Lower help-seeking intentions mediate subsequent depressive symptoms among adolescents with high autistic traits: a population-based cohort study.

Adolescents with high autistic traits are at increased risk of depression. Despite the importance of seeking help for early intervention, evidence on help-seeking intentions amongst this population is scarce. Using a population-based cohort in Japan, we examined adolescents' help-seeking intentions and preferences by the level of autistic traits and tested its mediating role on the association between high autistic traits and depressive symptoms. At age 12, we measured parent-rated autistic traits using the short version of the Autism Spectrum Quotient and classified the adolescents into two groups (≥ 6 as AQhigh, < 6 as AQlow); help-seeking intentions and preferences were assessed through a depression vignette. At age 14, depressive symptoms were self-rated using the Short Mood and Feelings Questionnaire. Hypothesised associations between autistic traits and help-seeking intentions or depressive symptoms were tested applying multivariable regression modelling, while mediation was tested with structural equation modelling. Of the 2505 adolescent participants, 200 (8%) were classified as AQhigh. In both groups, the main source of help-seeking was their family; however, 40% of the AQhigh group reported having no help-seeking intentions compared to 27% in the AQlow. The AQhigh group was at increased risk of not having help-seeking intentions (OR 1.84, 95% CI 1.35-2.50) and higher depressive symptoms (b coefficient 1.06, 0.33-1.79). Help-seeking intentions mediated 18% of the association mentioned above. Interventions to promote help-seeking intentions among adolescents with high autistic traits could reduce their subsequent depressive symptoms. Ideally, such interventions should be provided prior to adolescence and with the involvement of their parents.

Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence.

BACKGROUND: Autism can be diagnosed from 2 years of age, although most autistic people receive their diagnosis later than this after they have started education. Research is required to understand why some autistic children are diagnosed late, and the level and nature of unmet need prior to diagnosis for late-diagnosed children. METHODS: We examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing 'earlier-diagnosed' (diagnosed 7 years or younger) with 'late-diagnosed' (diagnosed between 8 and 14 years) autistic children. Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n = 146) and late-diagnosed (n = 284) autistic children. RESULTS: Aged 5, earlier-diagnosed autistic children had more emotional (i.e., internalising), conduct, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of EBSDs. These results persisted when we ran adjusted models, to account for the late-diagnosed group having higher rates of late-diagnosed attention deficit/hyperactivity disorder, higher IQ, a higher proportion of females and older and more educated mothers. CONCLUSIONS: Emotional, behavioural and social difficulties are associated with, and may influence, the timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence.

Appetite disinhibition rather than hunger explains genetic effects on adult BMI trajectory.

BACKGROUND/OBJECTIVES: The mediating role of eating behaviors in genetic susceptibility to weight gain during mid-adult life is not fully understood. This longitudinal study aims to help us understand contributions of genetic susceptibility and appetite to weight gain. SUBJECTS/METHODS: We followed the body-mass index (BMI) trajectories of 2464 adults from 45 to 65 years of age by measuring weight and height on four occasions at 5-year intervals. Genetic risk of obesity (gene risk score: GRS) was ascertained, comprising 92 BMI-associated single-nucleotide polymorphisms and split at a median (=high and low risk). At the baseline, the Eating Inventory was used to assess appetite-related traits of 'disinhibition', indicative of opportunistic eating or overeating and 'hunger' which is susceptibility to/ability to cope with the sensation of hunger. Roles of the GRS and two appetite-related scores for BMI trajectories were examined using a mixed model adjusted for the cohort effect and sex. RESULTS: Disinhibition was associated with higher BMI (ß = 2.96; 95% CI: 2.66-3.25 kg/m2), and accounted for 34% of the genetically-linked BMI difference at age 45. Hunger was also associated with higher BMI (ß = 1.20; 0.82-1.59 kg/m2) during mid-life and slightly steeper weight gain, but did not attenuate the effect of disinhibition. CONCLUSIONS: Appetite disinhibition is most likely to be a defining characteristic of genetic susceptibility to obesity. High levels of appetite disinhibition, rather than hunger, may underlie genetic vulnerability to obesogenic environments in two-thirds of the population of European ancestry.

Association Between Social Isolation and Smoking in Japan and England.

BACKGROUND: Existing evidence suggest that those who are socially isolated are at risk for taking up or continuing smoking. This study investigated country-based differences in social isolation and smoking status. METHODS: We performed a repeated cross-sectional study using two waves of data from two ongoing aging studies: the English Longitudinal Study of Ageing and the Japan Gerontological Evaluation Study. Participants from both studies aged ≥65 years were included. We applied a multilevel Poisson regression model to examine the association between social isolation and smoking status and adjusted for individual sociodemographic characteristics. We used the social isolation index which comprises the following domains: marital status; frequency of contact with friends, family, and children; and participation in social activities. Interaction terms between each country and social isolation were also entered into the mode. RESULTS: After exclusion of never smokers, we analyzed 75,905 participants (7,092 for ELSA and 68,813 for JAGES, respectively). Taking ex-smokers as the reference, social isolation was significantly associated with current smoking; the prevalence ratios (PRs) were 1.06 (95% credible interval [CrI], 1.05-1.08) for men and 1.08 (95% CrI, 1.04-1.11) for women. Taking Japan as a reference, the interaction term between country and social isolation was significant for both sexes, with increased PRs of 1.32 (95% CrI, 1.14-1.50) for men and 1.30 (95% CrI, 1.11-1.49) for women in England. CONCLUSIONS: Older people who were less socially isolated were more likely to quit smoking in England than in Japan, possibly explained by the strict tobacco control policies in England.

The stability of health-related behaviour clustering during mid-adulthood and the influence of social circumstances on health-related behaviour change.

Evidence suggests that health-related behaviours (HRBs) cluster in mid-adulthood and are associated with social circumstances (i.e. economic circumstances, cultural norms, employment relations) at the same age. However, little is known about the level of stability in HRB cluster membership during mid-adulthood and how social circumstances in early mid-adulthood may influence movement between HRB clusters during mid-life. Data were taken from a British cohort born in 1958 (N = 12,784), to examine the stability of membership of three HRB clusters: 'Risky', 'Moderate Smokers' and 'Mainstream' (the latter pattern consisting of more beneficial HRBs such as not smoking, moderate alcohol consumption, being physically active), between ages 33 and 42. The relationship between social circumstances at age 33 and movement between HRB clusters during mid-adulthood was also examined. HRB cluster membership was relatively stable during mid-adulthood, over 60% of the participants remained in the same cluster at both ages. However, there was considerable probability of movement from the 'Risky' and 'Moderate Smokers' clusters at age 33 to the 'Mainstream' cluster at age 42. Members of the 'Risky' cluster had a lower probability of transitioning to the 'Mainstream' cluster (men = 17%, women = 9%, p < 0.001) in comparison to the 'Moderate Smokers' cluster (men = 26%, women = 27%, p < 0.001). Social circumstances at age 33 did not influence change in HRB cluster membership between ages 33 and 42 (p > 0.05). Movement from the 'Risky' and 'Moderate Smokers' cluster to the 'Mainstream' cluster during mid-adulthood highlights improvements for most HRBs. Person-centred interventions are required to prevent persistent negative HRBs amongst 'Risky' cluster members.

Social influences on health-related behaviour clustering during adulthood in two British birth cohort studies.

Building upon evidence linking socio-economic position (SEP) in childhood and adulthood with health-related behaviours (HRB) in adulthood, we examined how pre-adolescent SEP predicted membership of three HRB clusters: "Risky", "Moderate Smokers" and "Mainstream" (the latter pattern consisting of more beneficial HRBs), that were detected in our previous work. Data were taken from two British cohorts (born in 1958 and 1970) in pre-adolescence (age 11 and 10, respectively) and adulthood (age 33 and 34). SEP constructs in pre-adolescence and adulthood were derived through Confirmatory Factor Analysis. Conceptualised paths from pre-adolescent SEP to HRB cluster membership via adult SEP in our path models were tested for statistical significance separately by gender and cohort. Adult SEP mediated the path between pre-adolescent SEP and adult HRB clusters. More disadvantaged SEP in pre-adolescence predicted more disadvantaged SEP in adulthood which was associated with membership of the "Risky" and "Moderate Smokers" clusters compared to the "Mainstream" cluster. For example, large positive indirect effects between pre-adolescent SEP and adult HRB via adult SEP were present (coefficient 1958 Women = 0.39; 1970 Women = 0.36, 1958 Men = 0.51; 1970 Men = 0.39; p < 0.01) when comparing "Risky" and "Mainstream" cluster membership. Amongst men we found a small significant direct association (p < 0.001) between pre-adolescent SEP and HRB cluster membership. Our findings suggest that associations between adult SEP and HRBs are not likely to be pre-determined by earlier social circumstances, providing optimism for interventions relevant to reducing social gradients in HRBs. Observing consistent findings across the cohorts implies the social patterning of adult lifestyles may persist across time.

Social and Behavioural Determinants of the Difference in Survival among Older Adults in Japan and England.

BACKGROUND: A rapidly ageing population presents major challenges to health and social care services. Cross-country comparative studies on survival among older adults are limited. In addition, Japan, the country with the longest life expectancy, is rarely included in these cross-country comparisons. OBJECTIVE: We examined the relative contributions of social and behavioural factors on the differences in survival among older people in Japan and England. METHODS: We used data from the Japan Gerontological Evaluation Study (JAGES; n = 13,176) and the English Longitudinal Study of Ageing (ELSA; n = 5,551) to analyse all-cause mortality up to 9.4 years from the baseline. Applying Laplace regression models, the 15th survival percentile difference was estimated. RESULTS: During the follow-up, 31.3% of women and 38.6% of men in the ELSA died, whereas 19.3% of women and 31.3% of men in the JAGES died. After adjusting for age and baseline health status, JAGES participants had longer survival than ELSA participants by 318.8 days for women and by 131.6 days for men. Family-based social relationships contributed to 105.4 days longer survival in JAGES than ELSA men. Fewer friendship-based social relationships shortened the JAGES men's survival by 45.4 days compared to ELSA men. Currently not being a smoker contributed to longer survival for JAGES women (197.7 days) and ELSA men (46.6 days), and having lower BMI reduced the survival of JAGES participants by 129.0 days for women and by 212.2 days for men. CONCLUSION: Compared to participants in England, Japanese older people lived longer mainly because of non-smoking for women and family-based social relationships for men. In contrast, a lower rate of underweight, men's better friendship-based social relationships, and a lower smoking rate contributed to survival among participants in England.

Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005-2015.

BACKGROUND: Non-drinking among young people has increased over the past decade in England, yet the underlying factor driving this change is unknown. Traditionally non-drinking has been found to be associated with lower socio-economic status and poorer health. This study explores among which sub-groups non-drinking has increased, and how this correlates with changes in drinking patterns, to identify whether behaviours are becoming more polarised, or reduction is widespread among young people. METHODS: Among participants aged 16 to 24 years (N = 9699), within the annual cross-sectional nationally-representative Health Survey for England 2005-2015 datasets, the following analyses were conducted: 1) The proportion of non-drinkers among social-demographic and health sub-groups by year, and tests for linear trends among sub-groups, adjusting for age were calculated. In pooled analyses, an interaction between year and each variable was modelled in sex- and age-adjusted logistic regression models on the odds of being a non-drinker versus drinker 2) At the population level, spearman correlation co-efficients were calculated between the proportion non-drinking and the mean alcohol units consumed and binge drinking on the heaviest drinking day, by year. Ordinary least squares regression analyses were used, modelling the proportion non-drinking as the independent variable, and the mean units/binge drinking as the dependent variable. RESULTS: Rates of non-drinking increased from 18% (95%CI 16-22%) in 2005 to 29% (25-33%) in 2015 (test for trend; p < 0.001), largely attributable to increases in lifetime abstention. Not drinking in the past week increased from 35% (32-39%) to 50% (45-55%) (p < 0.001). Significant linear increases in non-drinking were found among most sub-groups including healthier sub-groups (non-smokers, those with high physical activity and good mental health), white ethnicity, north and south regions, in full-time education, and employed. No significant increases in non-drinking were found among smokers, ethnic minorities and those with poor mental health. At the population-level, significant negative correlations were found between increases in non-drinking and declines in the mean units consumed (ρ = - 0.85, p < 0.001), and binge drinking (ρ = - 0.87, p < 0.001). CONCLUSION: Increases in non-drinking among young people has coincided with a delayed initiation into alcohol consumption, and are to be welcomed. Future research should explore attitudes towards drinking among young people.

What could keep young people away from alcohol and cigarettes? Findings from the UK Household Longitudinal Study.

BACKGROUND: Adolescents are vulnerable to risky behaviours that are likely to co-occur. We examined whether happiness, awareness of alcohol- or smoking-related harm or the size of friendship networks would be longitudinally associated with young people's risky behaviours. METHODS: We used available cases (N=1,729) from adolescents aged between 10 and 15 who participated in waves 2 and 3 of the UK Longitudinal Household Study that has annually collected population representative data from 40,000 UK households. The outcome variable was patterns of cigarette and alcohol use among adolescents (1= persistent non-use; 2= ex-use; 3= initiation; 4= persistent use) that we derived by tabulating current alcohol or cigarette use at waves 2 and 3. Explanatory variables were scores on participants' perception of overall happiness, awareness of harm due to alcohol and cigarette use, and supportive friendship network size, collected at wave 2. Covariates were participants' sex, age, base level of self-reported health status, reported religious affiliation, and household social position. All estimates were corrected for the complex survey design and non-response. Multinomial logistic regression was used to test assumed associations by taking persistent cigarette and alcohol use as the reference category. RESULTS: Findings showed higher happiness scores were longitudinally associated with adolescents' persistent non-use (RRR=1.06, 95% CI=1.01-1.13). Awareness of alcohol or cigarette use-related harm was longitudinally associated with persistent non-use (RRR=1.24, 95% CI 1.15-1.35) as well as initiation of alcohol or cigarette use (RRR=1.21, 95% CI=1.11-1.32). CONCLUSION: Joint interventions to promote happiness and harm awareness could help young adolescents from engaging with drinking alcohol or smoking cigarettes.

The clustering of health-related behaviours in a British population sample: Testing for cohort differences.

Research findings indicate that health-related behaviours (HRBs) do not co-occur within individuals by chance and therefore cluster. This study uses Latent Profile Analysis (LPA), to identify the clustered patterns and prevalence of four HRBs: smoking, alcohol, diet, physical activity. We used data, collected from participants in their early 30s, from two British cohorts born in 1958 and 1970 (N=21,019). Multi-group LPA models were run separately by gender testing for cohort differences in HRB cluster patterns. For both genders three clusters emerged: 'Risky' (1-9%), 'Moderate Smokers' (20-30%) and 'Mainstream' (68-77%). HRBs amongst members of the 'Mainstream' cluster were more beneficial than HRBs amongst members of the other two clusters, characterised as not smoking, frequent fruit and vegetable consumption, less frequent consumption of chips and fried food and being more physically active. Nevertheless, frequent consumption of sweet foods was common in the 'Mainstream' cluster. There was a large shift in membership to the 'Mainstream' cluster for men and women born in 1970. Amongst women members of the 'Mainstream' cluster, a higher proportion of those born in 1970 appeared to have drunk alcohol above the contemporaneous UK recommended limits but consumed sweet foods less frequently, than those born in 1958. In summary our findings provide additional evidence of HRB clustering, identifying largely consistent HRBs cluster patterns across cohort and gender groups, with some differences in prevalence. This evidence of HRB clustering across time and by gender provides a person-centred understanding that can inform interventions to improve HRBs.

Drunkenness and heavy drinking among 11year olds - Findings from the UK Millennium Cohort Study.

Heavy drinking among young people is linked to negative consequences including other risky behaviours, educational failure and premature mortality. There is a lack of research examining factors that influence heavy and binge drinking in early adolescence as prior work has focused on older teenagers. The objective of this paper was to identify individual and family factors associated with drunkenness and episodes of heavy drinking in early adolescence. We analysed data on 11,046 11year olds from the UK Millennium Cohort Study. Multivariate logistic regression was used to estimate odds ratios for associations. 1.2% of participants reported having been drunk, and 0.6% reported having had 5 or more drinks in a single episode. Participants who reported drunkenness were more likely to be boys (1.6% vs 0.7%, p<0.01), to have socioemotional difficulties (2.6% vs 1.0%, p<0.001), to report antisocial behaviours (none=0.6%, 1=2.0%, 2 or more=7.0%, p<0.001), report truancy (6.0% vs 1.0%, p<0.001), smoke cigarettes (12.0% vs 0.8%, p<0.001). Parental drinking did not appear to be associated with the odds of drunkenness. Associated with higher odds of drunkenness were: having friends who drank (OR=5.17); having positive expectancies towards alcohol (OR 2+=2.02); ever having smoked cigarettes (OR=5.32); the mother-child relationship not being close (OR=2.17). Associated with a reduced odds of drunkenness was having a heightened perception of harm from drinking 1-2 drinks daily (OR - some risk=0.48, great risk=0.40). Our findings support policies aimed at multiple levels, starting in the preadolescent years, which incorporate individual, family, and peer factors.

What influences 11-year-olds to drink? Findings from the Millennium Cohort Study.

BACKGROUND: Drinking in youth is linked to other risky behaviours, educational failure and premature death. Prior research has examined drinking in mid and late teenagers, but little is known about the factors that influence drinking at the beginning of adolescence. Objectives were: 1. to assess associations of parental and friends' drinking with reported drinking among 11 year olds; 2. to investigate the roles of perceptions of harm, expectancies towards alcohol, parental supervision and family relationships on reported drinking among 11 year olds. METHODS: Analysis of data from the UK Millennium Cohort Study on 10498 11-year-olds. The outcome measure was having drank an alcoholic drink, self-reported by cohort members. RESULTS: 13.6 % of 11 year olds reported having drank. Estimates reported are odds ratios and 95 % confidence intervals. Cohort members whose mothers drank were more likely to drink (light/moderate = 1.6, 1.3 to 2.0, heavy/binge = 1.8, 1.4 to 2.3). Cohort members whose fathers drank were also more likely to drink but these estimates lost statistical significance when covariates were adjusted for (light/moderate = 1.3, 0.9 to 1.9, heavy/binge = 1.3, 0.9 to 1.9). Having friends who drank was strongly associated with cohort member drinking (4.8, 3.9 to 5.9). Associated with reduced odds of cohort member drinking were: heightened perception of harm from 1-2 drinks daily (some = 0.9, 0.7 to 1.1, great = 0.6, 0.5 to 0.7); and negative expectancies towards alcohol (0.5, 0.4 to 0.7). Associated with increased odds of cohort member drinking were: positive expectancies towards alcohol (1.9, 1.4 to 2.5); not being supervised on weekends and weekdays (often = 1.2, 1.0 to 1.4); frequent battles of will (1.3, 1.1 to 1.5); and not being happy with family (1.2, 1.0 to 1.5). CONCLUSIONS: Examining drinking at this point in the lifecourse has potentially important public health implications as around one in seven 11 year olds have drank, although the vast majority are yet to explore alcohol. Findings support interventions working at multiple levels that incorporate family and peer factors to help shape choices around risky behaviours including drinking.

[History and Current Status of Birth Cohort Studies in the UK, and Feasibility in Japan].

Birth cohort studies are conducted by prospectively following the participants with a spe- cific characteristic background from their birth or prenatal birth, and can explore the causal relationship of various factors with outcomes. In the UK, birth cohort studies with long-term follow-ups have been launched every ten years, which have provided many significant results and related useful policy recommendation. However, these have not necessarily intended to be launched as the national project with long-term observations, rather existing birth cohorts are accept to continue because of the excellent results and survey condition. In 1990s, birth cohort studies have been revalued as national resources, and widely used by domestic and international researchers. As the contribution to psychiatry and mental health, most of the cohort studies have been conducted to identify risk factors for onset of psychiatric diseases such as schizophrenia. Nowadays, broader studies were conducted and highly evaluated for the relationships between physical and psychological illnesses, and biological studies. Recent cohort studies also showed that cognitive abilities in childhood or adolescence was similar between those who later developed schizophrenia and those who experienced psychotic symptoms, sug- gesting that a spectrum in psychiatric diseases would be useful for elucidating the pathophysiology. In Japan, birth cohort studies which findings could be reflected on policy implications have been required as national resources. However, as there have been no birth cohort studies that have conducted for long-term follow-ups, there are little techniques and knowledge for launching and continuing a birth cohort study with low attrition, and providing evidences to society. It is necessary to establish these techniques and knowledge by learning from the UK cases within the cultural and social contexts in Japan. High quality routine studies including examination have been implemented in Japan in various fields such as perinatal and infant care, schools, work places, medical care, and the central and local governments. Supplementation of those data will be needed for high quality birth cohort studies. Until now, there has been no relevant law to conduct any data linkage between the data from various fields in research settings and it is necessary to be prepared.

Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life course.

BACKGROUND: Ex-drinkers suffer from worse health than drinkers; however, whether a worsening of health is associated with a change in drinking status from early adulthood has not been previously investigated. We assess whether a worsening of health is associated with a cessation in consumption or reduction to special occasion drinking from early adulthood to middle age. METHODS: Multinomial logistic regression assessing whether a change in self-reported limiting longstanding illness (LLI) was associated with ceasing alcohol consumption, or a reduction to special occasion drinking compared with being a persistent drinker from age 23 in separate models at ages 33, 42, and 50. All models adjusted for sex, poor psychosocial health, education, marital status, and children in the household. Sample included participants from Great Britain followed longitudinally in the National Child Development Study from ages 23 to 33 (N = 5,529), 42 (N = 4,787), and 50 (N = 4,476). RESULTS: Developing an LLI from the previous wave was associated with ceasing alcohol consumption at ages 33 (odds ratio [ORs] = 2.71, 95% confidence interval [CI] = 1.16-4.93), 42 (OR = 2.44, 95% CI = 1.24-4.81), and 50 (OR = 3.33, 95% CI = 1.56-7.12) and a reduction to special occasion drinking at ages 42 (OR = 2.04, 95% CI = 1.40-2.99) and 50 (OR = 2.04, 95% CI = 1.18-3.53). Having a persistent LLI across 2 waves increased the odds of ceasing consumption at ages 42 (OR = 3.22, 95% CI = 1.06-9.77) and 50 (OR = 4.03, 95% CI = 1.72-9.44) and reducing consumption to special occasion drinking at ages 33 (OR = 3.27, 95% CI = 1.34-8.01) and 42 (OR = 2.25, 95% CI = 1.23-4.50). Persistent drinkers at older ages had the best overall health suffering less from previous poor health compared with those who reduced or ceased consumption at an earlier time point. CONCLUSIONS: Developing an LLI was associated with a cessation in alcohol consumption and a reduction in consumption to special occasion drinking from early adulthood. Persistent drinkers who drank at least till 50 were the healthiest overall. Health selection is likely to influence nondrinking across the life course.

Life course approach in social epidemiology: an overview, application and future implications.

The application of the life course approach to social epidemiology has helped epidemiologists theoretically examine social gradients in population health. Longitudinal data with rich contextual information collected repeatedly and advanced statistical approaches have made this challenging task easier. This review paper provides an overview of the life course approach in epidemiology, its research application, and future challenges. In summary, a systematic approach to methods, including theoretically guided measurement of socioeconomic position, would assist researchers in gathering evidence for reducing social gradients in health, and collaboration across individual disciplines will make this task achievable.

Parental separation and adult psychological distress: an investigation of material and relational mechanisms.

BACKGROUND: An association between parental separation or divorce occurring in childhood and increased psychological distress in adulthood is well established. However relatively little is known about why this association exists and how the mechanisms might differ for men and women. We investigate why this association exists, focussing on material and relational mechanisms and in particular on the way in which these link across the life course. METHODS: This study used the 1970 British Cohort Study (n=10,714) to investigate material (through adolescent and adult material disadvantage, and educational attainment) and relational (through parent-child relationship quality and adult partnership status) pathways between parental separation (0-16 years) and psychological distress (30 years). Psychological distress was measured using Rutter's Malaise Inventory. The inter-linkages between these two broad mechanisms across the life course were also investigated. Missing data were multiply imputed by chained equations. Path analysis was used to explicitly model prospectively-collected measures across the life course, therefore methodologically extending previous work. RESULTS: Material and relational pathways partially explained the association between parental separation in childhood and adult psychological distress (indirect effect=33.3% men; 60.0% women). The mechanisms were different for men and women, for instance adult partnership status was found to be more important for men. Material and relational factors were found to interlink across the life course. Mechanisms acting through educational attainment were found to be particularly important. CONCLUSIONS: This study begins to disentangle the mechanisms between parental separation in childhood and adult psychological distress. Interventions which aim to support children through education, in particular, are likely to be particularly beneficial for later psychological health.

Life-Course Socioeconomic Position and Mild Cognitive Impairment in Midlife: Evidence from the 1958 British Birth Cohort.

BACKGROUND: Dementia has been the leading cause of death in the UK since 2015. Increasing evidence supports an association between socioeconomic position (SEP) and dementia onset in later life. However, limited studies have examined how life-course SEP influences the development of mild cognitive impairment (MCI), an intermediate state potentially preceding dementia. Therefore, the present study aims to examine the relationship between life-course SEP and MCI amongst adults aged 50 years in Great Britain. METHODS: We employed data from the National Child Development Study (NCDS), also known as the 1958 British Birth Cohort, to determine the associations between SEP and MCI in 6590 participants. We categorised life-course measures of SEP as stable high/low or moving upward/downward over the life course. We assessed MCI at age 50 using one standard deviation below the averaged combined scores from all cognitive tests available. We then used binary logistic regression to estimate the longitudinal associations between life-course SEP and MCI. RESULTS: Relative to those of a high SEP across the life course, participants who moved upward, downward, or remained at a low SEP were significantly associated with 25% (95% CI 1.02-1.54, p = 0.035), 70% (95% CI 1.27-2.27, p < 0.001), and 85% (95% CI 1.50-2.29, p < 0.001), respectively, higher odds of MCI, independent of all selected covariates. CONCLUSIONS: Lower life-course SEP was associated with significantly higher odds of MCI onset in middle life within the NCDS cohort. Public health policies targeting cognitive impairment should encompass a life-course approach to reduce socioeconomic inequalities.

Maternal Autistic Traits and Adverse Birth Outcomes.

Importance: Women with a high level of autistic traits in the general population may experience larger health disparities during pregnancy, particularly women diagnosed with autism spectrum disorder (ASD), which in turn may be associated with increased risk of adverse birth outcomes. Objective: To investigate the association between maternal autistic traits and the risk of adverse birth outcomes in the general population. Design, Setting, and Participants: This cohort study included mothers of singletons from a nationwide, multicenter prospective birth cohort, the Japan Environmental Children's Study. Expecting mothers were recruited between January 2011 and March 2014. Data were analyzed between June 2021 and November 2023. Exposures: Autistic traits were self-reported during the second and third trimesters using the short form of the Autism-Spectrum Quotient Japanese version (AQ-J10) (score range, 0-10; clinical range, ≥7). Main Outcomes and Measures: Data on preterm birth (<37 weeks' gestation) and neonates born small for gestational age (SGA) were transcribed from medical records. Additional analysis of gestational age groups (very preterm birth, <32 weeks' gestation; moderate-to-late preterm birth, 32-36 weeks' gestation) was also performed. Results: Among 87 687 women (mean [SD] age, 31.2 [5.0] years) included in the study, 2350 (2.7%) had AQ-J10 scores within the clinical range yet only 18 (0.02%) were diagnosed with ASD. A higher AQ-J10 score was associated with an increased risk of all birth outcomes, including preterm births (relative risk [RR] per 1-SD increase, 1.06; 95% CI, 1.03-1.09), moderate-to-late preterm births (RR per 1-SD increase, 1.05; 95% CI, 1.01-1.08), very preterm births (RR per 1-SD increase, 1.16; 95% CI, 1.06-1.26), and child born SGA (RR per 1-SD increase, 1.04; 95% CI, 1.01-1.06) after adjusting for maternal and pregnancy-related factors. The risks of all outcomes increased with higher AQ-J10 scores; compared with women below the clinical range, women within the clinical range had greater risk of preterm births (RR, 1.16; 95% CI, 1.07-1.26), moderate-to-late preterm births (RR, 1.12; 95% CI, 1.03-1.22), very preterm births (RR, 1.49; 95% CI, 1.18-1.89), and a child born SGA (RR, 1.11; 95% CI, 1.04-1.19). Conclusions and Relevance: In this cohort study, higher level of maternal autistic traits was associated with increased risk of adverse birth outcomes, particularly very preterm birth. Acknowledging the risks and providing tailored and timely antenatal care support to women with a high level of autistic traits in the general population, particularly women with autistic traits within the clinical range, regardless of formal diagnosis, is warranted.