Cognitive ability in childhood and the chronicity and suicidality of depression.

BACKGROUND: There is inconsistent evidence regarding the influence of general cognitive abilities on the long-term course of depression. AIMS: To investigate the association between general childhood cognitive abilities and adult depression outcomes. METHOD: We conducted a cohort study using data from 633 participants in the New England Family Study with lifetime depression. Cognitive abilities at age 7 were measured using the Wechsler Intelligence Scale for Children. Depression outcomes were assessed using structured diagnostic interviews administered up to four times in adulthood between ages 17 and 49. RESULTS: In analyses adjusting for demographic factors and parental psychiatric illness, low general cognitive ability (i.e. IQ<85 v. IQ>115) was associated with recurrent depressive episodes (odds ratio (OR) = 2.19, 95% CI 1.20-4.00), longer episode duration (rate ratio 4.21, 95% CI 2.24-7.94), admission to hospital for depression (OR = 3.65, 95% CI 1.34-9.93) and suicide ideation (OR = 3.79, 95% CI 1.79-8.02) and attempt (OR = 4.94, 95% CI 1.67-14.55). CONCLUSIONS: Variation in cognitive abilities, predominantly within the normal range and established early in childhood, may confer long-term vulnerability for prolonged and severe depression. The mechanisms underlying this vulnerability need to be established to improve the prognosis of depression among individuals with lower cognitive abilities.

Socioeconomic status gradients in inflammation in adolescence.

OBJECTIVE: To determine whether lower socioeconomic status (SES), broadly defined, is associated with increased inflammation in adolescence and whether adiposity mediates these relationships. METHODS: Fasting blood samples from 941 non-Hispanic black and white adolescents enrolled in a suburban, Midwestern school district were assayed for proinflammatory biomarkers (interleukin-6 [IL-6], tumor necrosis factor α soluble receptor 2 fibrinogen). A parent reported objective SES (parent education [E1 ≤ high school, E2 = some college, E3 = college graduate, E4 = professional degree], household income), and youth perceived SES (PSES). Multivariable linear regressions assessed the relationship of SES measures to biomarkers adjusting for age, race, sex, and puberty status. In the final step, body mass index (BMI) z score (BMIz) was added to models, and Sobel tests were performed to assess mediation by adiposity. RESULTS: Parent education was inversely associated with IL-6 (ßE1 = .11, ßE2 = .10, ßE3 = .02; p < .001). This association was attenuated but remained significant after BMIz adjustment (p = .01). Sobel testing confirmed BMIz's partial mediating role (p < .001). Parent education was also inversely associated with sTNFR2 (ßE1 = .03, ßE2 = .02, ßE3 = .001; p = .01); this relationship was mediated by BMIz. Although no main effect was noted for PSES, PSES by race interactions was observed for sTNFR2 (p = .02) and IL-6 (p = .06). High PSES was associated with lower sTNFR2 and IL-6 for white but not black youth. There were no associations with household income. CONCLUSIONS: Social disadvantage, specifically low parent education, is associated with increased inflammation in adolescence. Adiposity explains some but not all associations, suggesting that other mechanisms link lower SES to inflammation. High PSES is associated with lower inflammation for white but not black youth.

Understanding pediatricians' views toward school-based BMI screening in Massachusetts: a pilot study.

BACKGROUND: Massachusetts (MA) mandated body mass index (BMI) screening in schools in 2010. However, little is known about pediatricians' views on school-based screening or how the pediatricians' perspectives might affect the school-based screening process. We assessed MA pediatricians' knowledge, attitudes, beliefs, and practices concerning BMI screening. METHODS: An anonymous Web-based survey was completed by 286 members of the MA Chapter of the American Academy of Pediatrics who provided primary care (40% response rate). RESULTS: Support for school-based BMI screening was mixed. While 16.1% strongly supported it, 12.2% strongly opposed it. About one fifth (20.2%) believed school-based screening would improve communication between schools and pediatricians; 23.0% believed school-based screening would help with patient care. More (32.2%) believed screening in schools would facilitate communication with families. In contrast, pediatricians embraced BMI screening in practice: 91.6% calculated and 85.7% plotted BMI at every well child visit. Pediatricians in urban practices, particularly inner city, had more positive attitudes toward BMI screening in schools, even when adjusting for respondent demographics, practice setting, and proportion of patients in the practice who were overweight/obese (p < .001). CONCLUSION: These data suggest MA pediatricians use BMI screening and support its clinical utility. However, support for school-based BMI screening was mixed. Urban-based pediatricians in this sample held more positive beliefs about screening in schools. Although active collaboration between schools and pediatricians would likely help to ensure that the screenings have a positive impact on child health regardless of location, it may be easier for urban-based schools and pediatricians to be successful in developing partnerships.