Associations between prenatal maternal stress, maternal inflammation during pregnancy, and children's internalizing and externalizing symptoms throughout childhood.

BACKGROUND: Maternal immune activation is a potential mechanism underlying associations between maternal stress during pregnancy and offspring mental health problems. This study examined associations between prenatal maternal stress, maternal inflammation during pregnancy, and children's internalizing and externalizing symptoms from 3 to 10 years of age, and whether maternal inflammation mediated the associations between prenatal maternal stress and children's internalizing and externalizing symptoms. METHODS: This study comprised 4,902 mother-child dyads in the Generation R study. Prenatal maternal stress was assessed using self-reported data collected during pregnancy and analyzed as a latent variable consisting of four stress domains. Maternal inflammation during pregnancy was assessed using serum concentrations of C-reactive protein (CRP) measured at a median of 13.5 weeks' gestation. Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist (CBCL) by maternal report at ages 3 years, 5 years, and 10 years; paternal-reported CBCL data were also available at 3 years and 10 years. RESULTS: Prenatal maternal stress was associated with maternal-reported internalizing and externalizing symptoms of the child at 3, 5, and 10 years of age, and with paternal-reported internalizing and externalizing symptoms at 3 and 10 years. Prenatal maternal stress was associated with maternal CRP concentrations prior to, but not after, covariate adjustment. Maternal CRP concentrations during pregnancy were associated with paternal-reported internalizing symptoms of offspring at 10 years of age prior to, but not after, covariate adjustment. There was no evidence that CRP concentrations mediated the associations between prenatal maternal stress and children's internalizing or externalizing symptoms. CONCLUSIONS: Maternal stress during pregnancy is associated with higher levels of internalizing and externalizing symptoms in children, but this association is not because of differences in maternal immune activation linked to maternal stress. Replication of these findings in other cohorts is required; examination of other biomarkers or variation in immune activity during pregnancy would also benefit from further exploration.

Prenatal maternal stress, child internalizing and externalizing symptoms, and the moderating role of parenting: findings from the Norwegian mother, father, and child cohort study.

BACKGROUND: Few studies have examined how parenting influences the associations between prenatal maternal stress and children's mental health. The objectives of this study were to examine the sex-specific associations between prenatal maternal stress and child internalizing and externalizing symptoms, and to assess the moderating effects of parenting behaviors on these associations. METHODS: This study is based on 15 963 mother-child dyads from the Norwegian Mother, Father, and Child Cohort Study (MoBa). A broad measure of prenatal maternal stress was constructed using 41 self-reported items measured during pregnancy. Three parenting behaviors (positive parenting, inconsistent discipline, and positive involvement) were assessed by maternal report at child age 5 years. Child symptoms of internalizing and externalizing disorders (depression, anxiety, attention-deficit hyperactivity disorder, conduct disorder, and oppositional-defiant disorder) were assessed by maternal report at age 8. Analyses were conducted using structural equation modeling techniques. RESULTS: Prenatal maternal stress was associated with child internalizing and externalizing symptoms at age 8; associations with externalizing symptoms differed by sex. Associations between prenatal maternal stress and child depression, and conduct disorder and oppositional-defiant disorder in males, became stronger as levels of inconsistent discipline increased. Associations between prenatal maternal stress and symptoms of attention-deficit hyperactivity disorder in females were attenuated as levels of parental involvement increased. CONCLUSIONS: This study confirms associations between prenatal maternal stress and children's mental health outcomes, and demonstrates that these associations may be modified by parenting behaviors. Parenting may represent an important intervention target for improving mental health outcomes in children exposed to prenatal stress.

Associations of sleep duration and sleep quality with indicators of mental health among youth and adults: findings from the 2015 Canadian Community Health Survey. / Associations entre durée et qualité du sommeil et indicateurs de santé mentale chez les jeunes et les adultes : résultats de l'Enquête sur la santé dans les collectivités canadiennes de 2015.

INTRODUCTION: A growing number of Canadian studies have examined the link between sleep and mental health. This research builds upon that work by investigating associations of sleep duration and quality with positive mental health (PMH) and mental illness and suicidal ideation (MI/SI) outcomes among youth and adults from threeCanadian provinces (i.e. Ontario, Manitoba and Saskatchewan). METHODS: Using cross-sectional data from respondents 12 years and older (n = 18 683) who were asked questions on their sleep in the 2015 Canadian Community Health Survey - Annual Component, we conducted unadjusted and adjusted logistic regressionswith self-reported measures of sleep duration and sleep quality as independent variables and a range of PMH (e.g. high self-rated mental health) and MI/SI indicators (e.g. mood disorder diagnosis) as dependent variables. Analyses were conducted of allcomplete cases and also stratified by sex and age group. RESULTS: Good sleep quality was associated with higher odds of PMH indicators (adjusted odds ratio [aOR]: 1.52-4.24) and lower odds of MI/SI indicators (aOR: 0.23- 0.47); associations remained significant when analyses were stratified. Meeting sleep duration recommendations was positively associated with PMH indicators (aOR: 1.27- 1.56) and negatively associated with MI/SI indicators (aOR: 0.41-0.80), but some associations did not remain significant when stratified. CONCLUSION: This study provides support for associations between sleep duration and quality and indicators of PMH and MI/SI. Findings can inform future research and surveillance efforts that monitor sleep behaviours and indicators of PMH and MI/SI.

The association between social media use and physical activity among Canadian adolescents: a Health Behaviour in School-aged Children (HBSC) study.

OBJECTIVE: To determine the association between social media use (SMU) and physical activity (PA) among Canadian adolescents. METHODS: We used data from 12,358 participants in grades 6 to 10 who responded to the Canadian component of the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Social media intensity and problematic SMU were assessed using a 4-point mutually exclusive scale that contained three categories based on intensity (non-active, active, and intense SMU) and one category based on the presence of addiction-like symptoms irrespective of intensity (problematic SMU). PA was assessed for five domains (i.e., school curriculum, organized sport, exercise, outdoor play, and active transport) and dichotomized using the first quartile to represent high PA engagement in each domain. Meeting PA recommendation of 60 min per day of moderate-to-vigorous PA was calculated using the sum of the five domains. Logistic regression models were used to assess the association between SMU and PA, with active SMU used as the reference group for all models. RESULTS: Non-active SMU was associated with lower odds of meeting the daily PA recommendations and of high engagement in all five domains of PA when compared to active SMU. Intense SMU was associated with higher odds of meeting the daily PA recommendations. Problematic SMU was not associated with meeting daily PA recommendations, but it was significantly associated with lower odds of high PA engagement in the exercise domain. CONCLUSION: The findings of this study suggest that non-active SMU was significantly associated with lower PA levels. Problematic SMU was only significantly associated with lower PA levels in the exercise domain. Intense SMU was associated with higher odds of meeting the PA recommendation.

RéSUMé: OBJECTIF: Établir la relation entre l'utilisation des médias sociaux et l'activité physique chez les adolescents canadiens. MéTHODES: Nous avons utilisé les données de 12 358 participants de la 6e à la 10e année qui ont répondu au volet canadien de l'Enquête sur les comportements de santé des jeunes d'âge scolaire de 2017­2018 (HBSC). L'intensité des médias sociaux et leur utilisation problématique ont été évaluées à l'aide d'une échelle à quatre points mutuellement exclusifs contenant trois catégories basées sur l'intensité (utilisation non active, active et intense des médias sociaux) et une catégorie basée sur la présence de symptômes de dépendance indépendamment de l'intensité (utilisation problématique des médias sociaux). L'activité physique a été évaluée pour cinq domaines (c'est-à-dire le programme scolaire, le sport organisé, l'exercice, le jeu en plein air et le transport actif) et dichotomisée en utilisant le premier quartile pour représenter la participation à une activité physique élevée dans chaque domaine. Le respect de la recommandation de 60 min par jour d'activité physique modérée à vigoureuse a été calculé en utilisant la somme des cinq domaines. Des modèles de régression logistique ont été utilisés pour évaluer la relation entre l'utilisation des médias sociaux et l'activité physique, l'utilisation active des médias sociaux étant utilisée comme groupe de référence pour tous les modèles. RéSULTATS: L'utilisation non active des médias sociaux était associée à une probabilité plus faible de respecter les recommandations en matière d'activité physique quotidienne et à une participation élevée dans les cinq domaines de l'activité physique, par rapport à l'utilisation active des médias sociaux. Une utilisation intense des médias sociaux était associée à une probabilité plus élevée de respecter les recommandations en matière d'activité physique quotidienne. Une utilisation problématique des médias sociaux n'était pas associée au respect des recommandations en matière d'activité physique quotidienne, mais elle était fortement associée à une probabilité moindre de participation élevée à une activité physique dans le domaine de l'exercice. CONCLUSION: Les résultats de cette étude suggèrent que l'utilisation non active des médias sociaux est fortement associée à des niveaux d'activité physique plus faibles. Une utilisation problématique des médias sociaux n'était fortement associée à des niveaux d'activité physique plus faibles que dans le domaine de l'exercice. Une utilisation intense des médias sociaux était associée à une probabilité plus élevée de respecter la recommandation en matière d'activité physique.

Young Adult Outcomes Associated With Adolescent Suicidality: A Meta-analysis.

CONTEXT: Suicide is one of the leading causes of death among adolescents worldwide. Adolescents who present with suicidality may be at an increased risk for future mental illness and suicidality in young adulthood. OBJECTIVE: The objective of this study was to systematically assess the relationship between adolescent suicidal ideation and suicide attempts (suicidality) and young adult psychopathological outcomes. DATA SOURCES: Medline, Embase, and PsychInfo (OVID Interface) were searched for articles published before August 2021. STUDY SELECTION: Included articles were prospective cohort studies that compared young adult (19-30 years) psychopathological outcomes between suicidal and nonsuicidal adolescents. DATA EXTRACTION: We extracted data related to suicidality in adolescence, mental health outcomes in young adulthood, and covariates. Outcomes were analyzed via random-effect meta-analyses and reported using odds ratios. RESULTS: Of 9401 references screened, we included 12 articles comprising over 25 000 adolescents. Four outcomes were meta-analyzed: depression, anxiety, suicidal ideation, and suicide attempt. Adjusted meta-analyses showed that adolescent suicidal ideation was associated with young adult suicide attempt (odds ratio [OR] = 2.75, 95% confidence interval [CI]:1.70-4.44), depressive disorders (OR = 1.58, 95% CI: 1.20-2.08), and anxiety disorders (OR = 1.41, 95% CI: 1.01-1.96), whereas adolescent suicide attempts were associated with young adult suicide attempt (OR = 5.71, 95% CI: 2.40-13.61), and young adult anxiety disorders (OR = 1.54, 95% CI: 1.01-2.34). Results for young adult substance use disorders were mixed. LIMITATIONS: Significant heterogeneity between studies was observed because of differences in timing, method of assessments, and covariate adjustment. CONCLUSIONS: Adolescents experiencing suicidal ideation or with a history of suicide attempt may have increased odds of further suicidality or mental disorders in young adulthood.

Positive maternal mental health attenuates the associations between prenatal stress and children's internalizing and externalizing symptoms.

Positive maternal mental health can improve perceptions of stressful situations and promote the use of adaptive coping strategies. However, few studies have examined how positive maternal mental health affects children's development. The aims of this study were to examine the associations between positive maternal mental health and children's internalizing and externalizing symptoms, and to ascertain whether positive maternal mental health moderated the associations between prenatal stress and children's internalizing and externalizing symptoms. This study is based on the Norwegian Mother, Father, and Child Cohort Study (MoBa), and comprised 36,584 mother-child dyads. Prenatal stress was assessed using 41 self-reported items measured during pregnancy. Positive maternal mental health (self-efficacy, self-esteem, and enjoyment) was assessed by maternal report during pregnancy and postpartum. Child internalizing and externalizing symptoms were assessed by maternal report at age 5. Structural equation modeling was used for analysis. Maternal self-efficacy, self-esteem, and enjoyment were negatively associated with internalizing and externalizing symptoms in males and females. The association between prenatal stress and internalizing symptoms in males was stronger at low than at high levels of maternal self-esteem and enjoyment, whereas for females, the association was stronger at low than at high levels of maternal self-esteem and self-efficacy. This study provides evidence of associations between positive maternal mental health and children's mental health, and suggests that higher positive maternal mental health may buffer against the impacts of prenatal stress. Positive maternal mental health may represent an important intervention target to improve maternal-child well-being and foster intergenerational resilience.

Investigating the association between sleep and aspects of mental health in children: findings from the Canadian Health Survey on Children and Youth. / Étude de l'association entre sommeil et composantes de la santé mentale des enfants : résultats de l'Enquête canadienne sur la santé des enfants et des jeunes.

INTRODUCTION: Sufficient sleep and good quality sleep are crucial aspects of children's healthy development. While previous research has suggested associations between sleep and positive mental health, few studies have been conducted in Canadian children. METHODS: This study used data from the 2019 Canadian Health Survey on Children and Youth. Parents of children aged 5 to 11 years (N = 16 170) reported on their children's sleep habits and mental health. Descriptive statistics were used to calculate means and percentages for sleep and mental health indicators. Logistic regression was used to compare mental health outcomes by meeting sleep duration recommendations (9-11 hours of sleep vs. < 9 or > 11 hours of sleep), sleep quality (difficulties getting to sleep) and having enforced rules for bedtime. RESULTS: Overall, 86.2% of children aged 5 to 11 years met sleep duration recommendations (9-11 hours of sleep), 90.0% had high sleep quality and 83.1% had enforced rules for bedtime. While 83.0% of children had high general mental health, mental health diagnoses were reported for 9.5% of children, and 15.8% of children required or received mental health care. High sleep quality was consistently associated with better mental health, enforced rules for bedtime were associated with some negative mental health outcomes and meeting sleep duration recommendations tended not to be associated with mental health outcomes. CONCLUSION: Sleep quality was strongly associated with mental health among children in this study. Future research should explore longitudinal associations between sleep and mental health in Canadian children.

INTRODUCTION: Un sommeil suffisant et un sommeil de bonne qualité sont des composantes cruciales du développement sain des enfants. Si des recherches antérieures laissent entrevoir des associations entre le sommeil et une bonne santé mentale, peu d'études ont été menées chez les enfants canadiens. MÉTHODOLOGIE: Cette étude se fonde sur les données de l'Enquête canadienne sur la santé des enfants et des jeunes de 2019. Des parents d'enfants âgés de 5 à 11 ans (N = 16 170) ont fait état des habitudes de sommeil et de la santé mentale de leurs enfants. Des statistiques descriptives ont servi à calculer les moyennes et les pourcentages des indicateurs du sommeil et de la santé mentale. Une régression logistique a été utilisée pour comparer les résultats en matière de santé mentale en fonction du respect des recommandations sur la durée du sommeil (9 à 11 heures de sommeil contre moins de 9 heures ou plus de 11 heures), la qualité du sommeil (difficulté à s'endormir) et l'application de règles relatives à l'heure du coucher. RÉSULTATS: Dans l'ensemble, 86,2 % des enfants de 5 à 11 ans respectaient les recommandations sur la durée du sommeil (9 à 11 heures de sommeil), 90,0 % avaient un sommeil de grande qualité et 83,1 % avaient des règles à respecter concernant l'heure du coucher. Si 83,0 % des enfants avaient un niveau élevé de santé mentale générale, des diagnostics en matière de santé mentale ont tout de même été déclarés pour 9,5 % des enfants, et 15,8 % ont eu besoin de soins de santé mentale ou en ont reçus. Un sommeil de grande qualité a été systématiquement associé à une meilleure santé mentale, l'application de règles relatives à l'heure du coucher a été associée à certains effets négatifs sur la santé mentale et le respect des recommandations sur la durée du sommeil ne semble pas avoir d'incidence sur la santé mentale. CONCLUSION: Cette étude révèle une forte association entre la qualité du sommeil et la santé mentale chez les enfants. Les recherches futures devraient se pencher sur les associations longitudinales entre le sommeil et la santé mentale des enfants canadiens.

Prenatal work stress is associated with prenatal and postnatal depression and anxiety: Findings from the Norwegian Mother, Father and Child Cohort Study (MoBa).

BACKGROUND: An emerging body of research suggests that stress experienced in the workplace can have detrimental impacts on maternal mental health, including greater risk of postnatal depression. However, few longitudinal studies have examined these associations during the perinatal period. The objective of this study was to examine the associations between prenatal work stress and subsequent depression and anxiety. METHODS: This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), and included 77,999 employed women recruited between 1999 and 2008. The exposure variable was prenatal work stress measured at 17 weeks' gestation, using an 8-item scale examining factors including autonomy, working relationships, and work enjoyment. Outcomes included depression and anxiety at 30 weeks' gestation and 6 months postpartum, measured using the Symptom Checklist-8. Analyses comprised of unadjusted and adjusted logistic regressions. RESULTS: After covariate adjustment, prenatal work stress was associated with depression and anxiety at 30 weeks' gestation (OR = 1.33, 95% CI: 1.19-1.49), and 6 months postpartum (OR = 1.44, 95% CI: 1.28-1.61). Most associations remained after adjustment for additional work-related variables and maternity leave. LIMITATIONS: Work stress was measured once during pregnancy, thus variation of associations by trimester could not be investigated. Findings are reported for a sample with high socioeconomic status, and may not generalize to other populations. CONCLUSIONS: Women dealing with work stress during pregnancy are more likely to experience subsequent depression and anxiety. Findings can inform the development of workplace strategies to support the mental health of expecting and new mothers.

Parenting practices in childhood and depression, anxiety, and internalizing symptoms in adolescence: a systematic review.

PURPOSE: Parenting practices represent important and modifiable factors for health and wellbeing in children and adolescents; however, strength and quality of studies examining relationships between parenting practices in childhood and risk of depression and anxiety in adolescence are unclear. The objective of this systematic review was to synthesize the longitudinal literature that describes these associations. METHODS: Six electronic databases were searched for articles published through March 2018. Eligible articles were published in the English language, peer-reviewed, and had prospective cohort study designs. Articles eligible for inclusion examined positive and negative parenting practices of parents and/or guardians when study subjects were between 0 and 9 years of age, and symptoms of depression, anxiety, and internalizing symptoms when subjects were between 10 and 19 years of age. Heterogeneity of included articles precluded meta-analysis: findings were reported narratively. RESULTS: 4558 references were screened for inclusion, and 19 articles met eligibility criteria and were included for review. Ten articles examined positive parenting practices, and four demonstrated statistically significant associations between positive parenting practices and lower risk of adolescent depression, anxiety, and/or internalizing symptoms. Fifteen articles examined negative parenting practices, and five demonstrated significant associations between negative parenting practices and higher risk of adolescent depression, anxiety, and/or internalizing symptoms. CONCLUSION: This review demonstrates that the evidence base supporting longitudinal associations between parenting practices in childhood and adolescent symptoms of depression, anxiety, and internalizing problems is inconsistent. Findings from this review highlight limitations of the existing literature and identify understudied parenting dimensions that require further investigation.

Mental Health Service Use in Depressed Military Personnel: A Systematic Review.

INTRODUCTION: Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. METHODS: We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. RESULTS: Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2-12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1-12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). CONCLUSIONS: There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.

The protective effect of neighbourhood social cohesion on adolescent mental health following stressful life events.

BACKGROUND: Exposure to stressful life events is an established risk factor for the development of adolescent mental disorder. Growing evidence also suggests that neighbourhood social environments, including strong social cohesion, could have a protective effect on mental health. However, little is known about how neighbourhood social cohesion may buffer against the effects of stressful life events on adolescent mental health. Our aim was to assess whether neighbourhood social cohesion modifies the association between stressful life events and adolescent mental health outcomes. METHODS: Data were drawn from a nationally-representative prospective sample of Canadian adolescents, including 5183 adolescents aged 12/13 years at T1 and 14/15 years at T2. Caregivers reported neighbourhood social cohesion at T1, and exposure to stressful life events between T1 and T2. Symptoms of mental health and behaviour problems were self-reported by adolescents at T1 and T2. Multivariable logistic regression was used to determine whether the relationship between stressful life events and outcomes was modified by neighbourhood social cohesion. RESULTS: Associations between stressful life events and adolescent outcomes were statistically significantly lower in neighbourhoods with greater social cohesion for: depression/anxiety (high cohesion OR = 0.98 v. low cohesion OR = 3.11), suicidal ideation (ORhigh = 1.30 v. ORlow = 5.25), aggression/conduct disorder (ORhigh = 1.09 v. ORlow = 4.27), and property offence (ORhigh = 1.21 v. ORlow = 4.21). CONCLUSIONS: Greater neighbourhood social cohesion appeared to buffer the effects of stressful life events on several domains of adolescent mental health. This potentially presents a target for public health intervention to improve adolescent mental health and behavioural outcomes.

Social media use and parent-child relationship: A cross-sectional study of adolescents.

We examined the association between social media use and parent-child relationship quality and tested whether this association is independent of total screen time. Data on 9,732 students (48.4% female) aged 11-20 years were obtained from a provincially representative school-based survey. Heavy use of social media (daily use of more than 2 hr) was associated with greater odds of negative relationships between mother-daughter (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.27-2.52), father-daughter (OR = 1.56; 95% CI: 1.16-2.09), father-son (OR = 2.19; 95% CI: 1.58-3.05) but not mother-son (OR = 1.17; 95% CI: 0.88-1.55). Results were similar after further adjusting for total screen time. There were no significant associations between regular use of social media (2 hr or less) and parent-child relationships. These findings suggest that heavy use of social media is associated with negative parent-child relationships. Longitudinal research is necessary to disentangle the pathways between social media use and the parent-child relationship.

Associations between Depression and Health Behaviour Change: Findings from 8 Cycles of the Canadian Community Health Survey.

OBJECTIVES: The primary objective of this study was to examine associations between depression and several measures of health behaviour change across 8 cycles of a population-based, cross-sectional survey of Canadians. The secondary objective of this study was to describe the prevalence of the types of health behaviour changes undergone/sought and types of barriers to change reported, comparing those with and without depression. METHODS: The sample comprised 65,801 respondents to the Canadian Community Health Survey between 2007 and 2014. Past-year depression was assessed via structured interview (CIDI-SF). Measures of health behaviour change included recent changes made, desire to make changes, and barriers towards making changes. Analyses involved logistic regression, with estimates across cycles pooled using fixed-effects meta-analyses. Pooled prevalences of types of health behaviour changes undergone/sought and types of barriers to change experienced were reported, and associations with depression were examined. RESULTS: Depression was associated with higher odds of reporting a recent health behaviour change (pooled odds ratio [OR] = 1.39; 95% confidence interval [CI], 1.30 to 1.48), desire to make health behaviour changes (pooled OR = 1.61; 95% CI, 1.49 to 1.74), and barriers towards change (pooled OR = 1.54; 95% CI, 1.44 to 1.65). The most common change undergone and sought was increased exercise; the most common barrier reported was a lack of willpower. CONCLUSIONS: Individuals dealing with depression are more likely to report recent health behaviour changes and the desire to make changes but are also more likely to report barriers towards change.

Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes.

OBJECTIVE: Experiencing depression in adolescence can disrupt important developmental processes, which can have longstanding effects on socioeconomic status and relationships. The objective of this article was to systematically review the evidence examining associations between adolescent depression and adult psychosocial outcomes. METHOD: Five databases (MEDLINE, Embase, PsycINFO, CINAHL, and ERIC) were searched for articles published from 1980 through March 2017. Eligible articles were peer reviewed, published in English, had prospective cohort study designs, and contrasted adult psychosocial outcomes in those with versus without adolescent depression. Outcomes with sufficient data were pooled using random-effects meta-analyses, with summary measures reported as odds ratios (ORs). A protocol for this review was registered on PROSPERO (CRD42017059662). RESULTS: Of the 4,988 references screened for inclusion, 31 articles comprising 136 analyses were included for review. Twenty-four cohorts were represented. Seventy-seven analyses across 10 outcomes were meta-analyzed, with remaining analyses summarized narratively. Meta-analyses suggested that adolescent depression was associated with outcomes including, but not limited to, failure to complete secondary school (OR 1.76, 95% CI 1.29-2.39), unemployment (OR 1.66, 95% CI 1.29-2.14), and pregnancy/parenthood (OR 1.38, 95% CI 1.06-1.81). CONCLUSION: This review demonstrates that adolescent depression is associated with a myriad of adult psychosocial outcomes. Many are linked and can lead to the propagation of difficulties across the lifespan. These findings can have important implications for encouraging the provision of targeted mental health care early in development to improve life chances.

Adult mental health outcomes of adolescent depression: A systematic review.

BACKGROUND: Adolescent depression may increase risk for poor mental health outcomes in adulthood. The objective of this study was to systematically review the literature on the association between adolescent depression and adult anxiety and depressive disorders as well as suicidality. METHODS: EMBASE, MEDLINE, and PSYCinfo databases were searched and longitudinal cohort studies in which depression was measured in adolescence (age 10-19) and outcomes of depressive disorders, anxiety disorders, or suicidality were measured in adulthood (age 21+), were selected. Meta-analysis using inverse variance and random effects modeling, along with sensitivity analyses, were used to synthesize article estimates. RESULTS: Twenty articles were identified, representing 15 unique cohorts. Seventeen of 18 articles showed adolescent depression increased risk for adult depression; eleven pooled cohorts estimated that adolescents with depression had 2.78 (1.97, 3.93) times increased odds of depression in adulthood. Seven of eight articles that investigated the association between adolescent depression and any adult anxiety found a significant association. Three of five articles showed a significant association between adolescent depression and adult suicidality. CONCLUSION: This review shows that adolescent depression increases the risk for subsequent depression later in life. Articles consistently found that adolescent depression increases the risk for anxiety disorders in adulthood, but evidence was mixed on whether or not a significant association existed between adolescent depression and suicidality in adulthood. Early intervention in adolescent depression may reduce long-term burden of disease.

Relations between neighbourhood socioeconomic status and birth outcomes are mediated by maternal weight.

Lower neighbourhood-level socioeconomic status (SES) has been repeatedly associated with an increased risk of adverse birth outcomes, even after controlling for individual-level SES. Few studies have empirically assessed potential mechanisms underlying the associations. The objectives of this study were to (1) examine relations between neighbourhood SES and birth outcomes, and (2) explore if maternal weight variables mediated these relations. Data came from a provincial prospective pregnancy cohort study in Canada. Census data was used to create a continuous measure of neighbourhood SES. Using information from maternal questionnaires and medical records, two mediators (pre-pregnancy body mass index (BMI), and gestational weight gain (GWG)) and five birth outcomes (preterm birth, low birth weight, macrosomia, small for gestational age (SGA), large for gestational age (LGA)) were examined. After adjusting for individual-level covariates, mediation analyses supported significant associations between lower neighbourhood SES and increased risk of macrosomia (b = 0.1183, 95% BCa CI: 0.0607-0.1896) and LGA (b = 0.0565, 95% BCa CI: 0.0040-0.1186) through higher pre-pregnancy BMI. Significant associations were also observed between neighbourhood SES and macrosomia, LGA, and preterm birth (b = 0.0105, 95% BCa CI: 0.0014-0.0246) through pre-pregnancy BMI and GWG in tandem; pairwise comparisons suggested that associations with macrosomia and LGA through pre-pregnancy BMI alone were significant over associations through pre-pregnancy BMI and GWG together. These findings add to a growing body of literature assessing potential mechanisms underlying relations between neighbourhood SES and adverse birth outcomes, and suggest that neighbourhood-level SES may influence birth outcomes through maternal weight.

Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy.

Insomnia and disturbed sleep are common during pregnancy. This study investigated the effectiveness of group cognitive-behavioral therapy for insomnia (CBT-I) delivered in pregnancy. Thirteen pregnant women with insomnia participated in five weekly CBT-I group sessions. All participants completed the study and provided baseline and follow-up data. Significant reductions in insomnia symptoms and increases in subjective sleep quality were observed over the course of the study. Diary and actigraphy assessments of sleep also changed, such that participants reported less time in bed (TIB), shorter sleep onset latency (SOL), increased sleep efficiency (SE), and increased subjective total sleep time (TST). Additionally, symptoms of depression, pregnancy-specific anxiety, and fatigue all decreased over the course of treatment. Effect sizes ranged from medium to large. CBT-I delivered during pregnancy was associated with significant improvements in sleep and mood. The next step in this area of inquiry is to better establish effectiveness via a randomized controlled trial.