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Purpose: This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK., Methods: We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability)., Results: Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males., Conclusion: Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced., Trial Registration: Not applicable., (© 2023. The Author(s).)

Background: Positive social relationships are known to mitigate the negative effects of stress on mental health. However, the direction of association between social resources and mental health remains unclear, and it is not known whether higher than average levels of social resources confer additional benefits, in the short and longer term., Aims: To investigate the concurrent and longitudinal contribution of higher levels of social resources in reducing the risk of mental health symptoms after exposure to stress at age 45, and to identify life-course precursors of mid-life social resources., Method: The National Child Development Study (NCDS) is a prospective birth cohort of over 17 000 births in 1958. We tested concurrent and longitudinal associations between different levels of social resources at age 45 and mental health symptoms among individuals exposed to stress and verified whether prior mental health symptoms (age 42) explained these associations. We also tested a range of child, family and adult precursors of mid-life social resources., Results: Higher than average levels of social resources were required to confer benefits to mental health among individuals exposed to high stress levels, both concurrently at age 45 and in the longer term at age 50. In general, these associations were not attributable to prior mental health symptoms. Key predictors of mid-life social resources included evidence of early sociability., Conclusions: Having a broad network of social ties and better personal support helps individuals withstand exposure to higher levels of stress. Given that sociable children had better mid-life social resources, early intervention may benefit individuals' social resources later in life.

Background: Child mental health problems are common. Previous studies have examined secular changes in their prevalence but have not assessed whether later outcomes have changed. We therefore aimed to test whether outcomes of child mental health problems have changed over a 40-year period., Methods: Three cohorts were utilized: The National Child Development Study (NCDS: N = 14,544, aged 7 in 1965), the Avon Longitudinal Study of Parents and Children (ALSPAC: N = 8,188, aged 7 in 1998), and the Millennium Cohort Study (MCS: N = 13,192, aged 7 in 2008). Mental health problems at age 7 were identified using the parent-reported Rutter-A scale (NCDS) and Strengths and Difficulties Questionnaire (ALSPAC and MCS). Associated outcomes were compared across cohorts: age 11 social functioning, age 16 exam attainment and age 16 mental health., Results: Child mental health problems were common in each cohort (boys: 7.0%-9.7%; girls: 5.4%-8.4%). Child mental health problems became more strongly associated with social functioning problems (boys: NCDS OR = 1.95 (1.50, 2.53), MCS OR = 3.77 (2.89, 4.92); interaction p < .001; girls: NCDS OR = 1.69 (1.22, 2.33), MCS OR = 3.99 (3.04, 5.25), interaction p < .001), lower academic attainment for boys (NCDS OR = 0.49 (0.31, 0.78), ALSPAC OR = 0.30 (0.22, 0.41), interaction p = .009), and age 16 mental health problems (boys: NCDS d' = 0.55 (0.38, 0.72), ALSPAC d' = 0.95 (0.73, 1.16); interaction p = .004; girls: NCDS d' = 0.50 (0.34, 0.65), ALSPAC d' = 0.99 (0.78, 1.20); interaction p < .001)., Conclusions: Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations., (© 2019 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Reading problems often co-occur with ADHD and conduct disorder. However, the patterns of co-occurrence and familial overlap between reading problems and other psychiatric disorders have not been systematically explored. We conducted a register-based cohort study including 8719 individuals with reading problems and their siblings, along with matched comparison individuals. Conditional logistic regressions estimated risks for ADHD, autism, obsessive-compulsive disorder, anorexia nervosa, schizophrenia, bipolar disorder, depression, substance use disorder, and violent/non-violent criminality in individuals with reading problems and their siblings. Diagnoses of psychiatric disorders were physician-assigned and ascertained from the Swedish National Patient Register, and crime convictions from the Swedish National Crime Register. We found that individuals with reading problems had excess risks for all psychiatric disorders (except anorexia nervosa) and criminality, with risk ratios between 1.34 and 4.91. Siblings of individuals with reading problems showed excess risks for ADHD, autism, schizophrenia, bipolar disorder, depression, substance use disorder, and non-violent criminality, with risk ratios between 1.14 and 1.70. In summary, individuals with reading problems had increased risks of virtually all psychiatric disorders, and criminality. The origin of most of these overlaps was familial, in that siblings of individuals with reading problems also had elevated risks of ADHD, autism, schizophrenia, bipolar disorder, depression, substance use disorder, and non-violent criminality. These findings have implications for gene-searching efforts, and suggest that health care practitioners should be alert for signs of psychiatric disorders in families where reading problems exist., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Growing evidence suggests heterogeneity within interpersonal-callous (IC) youth based on co-occurring anxiety. The developmental validity of this proposed taxonomy remains unclear however, as most previous research is cross-sectional and/or limited to adolescence. We aimed to identify low-anxiety (IC/ANX-) and high-anxiety (IC/ANX+) IC variants, and compare these groups on (a) early risk exposures, (b) psychiatric symptoms from midchildhood to early adolescence, and (c) school-based functioning. Using the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective epidemiological birth cohort, model-based cluster analysis was performed on children with complete age-13 IC and anxiety scores (n = 6,791). Analysis of variance was used to compare resulting clusters on (a) prenatal and postnatal family adversity and maternal psychopathology, and harsh parenting; (b) developmental differences in attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), emotional difficulties, and low pro-social behavior at 7, 10, and 13 years; and (c) teacher-reported discipline problems, along with standardized test performance. We identified a 4-cluster solution: "typical," "low," "IC/ANX-", and "IC/ANX+." IC/ANX+ youth showed the highest prenatal and postnatal levels of family adversity and maternal psychopathology, highest levels of ADHD, CD, ODD, and emotional difficulties, greatest discipline problems, and lowest national test scores (all p < .001). IC/ANX+ also showed a distinct pattern of increasing psychopathology from age 7 to 13 years. Adolescent IC subtypes were successfully validated in ALSPAC across multiple raters using prenatal and early postnatal risk, repeated measures of psychopathology, and school-based outcomes. Greater prenatal environmental risk among IC/ANX+ youth suggests an important target for early intervention. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: The Strengths and Difficulties Questionnaire (SDQ) is widely used to screen for child mental health problems and measure common forms of psychopathology in 4- to 16-year-olds. Using longitudinal data, we examined the validity of a version adapted for 3- to 4-year-olds., Methods: We used SDQ data from 16,659 families collected by the Millennium Cohort Study, which charts the development of children born throughout the United Kingdom during 2000-2001. Parents completed the preschool SDQ when children were aged 3 and the standard SDQ at ages 5 and 7. The SDQ's internal factor structure was assessed by using confirmatory factor analysis, with a series of competing models and extensions used to determine construct, convergent, and discriminant validity and measurement invariance over time. Predictive validity was evaluated by examining the relationships of age 3 SDQ scores with age 5 diagnostic measures of attention-deficit/hyperactivity disorder, autism spectrum disorder/Asperger syndrome, and teacher-reported measures of personal, social, and emotional development., Results: Confirmatory factor analysis supported a 5-factor measurement model. Internal reliability of subscales ranged from ω = 0.66 (peer problems) to ω = 0.83 (hyperactivity). Item-factor structures revealed measurement invariance over time. Strong positive correlations between ages 3 and 5 SDQ scores were not significantly different from correlations between age 5 and 7 scores. Conduct problems and hyperactivity subscales independently predicted developmental and clinical outcomes 2 years later., Conclusions: Satisfactory psychometric properties of the adapted preschool version affirm its utility as a screening tool to identify 3- to 4-year-olds with emotional and behavioral difficulties., (Copyright © 2015 by the American Academy of Pediatrics.)

Background: 'Optimal outcomes' of child and adolescent psychiatric disorders may mean the best possible outcome, or the best considering a child's history. Most research into the outcomes of child and adolescent psychiatric disorder concentrates on the likelihood of adult illness and disability given an earlier history of psychopathology., Methods: In this article, we review the research literature (based on a literature search using PubMed, RePORT and Google Advanced Scholar databases) on including optimal outcomes for young people with a history of anxiety, depression, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, or substance use disorders in childhood or adolescence. We consider three types of risks that these children may run later in development: future episodes of the same disorder, future episodes of a different disorder, and functional impairment. The impact of treatment or preventative interventions on early adult functioning is briefly reviewed., Results: We found that very few studies enabled us to answer our questions with certainty, but that in general about half of adults with a psychiatric history were disorder-free and functioning quite well in their 20s or 30s. However, their chance of functioning well was less than that of adults without a psychiatric history, even in the absence of a current disorder., Conclusions: Among adults who had a psychiatric disorder as a child or adolescent, about half can be expected to be disorder-free as young adults, and of these about half will be free of significant difficulties in the areas of work, health, relationships, and crime. Optimal outcomes are predicted by a mixture of personal characteristics and environmental supports., (© 2014 Association for Child and Adolescent Mental Health.)

Objective: The authors examined midlife outcomes of childhood bullying victimization., Method: Data were from the British National Child Development Study, a 50-year prospective cohort of births in 1 week in 1958. The authors conducted ordinal logistic and linear regressions on data from 7,771 participants whose parents reported bullying exposure at ages 7 and 11 years, and who participated in follow-up assessments between ages 23 and 50 years. Outcomes included suicidality and diagnoses of depression, anxiety disorders, and alcohol dependence at age 45; psychological distress and general health at ages 23 and 50; and cognitive functioning, socioeconomic status, social relationships, and well-being at age 50., Results: Participants who were bullied in childhood had increased levels of psychological distress at ages 23 and 50. Victims of frequent bullying had higher rates of depression (odds ratio=1.95, 95% CI=1.27-2.99), anxiety disorders (odds ratio=1.65, 95% CI=1.25-2.18), and suicidality (odds ratio=2.21, 95% CI=1.47-3.31) than their nonvictimized peers. The effects were similar to those of being placed in public or substitute care and an index of multiple childhood adversities, and the effects remained significant after controlling for known correlates of bullying victimization. Childhood bullying victimization was associated with a lack of social relationships, economic hardship, and poor perceived quality of life at age 50., Conclusions: Children who are bullied-and especially those who are frequently bullied-continue to be at risk for a wide range of poor social, health, and economic outcomes nearly four decades after exposure. Interventions need to reduce bullying exposure in childhood and minimize long-term effects on victims' well-being; such interventions should cast light on causal processes.

Background: Temperamental characteristics emerge early in life and can shape children's development, adjustment and behaviour. We aimed to investigate the association between early infant temperament and later childhood psychiatric disorder in a community sample., Methods: This prospective, population-based study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). In a sample of 7318 children, we investigated whether temperamental characteristics assessed at the ages of 6 months and 24 months are associated with an independent diagnosis of psychiatric disorder ascertained at age 7 years., Results: After adjusting for confounders, temperamental characteristics assessed at 6 and 24 months of age were associated with psychiatric disorder at age 7 years. In particular, intensity of emotional reaction at age 6 months was associated with later disorder (adjusted odds ratio = 1.56; 95% confidence interval 1.19, 2.04; P = 0.002). These associations were stronger in girls and in those children with high levels of intensity at both 6 and 24 months of age., Conclusions: Temperamental characteristics involving high levels of emotional intensity within the first year of life are longitudinally associated with psychiatric disorder in mid-childhood, suggesting that the roots of psychiatric disorder may, in some cases, lie very early in life., (© 2013 John Wiley & Sons Ltd.)

The publication of the first report from the Global Burden of Disease (GBD) Study (Murray & Lopez, 1996) radically changed evaluations of the public health significance of mental disorders. Before that time, diseases were typically ranked in terms of their impact on premature mortality. The GBD Study added estimates of impact on disability, and in so doing highlighted the huge public health burden attendant on poor mental health., (© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.)

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., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Background: It is not unusual for researchers to make apparently minor modifications to existing instruments without checking if this alters psychometric properties., Method: Equivalent items on child mental health from two different versions of the Rutter parent questionnaire were compared: items from the standard version and from a modified version. The parents of 400 children aged 5-7 years were randomised into two groups: each group completed one version of the Rutter as well as an independent measure of psychopathology (the Strengths and Difficulties Questionnaire; SDQ)., Results: The mean psychopathology scores of the two groups were comparable according to the SDQ but differed markedly between the two Rutter versions, principally because of changes in the response categories. Nevertheless, the validity of the two versions of the Rutter was similar as judged from Rutter-SDQ correlations., Conclusion: Seemingly minor changes in the wording of a measure can have a major impact on mean scores, thereby making it harder to compare or combine the results of studies using the original and the modified measure.

Purpose of Review: This review examines recent evidence on the comorbidity between literacy problems and psychiatric disorder in childhood and discusses possible contributory factors., Recent Findings: Recent studies confirm the substantial overlap of literacy problems with a range of emotional/behavioural difficulties in childhood. Literacy problems and inattention may share genetic influences, contributing to associations with attention deficit hyperactivity disorder. To an extent, links with conduct problems may be also mediated by attentional difficulties. In addition, findings suggest bidirectional influences whereby disruptive behaviours impede reading progress and reading failure exacerbates risk for behaviour problems. Associations between literacy problems and anxiety disorders are not entirely mediated by inattentiveness. Rather, comorbid anxiety disorders seem likely to arise from the stressors associated with reading failure. Findings in relation to depression are less consistent, but suggest that poor readers may be vulnerable to low mood. Children with autism seem more likely to face problems in reading comprehension than the decoding difficulties more prominent in other disorders., Summary: Literacy problems are associated with increased risks of both externalizing and internalizing disorders in childhood, with different mechanisms likely to be implicated in each case. When comorbid problems occur, each is likely to require separate treatment.

Background: Literacy difficulties show high levels of comorbidity with both disruptive and emotional disorders, but questions remain over the nature and specificity of these links., Method: Relationships between specific literacy difficulties and psychiatric disorder were investigated in a large-scale national sample of children aged 9 to 15 years., Results: Specific literacy difficulties were more common in children from lower socio-economic backgrounds, and were significantly associated with increased risks of Attention-Deficit Hyperactivity Disorder (especially inattentive symptomatology), Conduct Disorder and anxiety disorders in both girls and boys, and with self-reports of depressed mood in boys. Associations between literacy difficulties and diagnoses of both Attention-Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) were mediated by inattentiveness, as were links with low mood. Links between specific literacy difficulties and anxiety were of a different nature, suggestive of a direct impact of literacy problems on risk for anxiety disorders., Conclusions: Literacy difficulties are significantly associated with externalizing disorders via inattention, but may constitute a more immediate risk factor for naturally anxious children to develop clinically significant levels of anxiety.

Objective: We set out to examine the relationship between unintentional injury and common child psychiatric disorders, including both internalizing and externalizing diagnoses., Methods: The 1999 British Child and Adolescent Mental Health Survey provided a nationally representative sample of over 10,000 children aged 5-15 years. Measures included assessment of diagnoses of psychiatric disorder from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, unintentional injury, and a range of potentially related psychosocial factors., Results: Children with psychiatric disorders had higher rates of unintentional injury. After accounting for psychosocial risk factors and comorbid psychopathology, oppositional defiant disorder (ODD) was independently associated with burns and poisoning. Attention deficit hyperactivity disorder (ADHD) was related to fractures, and depression and anxiety also showed independent links to some injury types., Conclusions: ODD and ADHD, rather than conduct disorder, appear to be the externalizing disorders associated with unintentional injury. We discuss possible models of the relationships between internalizing disorders and unintentional injury.

Background: Marital status is a strong correlate of psychiatric morbidity in adulthood, but debate continues on how far this association reflects causal influences or selection effects based on prior psychological characteristics., Method: Prospective data from the National Child Development Study were used to examine effects of adolescent emotional and behavioural problems on transitions into and out of first partnerships, and their implications for psychiatric morbidity at age 33., Results: Emotional and behavioural problems in adolescence showed systematic links with early partnership transitions (age at partnership formation, type of first partnership, and risks of first partnership breakdown). More detailed tests suggested that these effects only accounted for a modest proportion of the associations between partnership status and psychiatric morbidity at age 33., Conclusions: In a non-referred community sample selection effects associated with adolescent emotional and behavioural problems appear to play only a modest role in links between partnership status and adult mental health.

Objectives: To identify whether psychiatric disturbance in parentally bereaved children and surviving parents is related to service provision., Design: Prospective case-control study., Setting: Two adjacent outer London health authorities., Participants: 45 bereaved families with children aged 2 to 16 years., Main Outcome Measures: Psychological disturbance in parentally bereaved children and surviving parents, and statistical associations between sample characteristics and service provision., Results: Parentally bereaved children and surviving parents showed higher than expected levels of psychiatric difficulties. Boys were more affected than girls, and bereaved mothers had more mental health difficulties than bereaved fathers. Levels of psychiatric disturbance in children were higher when parents showed probable psychiatric disorder. Service provision related to the age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death., Conclusions: Service provision was not significantly related to parental wishes or to level of psychiatric disturbance in parents or children. There is a role for general practitioners and primary care workers in identifying psychologically distressed surviving parents whose children may be psychiatrically disturbed, and referring them to appropriate services.

Background: The Malaise Inventory is a commonly used self-completion scale for assessing psychiatric morbidity. There is some evidence that it may represent two separate psychological and somatic subscales rather than a single underlying factor of distress. This paper provides further information on the factor structure of the Inventory and on the reliability and validity of the total scale and two sub-scales., Methods: Two general population samples completed the full Inventory: over 11,000 subjects from the National Child Development Study at ages 23 and 33, and 544 mothers of adolescents included in the Isle of Wight epidemiological surveys., Results: The internal consistency of the full 24-item scale and the 15-item psychological subscale were found to be acceptable, but the eight-item somatic sub-scale was less reliable. Factor analysis of all 24 items identified a first main general factor and a second more purely psychological factor. Receiver operating characteristic (ROC) analysis indicated that the validity of the scale held for men and women separately and for different socio-economic groups, by reference to external criteria covering current or recent psychiatric morbidity and service use, and that the psychological sub-scale had no greater validity than the full scale., Conclusions: This study did not support the separate scoring of a somatic sub-scale of the Malaise Inventory. Use of the 15-item psychological sub-scale can be justified on the grounds of reduced time and cost for completion, with little loss of reliability or validity, but this approach would not significantly enhance the properties of the Inventory by comparison with the full 24-item scale. Inclusion of somatic items may be more problematic when the full scale is used to compare particular sub-populations with different propensities for physical morbidity, such as different age groups, and in these circumstances it would be a sensible precaution to utilise the 15-item psychological sub-scale.

The developmental interplay between nature and nurture is discussed, with particular reference to implications for research in developmental psychopathology. The general principles include individual differences in reactivity to the environment, two-way interplay between intraindividual biology and environmental influences, and the need to consider broader social contextual features. Individuals actively process their experiences; they also act on their environment to shape and select their experiences, and individual characteristics change over time. Key findings on genetic effects include their ubiquitous influence, the multifactorial origin of most psychopathology, the involvement of several genes in most mental disorders, some genetic effects operate through dimensional risk features rather than directly on disorder, some genetic effects are dependent on gene-environment correlations and interactions, and genetic effects increase with age. Key findings on environmental effects include their ubiquitous influence, the genetic mediation of some supposed environmental effects, the importance of passive gene-environment correlations, the paucity of evidence regarding environmental effects on lifetime liability to psychopathology, the lack of understanding of environmental effects on the organism, and the importance of nonshared environmental effects. Research strategies to investigate environmental risk mediation include the range of genetically sensitive designs, migration studies, secular trend investigations, studies of nonfamilial environments, and examination of intraindividual change in relation to measured environmental alterations. Proximal processes involved in person-environment interplay are discussed in relation to person-environment interactions and evocative and active person-environment correlations.

Adverse childhood experiences--especially inadequacies in early parental care--are associated with elevated rates of both acute and chronic psychosocial disorders in adult life. In most instances, adverse outcomes are confined to a minority of children exposed; variations in the severity or pervasiveness of early risk, individual differences in susceptibility, and interactions with later stressors are all thus likely to be important in mediating effects. At present, knowledge of intervening processes is limited, and dependent on retrospective studies of adult samples or short-term longitudinal findings in childhood. We review current evidence on the long-term outcomes of prenatal divorce, childhood maltreatment, and institutional rearing, and on the early antecedents of depression and antisocial behaviour in adult life, to highlight possible interviewing mechanisms. Most long-term sequelae seem likely to depend on a series of shorter-term links, some running through elevated risks of continued environmental adversity, others through psychological vulnerabilities and problems in social relationships.