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BackgroundIncreased circulating pro-inflammatory markers have repeatedly been associated with major depressive disorder (MDD). However, it remains unclear whether inflammation represents a causal mechanism for MDD, or whether the association is influenced by confounding factors such as body mass index (BMI).MethodsTo better understand this complex relationship, we generated polygenic risk scores (PRS) for MDD and BMI in a population cohort and attempted to isolate the impact these potential risk factors have on adulthood inflammation. Peripheral blood samples were collected as part of the South East London Community Health study, where we generated individualized PRS for MDD and BMI and quantified inflammatory markers using multiplex ELISA-based technology. We performed linear regressions to investigate the effects of PRS for MDD and BMI on inflammatory marker levels.ResultsOut of 35 inflammatory markers, we found a nominal effect of PRS for MDD on interleukin-10. We also found a significant positive effect of BMI on nine inflammatory markers, of which the two most strongly affected markers, interleukin-6 (IL-6) and C-reactive protein (CRP), were also nominally predicted by BMI PRS.LimitationsThe study utilized a cross-sectional design with a moderately sized sample.ConclusionsOur findings suggest there may not be a shared genetic mechanism contributing to MDD and higher inflammatory marker levels. However, there may be shared genetic etiology between BMI and adulthood levels of CRP and IL-6. Therefore, polygenic risk scores for BMI may represent a useful indicator for heightened levels of inflammation in adulthood.

Methods A representative sample of the UK population (n=17,152) from the European Health Interview Survey of 2014 was included in the analyses. The Patient Health Questionnaire (PHQ-8) was used to assess the prevalence of depressive symptoms and of probable depressive disorder. Prevalence estimates (95%CI) were calculated. The association between prevalence and age was assessed using multivariable multinomial logistic and logistic regression models. All analyses were carried out for the total sample and stratified by sex. Results The prevalence of depressive symptoms ranged from 11.3% (10.6-11.9) for mild, to 3.3% (3.0-3.7) for severe symptoms. The prevalence of probable depressive disorder was 7.5% (95%CI: 7.0-8.0). A significantly higher prevalence of probable depressive disorder was found in those aged 45 to 59 years old compared with those aged 16 to 29. For the prevalence of severe depressive symptoms those age differences were even higher: 2.55 times higher (5.38 for men and 1.75 for women). Limitations The cross-sectional design precludes stablishing the direction of the relationship between age and the prevalence. Conclusions The prevalence and age patterns of depression in the UK were described. A peak in the prevalence was identified during middle adulthood. These results could serve as a reference for the monitoring of depression in the UK and the development of preventive strategies, particularly in the high-risk population groups identified.

Background: The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. Methods: In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. Findings: Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06). Interpretation: By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. Funding: None.

Epidemiological studies have suggested that maternal diabetes in pregnancy increases the risk of schizophrenia in offspring. A recent cohort study observed that maternal diabetes in early pregnancy is also associated with psychotic experiences in the general adolescent population. However, it remains unclear whether maternal diabetes in early pregnancy is specifically associated with psychotic experiences, or is generally associated with broader mental health problems, including depressive symptoms in adolescence. The present study investigated the longitudinal associations between maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring. Our data were derived from the Tokyo Early Adolescence Survey, a population-based survey of early adolescents (N = 4478) and their primary caregivers. Diabetes in early pregnancy was determined by records in the mother's Maternal and Child Health Handbook, documented during the pregnancy. Psychotic experiences and depressive symptoms were established through self-report by the offspring at 10 years of age. Diabetes in early pregnancy was associated with an increased risk of hallucination in the offspring (auditory hallucination [odds ratio {OR} 4.33, 95% confidence interval {CI} 1.12–16.75]; visual hallucination [OR 6.58, 95% CI 1.69–25.66]), even after adjusting for depressive symptoms and other covariates. However, the association between maternal diabetes and delusional thoughts was not significant and diabetes in early pregnancy was not associated with adolescent depressive symptoms. Our investigation suggests that maternal diabetes in early pregnancy may specifically affect the risk of hallucinatory experiences in adolescent offspring.

BACKGROUND: The mental health of the UK population declined at the onset of the COVID-19 pandemic. Convenience sample surveys indicate that recovery began soon after. Using a probability sample, we tracked mental health during the pandemic to characterise mental health trajectories and identify predictors of deterioration.METHODS: This study was a secondary analysis of five waves of the UK Household Longitudinal Study (a large, national, probability-based survey that has been collecting data continuously since January, 2009) from late April to early October, 2020 and pre-pandemic data taken from 2018-19. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). We used latent class mixed models to identify discrete mental health trajectories and fixed-effects regression to identify predictors of change in mental health.FINDINGS: Mental health was assessed in 19 763 adults (≥16 years; 11 477 [58·1%] women and 8287 [41·9%] men; 3453 [17·5%] participants from minority ethnic groups). Mean population mental health deteriorated with the onset of the pandemic and did not begin improving until July, 2020. Latent class analysis identified five distinct mental health trajectories up to October 2020. Most individuals in the population had either consistently good (7437 [39·3%] participants) or consistently very good (7623 [37·5%] participants) mental health across the first 6 months of the pandemic. A recovering group (1727 [12·0%] participants) showed worsened mental health during the initial shock of the pandemic and then returned to around pre-pandemic levels of mental health by October, 2020. The two remaining groups were characterised by poor mental health throughout the observation period; for one group, (523 [4·1%] participants) there was an initial worsening in mental health that was sustained with highly elevated scores. The other group (1011 [7·0%] participants) had little initial acute deterioration in their mental health, but reported a steady and sustained decline in mental health over time. These last two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods, and be of Asian, Black or mixed ethnicity. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health.INTERPRETATION: Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. Around one in nine individuals had deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions, or infection with SARS-CoV-2 might benefit most from early intervention.FUNDING: None.

Background: The UK population’s mental health declined at the pandemic onset. Convenience sample surveys indicate recovery began soon after. Using a probability sample, we tracked average mental health during the pandemic, characterised distinct mental health trajectories and identified predictors of deterioration. Methods: Secondary analysis of five waves of UK Household Longitudinal Survey from late April-early October 2020 and pre-pandemic data, 2018-2019. Mental health was assessed in 19,763 adults (≥16 years) using 12-item General Health Questionnaire. Latent class growth models identified discrete mental health trajectories and fixed-effects regression identified predictors of change in mental health. Findings: Average population mental health deteriorated with onset of the pandemic and did not begin improving until July 2020. Latent class analysis identified six distinct mental health trajectories up to October 2020. Three-quarters had consistently good (46·2%) or very good (30·9%) mental health. Two ‘recovery’ groups (15·8%) initially experienced marked declines in mental health, improving to their pre-pandemic levels by October. For 4·8%, mental health steadily deteriorated and for 2·3% it was very poor throughout. These two groups were more likely to have pre-existing mental or physical ill-health, live in deprived neighbourhoods and be non-white. Infection with COVID-19, local lockdown and financial difficulties all predicted subsequent mental health deterioration. Interpretation: Between April-October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. One-in-fourteen experienced deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions or COVID infection might benefit most from early intervention. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: Ethics approval was granted by the University of Essex Ethics Committee for the COVID-19 web and telephone surveys (ETH1920-1271).

SummaryBackground Long-standing concerns exist about reverse causation and residual confounding in the prospective association between job strain and risk of future common mental disorders. We aimed to address these concerns through analysis of data collected in the UK National Child Development Study, a large British cohort study. Methods Data from the National Child Development Study (n=6870) were analysed by use of multivariate logistic regression to investigate the prospective association between job strain variables at age 45 years and risk of future common mental disorders at age 50 years, controlling for lifetime psychiatric history and a range of other possible confounding variables across the lifecourse. Population attributable fractions were calculated to estimate the public health effect of job strain on midlife mental health. Findings In the final model, adjusted for all measured confounders, high job demands (odds ratio 1·70, 95% CI 1·25–2·32; p=0·0008), low job control (1·89, 1·29–2·77; p=0·0010), and high job strain (2·22, 1·59–3·09; pInterpretation High job strain appears to independently affect the risk of future common mental disorders in midlife. These findings suggest that modifiable work-related risk factors might be an important target in efforts to reduce the prevalence of common mental disorders. Funding iCare Foundation and Mental Health Branch, NSW Health.

Background Few studies have explored ethnic inequalities in physical and mental health in non-pregnant women of reproductive age. We aimed to assess the differences in multimorbidity in women according whether they had been in contact with mental health services or not, and differences in primary care in women according to ethnicity. Methods In this data linkage study, we extracted data in May, 2021, from Lambeth DataNet (LDN; anonymised primary care records of residents of the ethnically diverse inner-city London borough of Lambeth), linked to anonymised electronic mental health records (Clinical Record Interactive Search [CRIS] secondary care database), on selected risk factors for morbidity including low or high body-mass index, smoking, alcohol consumption, substance misuse, micronutrient deficiencies, and physical health diagnoses for women aged 15–40 years who had received secondary mental health care between January, 2008, and December, 2018, and whose record contained no current or historical antenatal or postnatal codes, and an age-matched comparison cohort (case-to-control ratio of 1:4). Univariate and multivariate logistic regression analyses were used to examine the rate of outcomes across cases in contact with mental health services versus controls, and to explore disparities between different ethnic groups in primary care. CRIS was approved by the Oxfordshire Research Ethics Committee in 2008 (reference 18/SC/0372). Approval for linkage with LDN was granted by Lambeth Clinical Commissioning Group and Information Governance Steering Group. Findings We extracted data for 3633 women in contact with mental health services, and 14 532 controls. Women in contact with mental health services (with or without severe mental illness diagnoses) had a higher prevalence of all risk factors and physical health diagnoses studied after adjustment for deprivation and ethnicity than did controls. Women from minority ethnic groups (12 234 [79·0%] of all 15 491 women with data on ethnicity, comprising 5503 [35·5%] who reported as White Other, 2050 [13·2%] as Black, 1011 [6·5%] as Asian, and 3670 [23·7%] as Mixed or Other) were less likely to be diagnosed with depression in primary care than were White British women (adjusted odds ratio [OR] 0·66, 95% CI 0·55–0·79; p Interpretation The differences in multimorbidity present across ethnic groups with and without mental illness in non-pregnant women without children highlight a need for culturally centered integrative models of care across primary and secondary mental health services. Our data also indicate that there are mental and physical health needs of women in contact with mental health services that are not being met by the current model of service provision. Funding Closing the Gap network.

Background We aimed to identify specific patterns of physical multimorbidity, defined as the presence of two or more physical long-term conditions, and to examine the extent to which these specific patterns could predict future incident and persistent common mental health disorders (CMDs) in middle-aged adults enrolled in the UK Biobank. Methods We assessed prospective associations between physical multimorbidity status at the baseline assessment (2006–2010) and depression and anxiety ‘caseness' according to the Patient Health Questionnaire (PHQ)-9 and the Generalised Anxiety Disorder Assessment (GAD)-7 at the follow-up assessment (2016) in 154,367 middle-aged adults enrolled in the UK Biobank (median age: 57 years, interquartile range = 50–62 years, 56.5% female, mean duration of follow-up: 7.6 years, standard deviation = 0.87). Patterns of physical multimorbidity were identified using exploratory factor analysis. Logistic regression was used to assess prospective associations between physical multimorbidity patterns at baseline and both incident and persistent depression and anxiety at follow-up. Findings Compared to those with no physical multimorbidity, having two (adjusted odds ratio (aOR) =1.41, 95%CI 1.32 to 1.53), three (aOR = 1.94, 95%CI 1.76 to 2.14), four (aOR = 2.38, 95%CI 2.07 to 2.74), and five or more (aOR = 2.89, 95%CI 2.42 to 3.45) physical conditions was prospectively associated with incident depression at follow-up in a dose response manner. Similar trends emerged for incident anxiety, persistent depression, and persistent anxiety, but associations were strongest for incident CMDs. Regarding specific patterns of physical MM, the respiratory pattern (aOR = 3.23, 95%CI 2.44 to 4.27) and the pain/gastrointestinal pattern (aOR = 2.19, 95%CI 1.92 to 2.50) emerged as the strongest predictors of incident depression. Similar results emerged for incident anxiety. Interpretation These findings highlight patterns of physical multimorbidity with the poorest prognosis for both emerging and persisting depression and anxiety. These findings might have significant implications for the implementation of integrated mental and physical healthcare and facilitate the development of targeted preventative interventions and treatment for those with physical multimorbidity. Funding AR is supported by Guy's Charity grant number EIC180702; JAT is funded by Medical Research Council (MRC) number MR/SO28188/1; AD is funded by Guy's Charity grant number EIC180702 and MRC grant number MR/SO28188/1. JD is part supported by the ESRC Centre for Society and Mental Health at King's College London (ES/S012567/1), grants from the ESRC (ES/S002715/1), by the Health Foundation working together with the Academy of Medical Sciences, for a Clinician Scientist Fellowship, and by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed are those of the author[s] and not necessarily those of the ESRC, NIHR, the Department of Health and Social Care or King's College London.

Purpose Social isolation is associated with suicidal ideation (SI) and self-harm (SH) among adolescents. However, the association between preference for solitude (PfS), SI, and SH is unknown. The prevalence of adolescents who have both of PfS and social isolation and the risks for SI and SH among them are also unknown. Methods Information on PfS, social isolation, SI, and SH was collected in a large-scale school-based survey on adolescents, using a self-report questionnaire. Associations between PfS, SI, and SH were examined by logistic regression analysis. The interactions between PfS and social isolation on SI and SH were also investigated. The odds of SI and SH were examined for groups defined by presence of PfS and social isolation. Results Responses from 17,437 students (89.3% of relevant classes) were available. After adjusting for demographic characteristics and social isolation, PfS was associated with increased odds of SI (odds ratio [OR] = 3.1) and SH (OR = 1.9). There was no interaction between PfS and social isolation on SI and SH. After adjusting for demographic characteristics, the odds for SI (OR = 8.6) and SH (OR = 3.8) were highest among adolescents with both PfS and social isolation (8.4% of all respondents). Conclusions PfS was associated with increased odds of SI and SH in adolescents. No interaction effect between PfS and social isolation on SI and SH was found, but adolescents with PfS and social isolation had the highest risk for SI and SH. Parents and professionals should pay attention to suicide risk in adolescents with PfS.

BACKGROUND: Opioid misusers have recognized high mortality but the influence of psychiatric comorbidity in excess cause-specific mortality is unclear.METHODS: Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Standard mortality ratios were calculated to compare mortality risk with the general population. Cox and competing risk regression models were used to investigate the effect of psychiatric comorbidity and psychological health on all-cause and cause-specific mortality (respectively) in OUD patients.RESULTS: Of 4837 OUD patients, 176 had died. Mortality rates were substantially higher than the general population (SMR 4.23; 95%CI 3.63-4.90). Among those with OUD, comorbid personality disorder (PD) and comorbid alcohol use disorder (AUD) was associated with increased all-cause mortality in all models, including the fully adjusted model, controlling for socio-demographic factors, severity of drug use, risk behaviours and physical health (HR2.15, 95%CI 1.17-3.95; HR2.28, 95%CI 1.54-3.36). AUD was associated with increased risk of fatal overdose (HR2.57, 95%CI 1.26-5.26) and hepatic-related deaths (HR7.26, 95%CI 2.79-18.86). Individuals with OUD and comorbid PD had almost four times greater risk of liver related deaths compared to those without PD (HR3.76, 95%CI 1.21-11.74). Comorbid severe mental illness and poor psychological health were not associated with increased mortality.CONCLUSIONS: This study highlights the importance of assessment for PD and AUD in OUD patients in order to identify individuals at substantially elevated mortality risk to enable a more personalized approach to their medical care.

Background Public health understanding of variations in self-harm prevalence between populations largely relies on routinely collected service-use data. An unexpectedly low number of hospital inpatient admissions following self-harm has been observed in inner London despite established associations of area deprivation and social fragmentation with self-harm. We aimed to measure associations between rates of attendance at an Emergency Department following self-harm and area characteristics, and to explore the processes that might underlie the incidence of self-harm observed in inner inner-city areas. Method For the spatial analysis, we created a dataset of Emergency Department attendances following self-harm from 2009 to 2016 by residents of four southeast London boroughs who were older than 11 years using linked electronic patient record data and Hospital Episode Statistics. Age-standardised and sex-standardised small-area rates of self-harm attendance (SARs) were spatially smoothed using Bayesian models and mapped. Associations with area deprivation (assessed using the Index of Multiple Deprivation) and social fragmentation (Congdon Index) were analysed. For the qualitative study, we identified a case-study area from within the four boroughs studied of four contiguous census lower super output areas (LSOAs; approximately 2600 households that were both in the most deprived quintile of areas in the UK and had below average SARs for self-harm). We undertook semi-structured interviews with 14 individuals working in community organisations and two focus groups of 12 people older than 16 years and resident in the study area, recruited through community organisations. Ethical approval for data access and linkage was granted by the Oxford Research Ethics Committee C, Clinical Records Interactive Search system Oversight Committee, and the NHS Health Research Authority Confidentiality Advisory Group. The qualitative study was given ethical approval by the King's College London, Psychiatry, Nursing and Midwifery Subcommittee. Findings We identified 20 750 Emergency Department attendances following self-harm by 12 577 individuals. The ratio of SARs in the highest versus the lowest 5% of areas was 2·87 (95% credible interval [CrI] 2·65–3·13). Associations with self-harm were found for area deprivation (most vs least deprived quintile: rate ratio 2·07, 95% CrI 1·88–2·26) and social fragmentation (1·39, 1·23–1·56); however, we identified clusters of deprived areas with a low incidence of self-harm Emergency Department attendance. Preliminary qualitative analysis suggests that individuals in the case-study population have substantial cumulative stressors and mental health difficulties despite a low incidence of Emergency Department presentation for self-harm (SARs for the four LSOAs ranged from 0·80 to 0·94 before adjustment for deprivation and 0·68–0·81 after adjustment). Frequent experiences of violence and an emphasis on appearing tough combine with discomfort with talking about self-harm and fear of negative treatment by mental health and other services, particularly within the Caribbean and African population who make up 44% of the local population. These factors might make people more likely to respond to distress in ways not defined by researchers as self-harm (even if they are also damaging); equally, these pressures might make individuals who self-harm less likely to identify themselves to services. Interpretation Relying on service-use data for self-harm risks underestimating the extent of distress and subsequent harmful behaviours in some deprived urban populations already disadvantaged by high levels of violence and minority ethnic and migrant status. Funding National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.

Purpose This study compares polydrug use in national and inner city samples to (1) examine patterns of use underlying different prevalence rates and (2) identify how inner city polydrug use needs targeting in ways not suggested by national research. Methods Latent class analyses on indicators of illicit drug use in the last year, hazardous alcohol use, and cigarette smoking were compared between the inner city 2008-2010 South East London Community Health study (n = 1698) and the nationally representative 2007 Adult Psychiatric Morbidity Survey in England (n = 7403). Multinomial logistic regressions then examined latent class solutions with demographic and socioeconomic factors. Results Both samples revealed three notably similar classes of polydrug users: a "high-drug" group using multiple substances; a "moderate-drug" group using cannabis, alcohol, and cigarettes; and a "low-drug" group reporting minimal alcohol and cigarette use. However, South East London Community Health reported lower risks of polydrug use for ethnic minorities but not for more educated participants. Conclusions Despite higher polydrug use prevalence in the inner city, latent classes of polydrug users were similar between samples. Some demographic and socioeconomic factors differed between the samples, suggesting the need for inner city services to use both local and national data for policy planning.

The Structured Interview for Hoarding Disorder (SIHD) is a semi-structured instrument designed to assist clinicians and trained interviewers with the nuanced diagnosis of hoarding disorder (HD). The manuscript introduces the rationale, development, and design of the SIHD and presents a test of the instrument's inter-rater reliability and convergent/discriminant validity. Ninety-nine individuals with self-reported hoarding behavior, originally recruited as part of a large two-wave epidemiological study, were evaluated in their homes using the SIHD. Diagnoses of HD were determined by consensus, following a best estimate diagnosis procedure. To enable the assessment of inter-rater reliability, a psychiatrist with extensive experience diagnosing HD also independently and blindly reviewed each participant's SIHD. In addition, agreement of SIHD diagnoses with those indicated by other screening instruments for HD and depression were examined. Results indicate “substantial” or “near perfect” inter-rater reliability for all core HD criteria and specifiers. Convergent and discriminant validity were, furthermore, excellent. Overall, the SIHD offers an intuitive, valid, and reliable means of diagnosing HD. The interview also facilitates the assessment of other relevant features, such as risk. We offer recommendations for its use in both research and clinical settings, as well as suggestions for the training of interviewers.

PURPOSE: There isspeculation that high rates ofmental illness amongReservists returning from deployment to Iraq and Afghanistan may be due to the challenge of reintegrating into civilian life. We aimed to examine the postdeployment social functioning of Reservists and to explore the relationship between adverse postdeployment experiences and subsequent mental ill health. METHODS: A sample of 4,991 UK military personnel who had deployed to either Iraq or Afghanistan were asked about their postdeployment experiences with a particular focus on their levels of social integration,perceivedsupportfromthemilitary,andcivilianemployment.Allparticipantswereaskedtocomplete a series of validated measures of mental health. RESULTS: Compared with Regular personnel, Reservists were more likely to feel unsupported by the military and to have difficulties with social functioning in the postdeployment period. Perceived lack of support from the military was associated with increased reporting of probable posttraumatic stress disorder (PTSD) and alcohol misuse. Low levels of non-military postdeployment social support and participation were associated with increased reporting of common mental disorder, probable PTSD, and alcohol misuse. CONCLUSIONS: Many Reservists find the transition from military deployment to civilian life difficult. Differences in postdeployment experiences may explain some of the increased rates of mental ill health among Reservists. Ann Epidemiol 2011;21:666–672. 2011 Elsevier Inc. All rights reserved.

There is an increasing awareness of the social and economic burden of untreated mental illness. However, the question remains whether the individuals who are not identified as having a mental disorder are mentally healthy and socially functioning. This study aims to examine the sequence of Keyes's (Keyes, C. L. M. (2002). The mental health continuum: from languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207-222.) mental health categories based on psychological status and well-being, and to identify qualitative differences in these categories by developmental-contextual factors and concurrent physical health status and social functioning. This study uses data from the UK 1958 National Child Development Study. Information was collected on the cohort members from childhood to age 33 years. Psychological distress (measured using the Malaise Inventory) and well-being (self-efficacy and appraisals of life circumstances) were assessed at age 33 years. Multinomial (polytomous) logistic regression models were used to examine the effects of individual characteristics and social contextual factors from childhood through adolescence on cross categorisations of psychological distress and well-being. Our findings suggest that there are similar early life predictors for both poor psychosocial functioning and mental ill-health. Our results also demonstrated a clear gradient of physical health and social functioning across mental health categories, even in the absence of mental disorder. Individual and social contextual factors in early life appear to offer clues as to why the absence of psychological distress does not always imply good mental health or social functioning.

Background We examined the extent to which perceived life change following experiences of stressful life events, differentiated by type of stressor, influenced mental health during adulthood. Methods The analytic sample of 2073 cohort members was drawn from the MRC National Survey of Health and Development, a sample followed since their birth in March 1946. Logistic regression was used to assess the relationship between stressors reported at 36 and 43 years and common mental disorder at 36, 43, and 53 years. Common mental disorder was measured using the Present State Exam at 36 years, the Psychiatric Symptom Frequency at 43 years, and the 28-item General Health Questionnaire at 53 years. Results Data spanning across nearly 20 years suggest that stressors perceived to have contributed to a notable life change increased the likelihood of scoring above the cut off score for common mental disorder in comparison to stressors experienced without subsequent life change. Models were adjusted for gender, educational attainment, social class, relationship status, and past episodes of common mental disorder. This relationship appears to be most evident for proximal family and economic stressors and distal interpersonal relationship stressors experienced by close friends and relatives. Limitations All study information is based on self-reports and details about the nature of the life change or cognitive attribution style were not available. Conclusions Appraisals of changes following stressful life events may be more important than the occurrence of stressors alone in assessing the impact of stressful life events on adult mental health.

Article history: Lower cognitive ability is a risk factor for some forms of severe psychiatric disorder, but it is unclear whether it influences risk of psychological distress due to anxiety or the milder forms of depression. The participants in the present study were members of two British birth national birth cohorts, the 1958 National Child Development Survey (n=6369) and the 1970 British Cohort Study (n=6074). We examined the association between general cognitive ability (intelligence) measured at age 10 (1970 cohort) and 11 years (1958 cohort) and high levels of psychological distress at age 30 (1970 cohort) or 33 years (1958 cohort), defined as a score of 7 or more on the Malaise Inventory. In both cohorts, participants with higher intelligence in childhood had a reduced risk of psychological distress. In sex-adjusted analyses, a standard deviation (15 points) increase in IQ score was associated with a 39% reduction in psychological distress in the 1958 cohort and a 23% reduction in the 1970 cohort (odds ratios (95% confidence intervals) were 0.61 (0.56, 0.68) and 0.77 (0.72, 0.83), respectively). These associations were only slightly attenuated by further adjustment for potential confounding factors in childhood, including birth weight, parental social class, material circumstances, parental death, separation or divorce, and behaviour problems, and for potential mediating factors in adulthood, educational attainment and current social class. Intelligence in childhood is a risk factor for psychological distress due to anxietyand the milder forms of depression in young adults. Understanding the mechanisms underlying this association may help inform methods of prevention.

We examined whether childhood cognitive ability was associated with two mental health outcomes at age 53 years: the 28 item General Health Questionnaire (GHQ-28) as a measure of internalising symptoms of anxiety and depression, and the CAGE screen for potential alcohol abuse as an externalising disorder. A total of 1875 participants were included from the Medical Research Council National Survey of Health and Development, also known as the British 1946 birth cohort. The results indicated that higher childhood cognitive ability was associated with reporting fewer symptoms of anxiety and depression GHQ-28 scores in women, and increased risk of potential alcohol abuse in both men and women. Results were adjusted for educational attainment, early socioeconomic status (SES) and adverse circumstances, and adult SES, adverse circumstances, and negative health behaviours. After adjusting for childhood cognitive ability, greater educational attainment was associated with reporting greater symptoms of anxiety and depression on the GHQ-28. Although undoubtedly interrelated, our evidence on the diverging effects of childhood cognitive ability and educational attainment on anxiety and depression in mid-adulthood highlights the need for the two to be considered independently. While higher childhood cognitive ability is associated with fewer internalising symptoms of anxiety and depression in women, it places both men and women at higher risk for potential alcohol abuse. Further research is needed to examine possible psychosocial mechanisms that may be associated with both higher childhood cognitive ability and greater risk for alcohol abuse. In addition, the underlying mechanisms responsible for the gender-specific link between childhood cognitive ability and the risk of experiencing internalising disorders in mid-adulthood warrants further consideration.