Adult Functional Outcomes of Common Childhood Psychiatric Problems: A Prospective, Longitudinal Study.
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ABSTRACT:
SUBMITTER: Copeland WE
PROVIDER: S-EPMC4706225 | biostudies-literature | 2015 Sep
REPOSITORIES: biostudies-literature
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Adult Functional Outcomes of Common Childhood Psychiatric Problems: A Prospective, Longitudinal Study.
Copeland William E WE Wolke Dieter D Shanahan Lilly L Costello E Jane EJ
JAMA psychiatry 20150901 9
<h4>Importance</h4>Psychiatric problems are among the most common health problems of childhood.<h4>Objective</h4>To test whether these health problems adversely affect adult functioning even if the problems themselves do not persist.<h4>Design, setting, and participants</h4>Prospective, population-based study of 1420 participants from 11 predominantly rural counties of North Carolina who were assessed with structured interviews up to 6 times during childhood (9-16 years of age, for a total 6674 ...[more]
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Project description:ImportanceBeing exposed to trauma is a common childhood experience associated with symptoms and impairments in childhood.ObjectiveTo assess the association between cumulative childhood trauma exposure and adult psychiatric and functional outcomes.Design, setting, and participantsProspective, population-based cohort study of 1420 participants. A community representative sample of participants was assessed with structured Child and Adolescent Psychiatric Assessment interviews up to 8 times in childhood (ages 9-16 years; 6674 observations; 1993-2000) for lifetime trauma exposure as defined by the Diagnostic and Statistical Manual of Mental Disorders. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4556 observations of 1336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood. Analysis was completed in 2018.ExposureParticipants were assessed with the structured Child and Adolescent Psychiatric Assessment interview (parent and self-report) up to 8 times in childhood for lifetime trauma exposure (ages 9-16 years; 6674 observations; 1993-2000).Main outcomes and measuresParticipants were assessed up to 4 times with the structured Young Adult Psychiatric Assessment interview (self-report) in adulthood (ages 19, 21, 25, and 30 years; 4556 observations of 1336 participants; 1999-2015) for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood.ResultsAmong the 1420 study participants, 630 (49.0%) were female and 983 (89.4%) were white. By age 16 years, 30.9% of children (n = 451) were exposed to 1 traumatic event, 22.5% (n = 289) were exposed to 2 such events, and 14.8% (n = 267) were exposed to 3 or more. Cumulative childhood trauma exposure to age 16 years was associated with higher rates of adult psychiatric disorders (odds ratio for any disorder, 1.2; 95% CI, 1.0-1.4) and poorer functional outcomes, including key outcomes that indicate a significantly disrupted transition to adulthood (eg, failure to hold a job and social isolation). Childhood trauma exposure continued to be associated with higher rates of adult psychiatric and functional outcomes after adjusting for a broad range of childhood risk factors, including psychiatric functioning and family adversities and hardships (adjusted odds ratio for any disorder, 1.3; 95% CI, 1.0-1.5).Conclusions and relevanceCumulative childhood trauma exposure was associated with poor adult outcomes even after accounting for many of the childhood and family factors associated with both trauma exposure and poor adult outcomes. Childhood trauma exposures are common, but often preventable, thus providing a clear target for child-focused public health efforts to ameliorate long-term morbidity.
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Project description:ObjectiveDepression is common, impairing, and the leading cause of disease burden in youths. This study aimed to identify the effects of childhood/adolescent depression on a broad range of longer-term outcomes.MethodThe analysis is based on the prospective, representative Great Smoky Mountains Study of 1,420 participants. Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview up to 8 times in childhood (age 9-16 years; 6,674 observations; 1993-2000) for DSM-based depressive disorders, associated psychiatric comorbidities, and childhood adversities. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes and functional outcomes.ResultsIn all, 7.7% of participants met criteria for a depressive disorder in childhood/adolescence. Any childhood/adolescent depression was associated with higher levels of adult anxiety and illicit drug disorders and also with worse health, criminal, and social functioning; these associations persisted when childhood psychiatric comorbidities and adversities were accounted for. No sex-specific patterns were identified. However, timing of depression mattered: individuals with adolescent-onset depression had worse outcomes than those with child-onset. Average depressive symptoms throughout childhood and adolescence were associated with more adverse outcomes. Finally, specialty mental health service use was protective against adult diagnostic outcomes.ConclusionEarly depression and especially persistent childhood/adolescent depressive symptoms have robust, lasting associations with adult functioning. Some of these effects may be attenuated by service use.
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Project description:ObjectiveSuicidal thoughts and behavior (STBs) have their peak period of onset in adolescence, but little is known about how such behavior is associated with later functioning. The aim of this study is to test whether childhood STBs are related to adult psychiatric, suicidal, and functional outcomes.MethodThis is a prospective, population-based community study of 1,420 participants assessed with structured interviews up to 7 times in childhood/adolescence (ages 9-16 years; 6,674 observations) for STBs including passive and active ideation, plans, and attempts. Participants were then assessed 4 times in young adulthood (ages 19, 21, 24, and 30 years; 4,556 observations of 1,273 participants) for psychiatric diagnoses, STBs, and functional outcomes.ResultsBy age 16 years, 7.0% of participants had reported some type of STBs, with 3.9% reporting an attempt. Both ideation only and suicide attempts were associated with higher levels of anxiety disorders and STBs in adulthood, as well as poor functioning across financial, health, risky/illegal, and social domains. These observed effects generally were attenuated after adjusting for other psychiatric and psychosocial factors that predict childhood STBs (particularly maltreatment, depression, and disruptive behavior disorders). The exception was adult suicidal behavior, which was predicted by both childhood ideation and attempts, even in the fully adjusted model. Children and adolescents with STBs were more likely to have had a disrupted transition to adulthood.ConclusionChildhood STBs are a marker for a multitude of poor psychiatric and functional outcomes in adulthood, but these effects are largely accounted for by other factors. In contrast, childhood STBs are a robust risk factor for adult suicidal thoughts and behavior.
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Project description:Objective/backgroundCo-sleeping is common practice around the globe. The relationship between early childhood co-sleeping and adolescent behavior problems remains uncertain. We aim to identify whether early childhood co-sleeping can predict behavior problems in preadolescence.ParticipantsA cohort of 1,656 Chinese preschool children were followed up in adolescence.MethodsProspective cohort study design involving two waves of data collection from the China Jintan Cohort (1,656 children aged 3-5 years). Co-sleeping history was collected at 3-5-years-old via parent-reported questionnaire at wave I data collection. Behavior problems were measured twice in childhood and preadolescence, respectively. Adolescent behavior problems were measured by integrating data from self-report, parent-report and teacher-report using the Achenbach System of Empirically Based Assessment. Predictions were assessed using the general linear model with mixed effects on the inverse probability weight propensity-matched sample.Results1,656 children comprising 55.6% boys aged 4.9 ± 0.6 were initially enrolled in the first wave of data collection. In the second wave of data collection, 1,274 children were 10.99 ± 0.74 (76.9%) aged 10-13 years were retained. Early childhood co-sleeping is significantly associated with increased behavior problems in childhood (Odds Ratio [OR] 1.22-2.06, ps<0.03) and preadolescence (OR 1.40-2.27, ps<0.02). Moreover, co-sleeping history significantly predicted multiscale increase in internal (OR 1.63-2.61, ps<0.02) and external behavior problems in adolescence.ConclusionsEarly childhood co-sleeping is associated with multiple behavioral problems reported by parents, teachers, and children themselves. Early childhood co-sleeping predicts preadolescent internalizing and externalizing behavior after controlling for baseline behavior problems.
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