Child abuse and neglect and mental health outcomes in adulthood by ethnicity: Findings from a 40-year longitudinal study in New Zealand/Aotearoa.

BACKGROUND: Longitudinal studies consistently report adverse long-term outcomes of childhood maltreatment. Little is known about the impact of childhood maltreatment on mental health among a marginalized population (New Zealand Maori); therefore, we cannot assume the effects of maltreatment are the same across the population. OBJECTIVE: Associations were examined between childhood sexual abuse (CSA), childhood physical punishment (CPP) and childhood neglect (CN) (<16 years) and mental health outcomes 18-40 years, by ethnicity (Maori/non-Maori). PARTICIPANTS AND SETTING: Data from the Christchurch Health and Development Study, a study of a birth cohort of 1265 children born in Christchurch in 1977. By age 40, 17.8 % (n = 191) reported New Zealand Maori ethnic identity; 82.2 % (n = 883) were non-Maori. METHODS: CSA, CPP (<16 years) were measured at 18, 21 years; CN was measured at 40 years. Major depression, anxiety disorder, suicidal ideation, alcohol abuse/dependence and cannabis abuse/dependence were measured at ages 21, 25, 30, 35 and 40 years. Childhood confounding variables controlled. Analyses were extended to include Maori ethnicity. RESULTS: After statistical adjustment, experience of severe childhood maltreatment increased odds of mental health problems 1.8-2.6×, compared to no maltreatment; the effects of maltreatment were similar for males and females. For Maori, some higher rates of mental health problems were seen among those maltreated, no statistically significant associations were detected after Bonferroni correction (among severe maltreatment vs. no maltreatment). Limitations should be considered when interpreting results. CONCLUSIONS: Exposure to childhood maltreatment has long-term effects into middle-age. Further research employing culturally-sensitive approaches may help clarify Maori childhood maltreatment outcomes.

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.

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.

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.

Relation between age of first drinking and mental health and alcohol and drug disorders in adulthood: evidence from a 35-year cohort study.

AIMS: To estimate associations between age of first drinking (AFD) and alcohol use disorder, nicotine dependence, cannabis dependence, illicit drug dependence, major depression and anxiety disorder in adulthood, net of a series of covariate factors. DESIGN: Data were obtained from a longitudinal birth cohort. SETTING: Christchurch, New Zealand. PARTICIPANTS: The Christchurch Health Development Study (CHDS), a longitudinal study of a cohort born in 1977 and studied to age 35 years. Analysis samples ranged in size from 1056 (ages 11-13 years) to 962 (age 35 years); 50.2% of the total sample was male. MEASUREMENTS: A measure of AFD (ages 5-13+ years) was generated using latent class analysis. Outcome measures included: major depression, anxiety disorders, alcohol use disorder, nicotine dependence, cannabis dependence and other illicit drug dependence during the period 15-35 years. Covariate factors measured during childhood included family socio-economic status, family functioning, parental alcohol-related attitudes/behaviours and individual factors. FINDINGS: Earlier AFD was associated significantly (P < 0.05) with increased risk of later alcohol use disorders, nicotine dependence and illicit drug dependence, and was associated marginally (P < 0.10) with cannabis dependence, but not depression or anxiety disorder. After controlling for covariate factors, the associations between AFD and outcomes were no longer statistically significant [alcohol use disorder: B = -0.07, 95% confidence interval (CI) = -0.22, 0.08; nicotine dependence: B = -0.15, 95% CI = -0.34, 0.04; illicit drug dependence: B = -0.29, 95% CI = -0.73, 0.15; cannabis dependence: B = -0.05, 95% CI = -0.31, 0.22]. CONCLUSIONS: The associations between age of first drinking and later alcohol/drug disorders appear to be accounted for at least to some degree by factors related to characteristics of the individual and family during childhood.

Outcomes for 236 patients from a 2-year early intervention in psychosis service.

OBJECTIVE: To examine: i) changes in key outcome measures over time in treatment in a representative first-episode psychosis treatment cohort and ii) baseline predictors of service disengagement. METHOD: Baseline characteristics of 236 patients were examined for associations with outcomes over time using generalized estimating equation models. The data on disengagement were analysed using logistic regression. RESULTS: After controlling for admission scores, patients showed consistently improved outcomes while in treatment on functional recovery (unemployment, P < 0.01; HoNOS, P < 0.001; the Quality of Life Scale, P < 0.001; GAF, P < 0.05) but not symptomatology (as assessed by the PANSS and substance abuse). The 64 (33%) who disengaged were more likely to be unemployed (P < 0.01) and have higher HoNOS (P < 0.01) and GAF (P < 0.05) scores at baseline. CONCLUSION: This evaluation has shown significant improvements in psychosocial functioning but not psychopathology during treatment at an Early Intervention for Psychosis Service. Despite attempts to retain patients, there is a high rate of treatment discontinuation.

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.

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.

Repressive coping: distraction using pleasant thoughts and memories.

To avoid exposure to unpleasant or unwanted emotional material, some people may distract themselves by summoning up pleasant thoughts such as happy memories. Manipulation of negative affect might therefore result in heightened accessibility of pleasant thoughts and memories, contrary to hypotheses of mood-congruent recall. In Experiment 1, repressors were faster to recall happy memories after watching an unpleasant film than after watching a neutral film. Nonrepressors showed the opposite effect (i.e., mood-congruent memory). In Experiment 2, after an unpleasant film, repressors were faster to recall a happy memory than to recall a sad memory. In Experiment 3, repressors spontaneously generated pleasant thoughts after watching an unpleasant film, whereas nonrepressors did not. Thus, repressors apparently cope with exposure to negative affective material by accessing pleasant thoughts. Results are discussed in terms of cognitive defenses against emotional distress and the associative structure of repression.

Relation of threatened egotism to violence and aggression: the dark side of high self-esteem.

Conventional wisdom has regarded low self-esteem as an important cause of violence, but the opposite view is theoretically viable. An interdisciplinary review of evidence about aggression, crime, and violence contradicted the view that low self-esteem is an important cause. Instead, violence appears to be most commonly a result of threatened egotism--that is, highly favorable views of self that are disputed by some person or circumstance. Inflated, unstable, or tentative beliefs in the self's superiority may be most prone to encountering threats and hence to causing violence. The mediating process may involve directing anger outward as a way of avoiding a downward revision of the self-concept.