a British birth cohort

OBJECTIVE: This study investigates the influence of body mass index (BMI) at ages 15, 20, 26, 36, and 43, and of BMI trajectories from 20 to 36 years on the timing of menopause and hormone therapy (HT) use until age 57 years. METHODS: A nationally representative British cohort of 1583 women born in March 1946 with prospective data across the life course. RESULTS: By age 57, a total of 695 women had experienced natural menopause while 431 women had started HT prior to menopause. Cox regression models indicated no significant associations between BMI at any age, or BMI trajectory, and timing of natural menopause. At every age BMI was strongly (p< or =0.01) and linearly associated with age at HT use and BMI from 26 years onwards was associated with age at first event (menopause or HT use). Decreasing BMI was associated with earlier HT use at all ages. These associations were not accounted for by parity, cigarette smoking or childhood and adult social class. CONCLUSION: BMI across the reproductive lifespan did not influence age at menopause to an extent that would be clinically relevant for postmenopausal health. Lower BMI at all ages and underweight trajectory were related to an earlier start of HT. Further studies are required to understand whether such relationships are due to underweight women experiencing menopause earlier (and because of menopausal symptoms starting HT earlier) than heavier women, or having behavioural characteristics related to earlier HT use, independent of menopause.     

Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort

BACKGROUND: Childhood factors have been associated with increased risk of developing post-traumatic stress disorder (PTSD). Previous studies assessed only a limited number of childhood factors retrospectively. We examined the association between childhood neurodevelopmental, temperamental, behavioral and family environmental characteristics assessed before age 11 years and the development of PTSD up to age 32 years in a birth cohort. METHOD: Members of a 1972-73 New Zealand birth cohort (n=1037) who were assessed at ages 26 and 32 years for PTSD as defined by DSM-IV. RESULTS: We identified two sets of childhood risk factors. The first set of risk factors was associated both with increased risk of trauma exposure and with PTSD assessed at age 26. These included childhood externalizing characteristics and family environmental stressors, specifically maternal distress and loss of a parent. The second set of risk factors affected risk for PTSD only and included low IQ and chronic environmental adversity. The effect of cumulative childhood factors on risk of PTSD at age 26 was substantial; over 58% of cohort members in the highest risk quartile for three developmental factors had PTSD as compared to only 25% of those not at high risk on any factors. Low IQ at age 5, antisocial behavior, and poverty before age 11 continued to predict PTSD related to traumatic events that occurred between the ages of 26 and 32. CONCLUSIONS: Developmental capacities and conditions of early childhood may increase both risk of trauma exposure and the risk that individuals will respond adversely to traumatic exposures. Rather than being solely a response to trauma, PTSD may have developmental origins.     

Association between locus of control in childhood and psychotic symptoms in early adolescence: Results from a large birth cohort

Introduction. Episodic memory is significantly impaired in people with schizophrenia. The precise cause of this impairment has yet to be determined, as the formation of episodic memories is dependent on other processes, some of which also show impairment in schizophrenia. One such process is closure, that is, the filling-in of missing information. Failure to close adequately incomplete stimuli may cause people with schizophrenia to store inadequate or piecemeal representations in memory.

Methods. Forty people with schizophrenia and 21 healthy comparison subjects participated in the study. The experiment was divided into six blocks, each of which involved both an encoding and a recognition phase. During the encoding phase, 20 figures were presented sequentially and participants had to determine whether each was symmetric or asymmetric. These figures were either complete or fragmented at three different levels. In subsequent recognition phase, 40 abstract figures (20 new and 20 old) were presented. All figures were complete in this phase.

Results. Memory performance of both groups was affected similarly by fragmentation, with an additional increase in performance afforded by a slight fragmentation for participants with schizophrenia.

Conclusion. Slight fragmentation may have induced a perceptual difficulty that was mild enough to increase visual processing without compromising it. Closure was thus not involved in the episodic memory deficit of people with schizophrenia.     

Association between locus of control in childhood and psychotic symptoms in early adolescence: results from a large birth cohort

INTRODUCTION. Specific attributional styles have been demonstrated in individuals with psychotic disorders and are implicated in the development of psychotic symptoms. We aimed to examine the association between locus of control (LOC) assessed in childhood and psychotic symptoms reported in early adolescence. METHODS. We used a prospective longitudinal design using data from a large birth cohort (the Avon Longitudinal Study of Parents and Children, ALPSAC). 6455 subjects completed a semistructured clinical interview assessing 12 individual psychotic symptoms at a mean age of 12.9 years. A measure of LOC was previously collected in the cohort at the age of 8. RESULTS. Children who reported an externalised LOC at age 8 were at increased risk of reporting both broadly defined (OR 1.77, 95% CI 1.49 to 2.08) and narrowly defined (OR 2.06, 95% CI 1.58 to 2.67) psychotic symptoms at age 13 years. These associations were only slightly attenuated after adjustment for potential confounders. The associations were similar for broadly defined specific paranoid symptoms but weaker for narrowly defined specific paranoid symptoms. CONCLUSIONS. An externalised LOC appears to be associated with later reporting of psychotic symptoms in early adolescence. Further investigation of the role of attributional styles, such as LOC, in increasing the risk for psychotic disorders, is warranted.