Menopause status and climacteric symptoms in a birth cohort of mid-life New Zealand women.

BACKGROUND: There is little current research on the transition to natural menopause among contemporary groups of mid-life women at age 40 years. OBJECTIVE: This study reports on female members of the Christchurch Health and Development Study cohort. This research aimed to: document the menopause status, reproductive outcomes and climacteric symptoms of the women at age 40 years; examine the associations between menopause status and concurrent measures of psychosocial and economic well-being; and document the associations between menopause status and potential predictors of menopause reflecting childhood, family and individual factors prior to age 40 years. METHODS: The Christchurch Health and Development Study is a longitudinal, representative, prospective cohort of 1265 babies (630 females) born in New Zealand in 1977. At age 40 years, 470 women (who had not experienced surgical menopause) were interviewed on their menopause status, climacteric symptoms and associated factors. RESULTS: The majority of women were premenopausal, around 20% were perimenopausal and 2% were postmenopausal. Statistically significant associations were found reflecting higher rates of diagnosed reproductive disorder, climacteric symptoms, low occupational status, non-heterosexual sexuality and exposure to childhood sexual abuse amongst both perimenopausal and postmenopausal women at age 40 years. CONCLUSION: These data will inform directions for future data collection and analyses.

Sexual orientation and mental health over the life course in a birth cohort.

BACKGROUND: Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples. METHODS: We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood. RESULTS: The latent class analysis identified four groups interpreted as: 'heterosexual' 82%, 'mostly heterosexual' 12.6%, 'bisexual' 3.5% and 'gay/lesbian' 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes. CONCLUSIONS: Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed.

Cognitive Development Trajectories of Very Preterm and Typically Developing Children.

Cognitive impairment is common among children born very preterm (VPT), yet little is known about how this risk changes over time. To examine this issue, a regional cohort of 110 VPT (≤ 32 weeks gestation) and 113 full-term (FT) born children was prospectively assessed at ages 4, 6, 9, and 12 years using the Wechsler Preschool and Primary Scale of Intelligence-Revised and then Wechsler Intelligence Scale for Children, 4th ed. At all ages, VPT children obtained lower scores than their FT born peers (p < .001). Growth curve modeling revealed stable cognitive trajectories across both groups. Neonatal white matter abnormalities and family socioeconomic adversity additively predicted cognitive risk. Despite some intraindividual variability, cognitive functioning of typically developing and high-risk VPT children was stable and influenced by early neurological development and family rearing context.

Life-stress and reactivity by gender in a longitudinal birth cohort at 30 and 35 years.

PURPOSE: Previous literature has shown gender differences in reactivity to stressful life events. However, it is unclear whether gender differences in stress reactivity are consistent across a series of life event domains among longitudinal adult sample populations. METHODS: Data were gathered from the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal birth cohort of 1265 children born in 1977 in Christchurch, New Zealand. Cohort members were questioned on their experience of, and distress from, a series of life event domains (interpersonal problems; victimization; illness/death; pregnancy/parenthood; employment/finance problems) spanning two age-periods 25-30 years (data collected in 2007) and 30-35 years (data collected in 2012). The data were pooled across observations and analyzed using population-averaged repeated-measures regression methods. RESULTS: Overall, men and women reported experiencing similar numbers of life events for each domain. However, men reported more victimization and more employment/financial problems; women reported more illness/death events. Women reported experiencing more distress per life event for the domains of interpersonal problems, illness/death and pregnancy/parenthood. Men and women reported similar distress per life event for the victimization and employment/finance domains. The results were robust to control for: child and adolescent factors (childhood abuse exposure; adolescent personality; mental health) and adult factors (mental health; self-esteem). CONCLUSION: These findings are consistent with a growing body of evidence indicating that some life events including interpersonal problems, illness/death and pregnancy/parenthood may be intrinsically more distressing for women. Detection of life event distress is important to aid in the prevention of mental/physical health problems.

Adolescent depression, adult mental health and psychosocial outcomes at 30 and 35 years.

BACKGROUND: There is limited information on long-term outcomes of adolescent depression. This study examines the associations between severity of depression in adolescence and a broad array of adult functional outcomes. METHOD: Data were gathered as part of the Christchurch Health and Development Study, a 35-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand in 1977. Severity of depression at age 14-16 years was classified into three levels according to DSM symptom criteria for major depression (no depression/sub-threshold symptoms/major depression). This classification was related to adult functional outcomes assessed at ages 30 and 35 years using a generalized estimating equation modeling approach. Outcome measures spanned domains of mental disorder, education/economic circumstances, family circumstances and partner relationships. RESULTS: There were modest but statistically significant bivariate associations between adolescent depression severity and most outcomes. After covariate adjustment there remained weak but significant (p < 0.05) associations with rates of major depression, anxiety disorder, illicit substance abuse/dependence, any mental health problem and intimate partner violence (IPV) victimization. Estimates of attributable risk for these outcomes ranged from 3.8% to 7.8%. For two outcomes there were significant (p < 0.006) gender interactions such that depression severity was significantly related to increased rates of unplanned pregnancy and IPV victimization for females but not for males. CONCLUSIONS: The findings reinforce the importance of the individual/family context in which adolescent depression occurs. When contextual factors and probable maturational effects are taken into account the direct effects of adolescent depression on functioning in mature adulthood appear to be very modest.

Bullying victimization in adolescence and psychotic symptomatology in adulthood: evidence from a 35-year study.

BACKGROUND: There has been considerable recent interest in possible causal linkages between exposure to bullying victimization and later psychotic symptomatology. Prior research in this area has had several limitations which make it difficult to ascertain causality, and to determine the extent to which these effects extend beyond adolescence. METHOD: Data were obtained from the Christchurch Health and Development Study, a 35-year study of a longitudinal birth cohort. This investigation used generalized estimating equation modelling to estimate the associations between bullying victimization (ages 13-16 years) and psychotic symptoms (ages 18-35 years), before and after controlling for possible confounding factors, including: gender; childhood socio-economic status; child intelligence quotient; exposure to sexual abuse in childhood; anxious/withdrawn behaviour and attention problems (ages 7-9 years); and adolescent psychotic symptoms and paranoid ideation (ages 15-16 years). RESULTS: There was a significant (p < 0.0001) bivariate association between bullying victimization in adolescence and psychotic symptomatology in adulthood. Successive models controlling for covariation reduced this association to statistical non-significance. After controlling for covariates, those with the highest level of bullying victimization had rates of psychotic symptoms that were 1.21 (95% confidence interval 0.73-1.99) times higher than those who were not victimized. CONCLUSIONS: The association between bullying victimization in adolescence and psychotic symptomatology in adulthood could be largely explained by childhood behavioural problems, and exposure to sexual abuse in childhood. The results suggest that bullying victimization was unlikely to have been a cause of adult psychotic symptoms, but bullying victimization remained a risk marker for these symptoms.

Life satisfaction and mental health problems (18 to 35 years).

BACKGROUND: Previous research has found that mental health is strongly associated with life satisfaction. In this study we examine associations between mental health problems and life satisfaction in a birth cohort studied from 18 to 35 years. METHOD: Data were gathered during the Christchurch Health and Development Study, which is a longitudinal study of a birth cohort of 1265 children, born in Christchurch, New Zealand, in 1977. Assessments of psychiatric disorder (major depression, anxiety disorder, suicidality, alcohol dependence and illicit substance dependence) using DSM diagnostic criteria and life satisfaction were obtained at 18, 21, 25, 30 and 35 years. RESULTS: Significant associations (p < 0.01) were found between repeated measures of life satisfaction and the psychiatric disorders major depression, anxiety disorder, suicidality, alcohol dependence and substance dependence. After adjustment for non-observed sources of confounding by fixed effects, statistically significant associations (p < 0.05) remained between life satisfaction and major depression, anxiety disorder, suicidality and substance dependence. Overall, those reporting three or more mental health disorders had mean life satisfaction scores that were nearly 0.60 standard deviations below those without mental health problems. A structural equation model examined the direction of causation between life satisfaction and mental health problems. Statistically significant (p < 0.05) reciprocal associations were found between life satisfaction and mental health problems. CONCLUSIONS: After adjustment for confounding, robust and reciprocal associations were found between mental health problems and life satisfaction. Overall, this study showed evidence that life satisfaction influences mental disorder, and that mental disorder influences life satisfaction.

Substance abuse and criminal activities following traumatic brain injury in childhood, adolescence, and early adulthood.

OBJECTIVE: Use a longitudinal birth cohort to evaluate the association of traumatic brain injury at ages 0 to 5, 6 to 15, and 16 to 21 years with drug and alcohol abuse and engagement in criminal activities. MAIN MEASURES: Follow-up over 21 to 25 years using self-report of drug and alcohol use, arrests, and violent and property offenses. Outcomes were assessed for 2 levels of severity (inpatient, hospitalized; outpatient, seen by general practitioner or at emergency department). PARTICIPANTS: Members of the Christchurch Health and Development Study, a longitudinal birth cohort. SETTING: Christchurch, New Zealand. RESULTS: Adjusted for child and family factors, compared with noninjured individuals, inpatients injured at 0 to 5 years or 16 to 21 years were more likely to have symptoms consistent with drug dependence. All inpatient groups had increased risk of arrest, with the age groups of 0 to 5 and 6 to 15 years more likely to be involved in violent offenses and the age group of 0 to 5 years more likely to engage in property offenses. Outpatient group had an increased risk of violent offenses for first injury 0 to 5 years, arrests and property offenses for injury 6 to 15 years, and increased risk of arrests and violent offenses for injury 16 to 21 years of age. However, when alcohol dependence and drug dependence were added as an additional covariate, traumatic brain injury was no longer associated with criminal behavior for the age group of 0 to 5 years. CONCLUSIONS: Traumatic brain injury is associated with increased criminal behavior and may represent a risk factor for offending. However, early substance use is a mediating factor for those injured early in life.

An investigation of the pre-injury risk factors associated with children who experience traumatic brain injury.

BACKGROUND AND OBJECTIVE: Traumatic brain injury (TBI) is a frequently occurring event in childhood that may have significant ongoing effects. Little is known about the child and family characteristics that predispose children to these injuries. A greater understanding of the risk factors associated with childhood TBI may provide an opportunity to prevent their occurrence. METHODS: Information provided by a large birth cohort study (n=1265) was used to determine the child and family risk factors of TBI in children aged 0-15 years (n=187). All information regarding child, family, and injury events were collected prospectively and unrelated to the injury event itself. Child variables included in the analysis were sex and the level of behavioural problems. Parental variables included were family socioeconomic status, mother's age, education level, depressive symptoms, number of adverse life events experienced by the family, and parenting style. RESULTS: The most important risk factors were sex, adverse life events, and parenting style. The results suggest evidence of modest increases in the rate of TBI for those in the highest risk categories (male, >or=4 life events per annum, high maternal punitiveness) compared to the lowest risk categories, with hazard ratios in the region of 1.4-1.6. CONCLUSIONS: Overall characteristics of both the family and child predicted a TBI event. An increased understanding of risks associated with TBI in childhood will provide an avenue to prevent these injuries by targeting at-risk families and aiding the development of appropriate intervention strategies.

Childhood exposure to sexual abuse and partnership outcomes at age 30.

BACKGROUND: In this study, 30-year longitudinal data from the Christchurch Health and Development Study (CHDS) were used to examine the associations between childhood exposure to sexual abuse and intimate relationship outcomes at age 30. In addition, a broad range of early childhood and family confounding factors were tested, and the role of intervening factors from adolescence was explored. METHOD: The investigation analyzed data from a birth cohort of over 900 New Zealand adults studied to the age of 30. At ages 18 and 21 cohort members reported on any exposure to sexual abuse prior to age 16. This information, along with prospective data gathered in childhood and adolescence, was used to predict partnership outcomes at age 30. RESULTS: After adjustment for early childhood and family factors, exposure to more severe forms of childhood sexual abuse (CSA) was associated with earlier and more frequent cohabitation, higher rates of perpetrated interpartner violence (IPV), and early parenthood, lower relationship satisfaction and investment. Several factors from adolescence partially or fully mediated these associations, notably a history of early consensual sexual intercourse, higher number of sexual partnerships, substance abuse problems, and self-esteem. After adjustment for intervening factors, exposure to CSA remained significantly associated with IPV. CONCLUSIONS: The findings support a causal chain process, whereby early childhood and family factors place some individuals at risk for CSA. The extent of CSA exposure is related to adolescent risk taking, which in turn leads to early and more frequent cohabitation, risk of IPV, and lower relationship satisfaction and investment.

Long-term behavioural outcomes of pre-school mild traumatic brain injury.

Abstract Background Mild traumatic brain injury (MTBI) is a leading cause of injury for children during their pre-school years. However, there is little information regarding the long-term outcomes of these injuries. Method We used fully prospective data from an epidemiological study of a birth cohort to examine behavioural effects associated with MTBI during the pre-school years. Cases of confirmed MTBI were divided into two groups, those that had received outpatient medical attention, and those that had been admitted to hospital for a brief period of observation (inpatient cases). The remainder of the cohort served as a reference control group. Results Mother/teacher ratings for behaviours associated with attention deficit/hyperactivity disorder and oppositional defiant/conduct disorder, obtained yearly from age 7 to 13, revealed evidence of deficits after inpatient MTBI (n = 21), relative to more minor outpatient injury MTBI (n = 55) and the reference control group (n = 852). For the inpatient group there was evidence of increasing deficits over years 7-13. Conclusions More severe pre-school MTBI may be associated with persistent negative effects in terms of psychosocial development. The vulnerability of pre-school children to MTBI signals a pressing need to identify high-risk cases that may benefit from monitoring and early intervention.

Dentine lead levels in childhood and criminal behaviour in late adolescence and early adulthood.

INTRODUCTION: There have been claims in the literature that lead exposure makes a strong contribution to criminal behaviour. OBJECTIVES: To examine linkages between lead exposure in childhood and crime in late adolescence/early adulthood to (a) determine whether higher levels of lead exposure were associated with increased levels of criminal behaviour and (b) estimate the extent to which lead exposure was responsible for increases in criminal behaviour. METHODS: Negative binomial regression models were fitted using data from a longitudinal birth cohort of New Zealand-born children studied from birth to age 21. RESULTS: There were statistically significant (p<0.05) bivariate associations between dentine lead levels at ages 6-9 and (a) officially recorded violence/property convictions (ages 14-21) and (b) self-reported violent/property offending (ages 14-21). The mean rate of convictions was 1.89 (SD 6.86) and the mean rate of offences was 15.24 (SD 49.24) for those with the highest level of exposure. Those with the lowest level of exposure had a mean rate of convictions of 0.0, and a mean rate of offending of 1.97 (SD 6.34). Adjustment for confounding factors reduced the magnitude of these associations, but the associations remained statistically significant. Further analyses suggested that the associations were largely explained by the linkages between lead exposure and educational underachievement. Lead exposure accounted for less than 1% of the variance in crime. CONCLUSIONS: These results suggest that, although lead exposure was associated with criminal behaviour, the associations were somewhat weak, and were largely explained by linkages between lead exposure and educational underachievement.

Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort.

BACKGROUND: Little is known about the incidence and prevalence of traumatic brain injury (TBI), particularly for infants, children and young adults. PRIMARY OBJECTIVE: The purpose of this study was to provide an accurate estimate of the incidence and prevalence of TBIs for individuals between 0-25 years of age. METHOD AND PROCEDURES: A birth cohort of 1265 individuals was used, for which information regarding TBI events, both hospitalized and non-hospitalized, had been recorded. MAIN OUTCOMES AND RESULTS: The average incidence for this age group ranged from 1.10-2.36 per 100 per year, with an overall prevalence of approximately 30%. The most common source of injury was falls for individuals 0-14 years of age and contact sports and motor vehicle accidents for 15-25 year olds. Approximately one third of the individuals who experienced a TBI went on to have one or more additional injuries. CONCLUSIONS: The incidence rates reported here are much higher than those previously found. It is clear that TBIs constitute a major health issue and therefore it is important to have accurate information to enable planning for primary healthcare services and to inform prevention programmes.

Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting.

The efficacy of the albumin/creatinine ratio (ACR) measurement in detection of significant proteinuria when performed in a high-risk antenatal clinic was compared with automated dipstick, protein/creatinine ratio (PCR), and 24-hour urine protein measurements. Both the ACR (DCA 2000) and PCR were strongly predictive for the presence or absence of significant proteinuria, with positive likelihood ratios (LRs) of 27.4 and 31.6 and negative LRs of 0.0 and 0.1, respectively. Both the ACR (DCA 2000) and PCR are effective tests for both identifying and excluding significant proteinuria in the outpatient setting. The ACR (DCA 2000) has the advantage of providing an immediate result.

Cigarette smoking and suicidal behaviour: results from a 25-year longitudinal study.

BACKGROUND: This study examined the associations between cigarette smoking and suicidal ideation and suicide attempts, both before and after control for potentially confounding using fixed effects regression models. METHOD: Data were gathered during the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children (635 males, 630 females). The analysis was based on a sample of 1041 participants with available data on cigarette smoking and suicidal behaviour from ages 16 to 25 years. The main outcome measures were suicidal ideation and suicide attempts, ages 16-18, 18-21, and 21-25. RESULTS: There were significant bivariate associations between the frequency of cigarette smoking and both suicidal ideation and suicide attempts. Cohort members who smoked 20 or more cigarettes per day had odds of suicidal ideation that were 3.39 times (95% CI 2.06-5.59) those of non-smokers, and odds of suicide attempt that were 4.39 (95% CI 2.18-8.85) times those of non-smokers. Control for non-observed fixed confounding factors reduced the association between cigarette smoking and suicidal ideation and suicide attempts to statistical non-significance. After adjustment, those smoking more than 20 cigarettes per day had odds of suicidal ideation that were 1.00 times (95% CI 0.46-2.18) those of non-smokers, and odds of suicide attempt that were 1.84 (95% CI 0.81-4.18) times those of non-smokers. CONCLUSIONS: The findings suggest that the associations between frequency of cigarette smoking and suicidal behaviour may largely be explained by the non-observed background factors and life circumstances that are associated with both cigarette smoking and suicidal behaviour.

Firearms legislation and reductions in firearm-related suicide deaths in New Zealand.

OBJECTIVE: To examine the impact of introducing more restrictive firearms legislation (Amendment to the Arms Act, 1992) in New Zealand on suicides involving firearms. METHOD: National suicide data were examined for 8 years before, and 10 years following the introduction of the legislation. RESULTS: After legislation, the mean annual rate of firearm-related suicides decreased by 46% for the total population (p < 0.0001), 66% for youth (15-24 years; p < 0.0001) and 39% for adults (> or = 25 years; p < 0.01). The fraction of all suicides accounted for by firearm-related suicides also reduced for all three populations (p < 0.0001). However, the introduction of firearms legislation was not associated with reductions in overall rates of suicide for all three populations. CONCLUSIONS: Following the introduction of legislation restricting ownership and access to firearms, firearm-related suicides significantly decreased, particularly among youth. Overall rates of youth suicide also decreased over this time but it is not possible to determine the extent to which this was accounted for by changes in firearms legislation or other causes.

Major depression and cigarette smoking: results of a 21-year longitudinal study.

BACKGROUND: The aim of this paper was to examine the association between major depression and cigarette smoking among young adults in a birth cohort before and after adjusting for confounding factors. METHOD: Data were gathered over the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 New Zealand children studied to age 21. Data were gathered by interview on: (a) major depression over the period 16-21 years; (h) daily smoking and nicotine dependence over the period from 16-21 years. In addition, the study included extensive information on social, family, and behavioural factors in childhood and adolescence. RESULTS: Young people meeting DSM-IV criteria for major depression had elevated rates of daily smoking and nicotine dependence. These associations were reduced substantially by control for potential confounding child and adolescent factors. Nonetheless, even after such control, major depression was associated with increased rates of daily smoking (IRR = 1.19; 95% CI = 1.03, 1.39) and elevated rates of nicotine dependence (OR = 1.75; 95% CI = 1.13, 2.70). CONCLUSIONS: The results suggest that much of the association between smoking and depression reflects common confounding factors that are associated with both outcomes. Nonetheless, even after control for these factors there is evidence of a possible causal linkage between smoking and depression. The direction of causality between smoking and depression remains unknown.

Neuroticism in adolescence and psychotic symptoms in adulthood.

BACKGROUND: The aims of this research were to examine the associations between the personality trait of neuroticism in adolescence and later psychotic symptoms, taking into account potential confounding factors. METHOD: Data were gathered over the course of a longitudinal study of a birth cohort of New Zealand born young people (N=1265). Over the course of the study, data were gathered on: (a) neuroticism at age 14; (b) psychotic symptoms predominantly subclinical, assessed on the Symptom Checklist (SCL-90), at ages 18 and 21; (c) a range of potential confounding factors including measures of childhood adversity and co-morbid mental disorders. RESULTS: Young people in the highest quartile of neuroticism at age 14 had rates of psychotic symptoms that were two to three times higher than those in the lowest quartile. After statistical adjustment for confounding factors, including childhood adversity and co-morbid mental disorders, the association between neuroticism and later psychotic symptoms reduced but remained statistically significant (P<0.05). After adjustment for confounding, young people with high levels of neuroticism had rates of psychotic symptoms that were between 1.5 to 1.8 times higher than those with low levels of neuroticism. CONCLUSIONS: Early neuroticism may be a precursor to the onset of psychotic symptoms. The mechanisms underlying this association are unclear, but may relate to overlapping features between prodromal phases of psychosis and items that measure neuroticism.

Arrests and convictions for cannabis related offences in a New Zealand birth cohort.

AIMS: To examine the associations between the use of cannabis and arrest/conviction for cannabis related offences. METHODS: Data on cannabis use and arrests/convictions for cannabis related offences were gathered during the course of a 21-year longitudinal study of a birth cohort of Christchurch (New Zealand) born children (N=983). Information on cannabis use, arrests and convictions was gathered over the period from 16 to 21 years. RESULTS: By the age of 21, over two thirds of the cohort had used cannabis on at least one occasion with 5% using cannabis on more than 400 occasions. Amongst cannabis users, 5.1% had been arrested for a cannabis related offence and 3.6% had been convicted of an offence. There was a strong association between the extent of cannabis use and risks of arrest/conviction: over a quarter of those using cannabis on more than 400 occasions had been arrested or convicted for a cannabis related offence compared with less than 1% of those using cannabis on fewer than ten occasions. Maori, those with a previous arrest record for non cannabis related offences and those reporting involvement in violent/property offending were more likely to be arrested or convicted than other cohort members having the same level of cannabis use; in addition, males were more likely to be convicted than females with the same level of cannabis use. Arrest/conviction for a cannabis related offence did not reduce the use of cannabis: of those arrested/convicted, 95% either increased their use or continued with the same level of cannabis use subsequent to their arrest. CONCLUSIONS: The results of this study reinforce concerns about laws relating to the use and possession of cannabis. The findings show that the law was administered in an inefficient way, the application of the law was biased, and the law was ineffective in reducing cannabis use.