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BackgroundAdolescents with continence problems experience a unique range of threats to their psychological wellbeing including perceived stigma, social isolation, and poor self-image. Despite this, the long-term mental health sequelae of adolescent continence problems are unknown.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (n=7,332: 3,639 males, 3,693 females) to examine prospective relationships between self-reported incontinence/lower urinary tract symptoms (LUTS) at 14 years (daytime wetting, bedwetting, soiling, urgency, frequent urination, low voided volume, voiding postponement, and nocturia) and common mental health problems at 18 years (any common mental disorder, depression, anxiety, self-harm, and disordered eating). We estimated multivariable regression models adjusted for sex, socioeconomic position, developmental level, IQ, stressful life events, maternal psychopathology, body mass index, and earlier emotional/behavioural problems.FindingsDaytime wetting and voiding postponement showed the greatest number of associations with mental health problems. All incontinence subtypes/LUTS were associated with increased odds of generalised anxiety disorder symptoms [e.g., odds ratio for daytime wetting= 3.01, 95% confidence interval (1.78, 5.09), pInterpretationIncontinence/LUTS at age 14 are associated with increased vulnerability to mental health problems in late adolescence. Treatment of incontinence/LUTS should be integrated with psychological support to mitigate long-term sequelae.

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child’s symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7–8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.

BackgroundEmotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition and being bullied as mediators.MethodsWe analysed Avon Longitudinal Study of Parents and Children data on 3453 males and 3481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships.ResultsEmotional dysregulation at age 7 years was associated with disordered eating (fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)) and self-harm (fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)) at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm.ConclusionsIn males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to relapses in urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent relapse in UI using multivariable logistic regression in a prospective UK cohort (n=6,408). Mothers provided information on their child’s symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with UI relapse in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p

ObjectivesTo coproduce a school-based protocol and examine acceptability and feasibility of collecting saliva samples for genetic studies from secondary/high school students for the purpose of mental health research.DesignProtocol coproduction and mixed-methods feasibility pilot.SettingSecondary schools in Wales, UK.ParticipantsStudents aged 11–13 years.Primary and secondary outcome measuresCoproduced research protocol including an interactive science workshop delivered in schools; school, parental and student recruitment rates; adherence to protocol and adverse events; ability to extract and genotype saliva samples; student enjoyment of the science workshop and qualitative analysis of teacher focus groups on acceptability and feasibility.ResultsFive secondary schools participated in the coproduction phase, and three of these took part in the research study (eligible sample n=868 students). Four further schools were subsequently approached, but none participated. Parental opt-in consent was received from 98 parents (11.3% eligible sample), three parents (0.3%) actively refused and responses were not received for 767 (88.4%) parents. We obtained saliva samples plus consent for data linkage for 79 students. Only one sample was of insufficient quality to be genotyped. The science workshop received positive feedback from students. Feedback from teachers showed that undertaking research like this in schools is viewed as acceptable in principle, potentially feasible, but that there are important procedural barriers to be overcome. Key recommendations include establishing close working relationships between the research team and school classroom staff, together with improved methods for communicating with and engaging parents.ConclusionsThere are major challenges to undertaking large-scale genetic mental health research in secondary schools. Such research may be acceptable in principle, and in practice DNA collected from saliva in classrooms is of sufficient quality. However, key challenges that must be overcome include ensuring representative recruitment of schools and sufficient parental engagement where opt-in parental consent is required.