Long-term Outcomes of Childhood Family Income Supplements on Adult Functioning.

Importance: During an ongoing longitudinal cohort study, a casino opening created a natural cash transfer experiment. Some participating families received income supplements, and others did not. The children in this study are now adults. Objective: To assess the long-term outcomes of family income supplements received in childhood. Design, Setting, and Participants: This community-representative longitudinal cohort study set in western North Carolina assessed 1266 participants aged 9, 11, and 13 years at intake up to 11 times up to age 30 years from January 1993 to December 2015. Data were analyzed from January to December 2021. Exposures: In 1996, a southeastern American Indian tribe implemented a cash transfer program of approximately $5000 annually per person for tribal members. Participants were compared on whether their family ever received the cash transfers (American Indian vs non-American Indian), the duration of the transfers, and annual amount based on the number of parents. Main Outcomes and Measures: Participants were followed up at ages 25 and 30 years to assess mental health symptoms, substance use symptoms, and functional outcomes (physical health, risky or illegal behaviors, and financial and social functioning). Results: Of 1266 included participants, 320 (25.3%) were American Indian and 581 (49.7%) were female. Participants whose families received cash transfers during childhood reported fewer anxiety symptoms (relative risk [RR], 0.33; 95% CI, 0.25-0.44), depressive symptoms (RR, 0.51; 95% CI, 0.42-0.62), and cannabis symptoms (RR, 0.47; 95% CI, 0.27-0.82). They also reported improved physical health (RR, 0.66; 95% CI, 0.55-0.80) and financial functioning (RR, 0.78; 95% CI, 0.67-0.89) and fewer risky or illegal behaviors (RR, 0.57; 95% CI, 0.46-0.72) compared with those who did not receive the cash transfer. This pattern was supported by a series of heterogeneity analyses in which children whose families received the transfers for the longest duration and whose families received the largest transfer (due to having multiple American Indian parents) had the lowest levels of symptoms and the highest levels of functioning. Conclusions and Relevance: In this natural experiment, a family cash transfer in childhood was associated with positive adult functioning 20 years later. The findings support programs like the child tax credit or universal basic income that provide cash directly to families with children.

Associations of Despair With Suicidality and Substance Misuse Among Young Adults.

Importance: Deaths of despair is a term that has recently been used to describe the increases in premature mortality from suicides, drug overdoses (particularly from opiates), and alcohol-related liver disease among US adults. Despite the use of the term despair, its role in these causes of premature death has not been empirically tested. Objective: To test whether despair among young adults is associated with suicidal thoughts and behavior, alcohol misuse, and drug misuse. Design, Setting, and Participants: The Great Smoky Mountains Study is a Southeastern, mixed urban-rural population-based cohort study conducted from November 10, 1992, to September 22, 2015. A total of 1420 participants originally 9, 11, and 13 years of age were followed up 11 times to 30 years of age (11 230 person-observations). A total of 1154 of 1400 living participants (82.4%) were assessed at 30 years of age. Statistical analysis was performed from May 7, 2019, to April 10, 2020. Exposures: Participants were assessed with structured interviews for indicators of despair (eg, hopelessness, helplessness, low self-worth, and feeling unloved). Despair was assessed with items from structured interviews: the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. Main Outcomes and Measures: Structured interviews were used to assess suicidal thoughts and behavior, substance use, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) alcohol use disorder and drug use disorder (including opioids) in young adulthood (2424 observations of 1266 individuals between 25 and 30 years of age). Results: This study included 1420 individuals (790 male individuals). During young adulthood (25 and 30 years of age), the 3-month weighted prevalence of any despair was 19.5% (476 of 2424 observations) with 7.6% of participants (201 of 2424 observations) reporting 2 or more despair items. In longitudinal, lagged models, despair scores (range, 0-3) were associated with more suicidal thoughts and behaviors (odds ratio [OR], 1.5; 95% CI, 1.1-2.0), illicit drug use (OR, 1.7; 95% CI, 1.2-2.5), and opioid use (OR, 1.9; 95% CI, 1.1-3.3) but not alcohol use disorder (OR, 0.8; 95% CI, 0.6-1.2). These associations persisted after accounting for sociodemographic factors (eg, poverty and educational level), lagged outcome status, and lagged depression status. The associations between despair and study outcomes were stronger in models accounting for long-term measures of despair extending back to childhood. There was no consistent pattern of moderation by sociodemographic factors. Conclusions and Relevance: This study's findings suggest an empirical basis for longitudinal associations between despair and several, but not all, precursors of "deaths of despair" in rural Appalachia. Individual despair should be studied as a potential factor associated with morbidity and impairment in young adulthood.

Income dividends and subjective survival in a Cherokee Indian cohort: a quasi-experiment.

Persons with high temporal discounting tend to value immediate gratification over future gains. Low self-reported lifespan (SRL)-an individual's assessment of a relatively short future lifespan-concentrates in low-income populations and may reflect high temporal discounting. We use casino-based cash dividends among the Eastern Band of Cherokee Indians (EBCI) as a quasi-experiment to test whether large income gains among EBCI members translate into increased SRL. We used SRL data for EBCI and White youth, aged 19 to 28, participating in two waves of the Life Time Trajectory of Youth (LTI-Y) survey from 2000 to 2010. We controlled for unobserved confounding across individuals, time, and region through a longitudinal design using a difference-in-difference analytic approach (N = 294). We conducted all analyses separately by gender and by quartile of socioeconomic status. Cash dividends correspond with a 15.23 year increase in SRL among EBCI men below the lowest socio-economic quartile at baseline relative to Whites (standard error = 5.39, p < .01). Results using other socio-economic cut-points support improved SRL among EBCI men (but not women). The large magnitude of this result among EBCI men indicates that a non-trivial cash dividend to a low-income population may confer long-term benefits on perceptions of future lifespan and, in turn, reduce temporal discounting.Abbreviations: EBCI: Eastern Band of Cherokee Indians; SES: Socioeconomic Status; LTI-Y: Life Trajectory Interview for Youth; GSMS: Great Smoky Mountains Study; SRL: Self-Reported Lifespan; SSS: Subjective Social Status.

Leveraging genome-wide data to investigate differences between opioid use vs. opioid dependence in 41,176 individuals from the Psychiatric Genomics Consortium.

To provide insights into the biology of opioid dependence (OD) and opioid use (i.e., exposure, OE), we completed a genome-wide analysis comparing 4503 OD cases, 4173 opioid-exposed controls, and 32,500 opioid-unexposed controls, including participants of European and African descent (EUR and AFR, respectively). Among the variants identified, rs9291211 was associated with OE (exposed vs. unexposed controls; EUR z = -5.39, p = 7.2 × 10-8). This variant regulates the transcriptomic profiles of SLC30A9 and BEND4 in multiple brain tissues and was previously associated with depression, alcohol consumption, and neuroticism. A phenome-wide scan of rs9291211 in the UK Biobank (N > 360,000) found association of this variant with propensity to use dietary supplements (p = 1.68 × 10-8). With respect to the same OE phenotype in the gene-based analysis, we identified SDCCAG8 (EUR + AFR z = 4.69, p = 10-6), which was previously associated with educational attainment, risk-taking behaviors, and schizophrenia. In addition, rs201123820 showed a genome-wide significant difference between OD cases and unexposed controls (AFR z = 5.55, p = 2.9 × 10-8) and a significant association with musculoskeletal disorders in the UK Biobank (p = 4.88 × 10-7). A polygenic risk score (PRS) based on a GWAS of risk-tolerance (n = 466,571) was positively associated with OD (OD vs. unexposed controls, p = 8.1 × 10-5; OD cases vs. exposed controls, p = 0.054) and OE (exposed vs. unexposed controls, p = 3.6 × 10-5). A PRS based on a GWAS of neuroticism (n = 390,278) was positively associated with OD (OD vs. unexposed controls, p = 3.2 × 10-5; OD vs. exposed controls, p = 0.002) but not with OE (p = 0.67). Our analyses highlight the difference between dependence and exposure and the importance of considering the definition of controls in studies of addiction.

Association of Parental Incarceration With Psychiatric and Functional Outcomes of Young Adults.

Importance: In 2016, an estimated 8% of US children younger than 18 years had experienced the incarceration of a parent, and rates were substantially higher among children from racial and ethnic minority backgrounds and disadvantaged groups. Little is known about whether parental incarceration during childhood is associated with adult psychiatric problems and functional outcomes. Objective: To examine whether parental incarceration is associated with increased levels of psychiatric diagnosis and poor outcomes in health, legal, financial, and social domains in adulthood. Design, Setting, and Participants: This cohort study used data from the community-representative, prospective, longitudinal Great Smoky Mountains Study. Children and their parents were interviewed up to 8 times from January 1993 to December 2000 (ages 9-16 years; 6674 observations of 1420 participants) using the Child and Adolescent Psychiatric Assessment, which assessed parental incarceration, childhood psychiatric diagnoses, and other adversities. Young adults were followed up at ages 19, 21, 25, and 30 years from January 1999 to December 2015 (4556 observations of 1334 participants) to assess psychiatric diagnoses and functional outcomes indicative of a disrupted transition to adulthood. Data analysis was conducted from June 2018 to June 2019. Results: By age 16 years, 475 participants (weighted percentage, 23.9%) had a parental figure who had been incarcerated, including 259 young men (22.2%) and 216 young women (25.5%). Parental incarceration was associated with higher prevalence of childhood psychiatric diagnoses (eg, any depressive diagnosis: adjusted odds ratio [aOR], 2.5; 95% CI, 1.3-4.6; P = .006; attention-deficit/hyperactivity disorder: aOR, 2.3; 95% CI, 1.0-5.5; P = .06; and conduct disorder: aOR, 2.5; 95% CI, 1.4-4.3; P = .001). After accounting for childhood psychiatric diagnoses and adversity exposure, parental incarceration remained associated with increased odds of having an adult anxiety disorder (aOR, 1.7; 95% CI, 1.0-3.0; P = .04), having an illicit drug use disorder (aOR, 6.6; 95% CI, 2.6-17.0; P < .001), having a felony charge (aOR, 3.4; 95% CI, 1.8-6.5; P < .001), incarceration (aOR, 2.8; 95% CI, 1.4-5.4; P = .003), not completing high school (aOR, 4.4; 95% CI, 2.2-8.8; P < .001), early parenthood (aOR, 1.7; 95% CI, 1.0-3.0; P = .04), and being socially isolated (aOR, 2.2; 95% CI, 1.2-4.0; P = .009). Conclusions and Relevance: This study suggests that parental incarceration is associated with a broad range of psychiatric, legal, financial, and social outcomes during young adulthood. Parental incarceration is a common experience that may perpetuate disadvantage from generation to generation.

Does Despair Really Kill? A Roadmap for an Evidence-Based Answer.

Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair-before, during, and after the Great Recession-offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data.

Early Pubertal Timing and Testosterone Associated With Higher Levels of Adolescent Depression in Girls.

OBJECTIVE: The prevalence of depression increases dramatically during puberty in girls. Earlier work in this sample reported that the sex steroids estradiol and testosterone were associated with increased depression in girls. Using three additional data waves (983 new observations), we retest the relative contributions of pubertal timing, pubertal status, and sex hormones on the increases in female depression. METHOD: Eight waves of data from the prospective, representative Great Smoky Mountains Study were used covering female participants in the community who were 9 to 16 years of age (3,005 assessments of 630 girls; 1993-2000). Structured interviews assessed depressive disorders. Youth rated their pubertal status using Tanner stage drawings, and sex steroids were assayed from dried blood spots. RESULTS: Risk for depression during puberty was associated with both age and Tanner stage in univariate models. In adjusted models accounting for pubertal timing and sex steroids, the apparent effects of age and Tanner stage were attenuated both in terms of statistical significance and effect size. The only significant predictors of change in depression status during puberty were early pubertal timing (odds ratio = 5.8, 95% CI = 1.9-17.9, p = .002 after age 12 years) and higher testosterone levels (odds ratio = 2.0, 95% CI = 1.1-3.8, p = .03 for quartile-split variable). CONCLUSION: The added observations have modified the original conclusions, implicating the following: testosterone only, but not estradiol; and early pubertal timing, but not age or pubertal status per se. These findings argue for multiple pubertal determinants of depression risk, including factors that are socially and biologically mediated.

How Does Household Income Affect Child Personality Traits and Behaviors?

We examine the effects of a quasi-experimental unconditional household income transfer on child emotional and behavioral health and personality traits. Using longitudinal data, we find that there are large beneficial effects on children's emotional and behavioral health and personality traits during adolescence. We find evidence that these effects are most pronounced for children who start out with the lowest initial endowments. The income intervention also results in improvements in parental relationships which we interpret as a potential mechanism behind our findings.

Association of Childhood Trauma Exposure With Adult Psychiatric Disorders and Functional Outcomes.

Importance: Being exposed to trauma is a common childhood experience associated with symptoms and impairments in childhood. Objective: To assess the association between cumulative childhood trauma exposure and adult psychiatric and functional outcomes. Design, Setting, and Participants: Prospective, population-based cohort study of 1420 participants. A community representative sample of participants was assessed with structured Child and Adolescent Psychiatric Assessment interviews up to 8 times in childhood (ages 9-16 years; 6674 observations; 1993-2000) for lifetime trauma exposure as defined by the Diagnostic and Statistical Manual of Mental Disorders. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4556 observations of 1336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood. Analysis was completed in 2018. Exposure: Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview (parent and self-report) up to 8 times in childhood for lifetime trauma exposure (ages 9-16 years; 6674 observations; 1993-2000). Main Outcomes and Measures: Participants were assessed up to 4 times with the structured Young Adult Psychiatric Assessment interview (self-report) in adulthood (ages 19, 21, 25, and 30 years; 4556 observations of 1336 participants; 1999-2015) for psychiatric outcomes, functional outcomes, and evidence of a disrupted transition to adulthood. Results: Among the 1420 study participants, 630 (49.0%) were female and 983 (89.4%) were white. By age 16 years, 30.9% of children (n = 451) were exposed to 1 traumatic event, 22.5% (n = 289) were exposed to 2 such events, and 14.8% (n = 267) were exposed to 3 or more. Cumulative childhood trauma exposure to age 16 years was associated with higher rates of adult psychiatric disorders (odds ratio for any disorder, 1.2; 95% CI, 1.0-1.4) and poorer functional outcomes, including key outcomes that indicate a significantly disrupted transition to adulthood (eg, failure to hold a job and social isolation). Childhood trauma exposure continued to be associated with higher rates of adult psychiatric and functional outcomes after adjusting for a broad range of childhood risk factors, including psychiatric functioning and family adversities and hardships (adjusted odds ratio for any disorder, 1.3; 95% CI, 1.0-1.5). Conclusions and Relevance: Cumulative childhood trauma exposure was associated with poor adult outcomes even after accounting for many of the childhood and family factors associated with both trauma exposure and poor adult outcomes. Childhood trauma exposures are common, but often preventable, thus providing a clear target for child-focused public health efforts to ameliorate long-term morbidity.

Adult Associations of Childhood Suicidal Thoughts and Behaviors: A Prospective, Longitudinal Analysis.

OBJECTIVE: Suicidal thoughts and behavior (STBs) have their peak period of onset in adolescence, but little is known about how such behavior is associated with later functioning. The aim of this study is to test whether childhood STBs are related to adult psychiatric, suicidal, and functional outcomes. METHOD: This is a prospective, population-based community study of 1,420 participants assessed with structured interviews up to 7 times in childhood/adolescence (ages 9-16 years; 6,674 observations) for STBs including passive and active ideation, plans, and attempts. Participants were then assessed 4 times in young adulthood (ages 19, 21, 24, and 30 years; 4,556 observations of 1,273 participants) for psychiatric diagnoses, STBs, and functional outcomes. RESULTS: By age 16 years, 7.0% of participants had reported some type of STBs, with 3.9% reporting an attempt. Both ideation only and suicide attempts were associated with higher levels of anxiety disorders and STBs in adulthood, as well as poor functioning across financial, health, risky/illegal, and social domains. These observed effects generally were attenuated after adjusting for other psychiatric and psychosocial factors that predict childhood STBs (particularly maltreatment, depression, and disruptive behavior disorders). The exception was adult suicidal behavior, which was predicted by both childhood ideation and attempts, even in the fully adjusted model. Children and adolescents with STBs were more likely to have had a disrupted transition to adulthood. CONCLUSION: Childhood STBs are a marker for a multitude of poor psychiatric and functional outcomes in adulthood, but these effects are largely accounted for by other factors. In contrast, childhood STBs are a robust risk factor for adult suicidal thoughts and behavior.

Predicting Persistent, Limited, and Delayed Problematic Cannabis Use in Early Adulthood: Findings From a Longitudinal Study.

OBJECTIVE: To identify risk profiles associated with patterns of problematic cannabis use in early adulthood. METHOD: Data came from 1,229 participants in the Great Smoky Mountains Study, a prospective 20-year cohort study from 1993 to 2015 that is representative of western North Carolina with yearly assessments conducted from ages 9 and 16 years, and assessments at ages 19, 21, 26, and 30 years. Patterns of problematic cannabis use (i.e., DSM-5 cannabis use disorder or daily use) in early adulthood included the following: nonproblematic use in late adolescence (ages 19-21) and early adulthood (ages 26-30); limited problematic use in late adolescence only; persistent problematic use in late adolescence and early adulthood; and delayed problematic use in early adulthood only. Multinominal logistic regression models examined pairwise associations between these patterns and risk factors in childhood/early adolescence (ages 9-16) and late adolescence (ages 19-21). Risk factors included psychiatric disorders (e.g., anxiety, depressive), other substance use (smoking, alcohol, illicit drugs), and challenging social factors (e.g., low socioeconomic status, family functioning, peers). Sex and race/ethnicity (white, African American, American Indian) interactions were tested. RESULTS: The persistent pattern (6.7% of sample) was characterized by more anxiety disorders across development and more DSM-5 CUD symptoms during late adolescence compared to the limited pattern (13.3%), which, in turn, had more childhood family instability and dysfunction. The delayed pattern (3.7%) was characterized by more externalizing disorders, maltreatment, and peer bullying in childhood compared to those in nonproblematic users. There were no significant interactions of sex or race/ethnicity. CONCLUSION: Problematic cannabis use patterns during early adulthood have distinctive risk profiles, which may be useful in tailoring targeted interventions.

Cannabis Use and Disorder From Childhood to Adulthood in a Longitudinal Community Sample With American Indians.

OBJECTIVE: Recent changes in DSM criteria require new documentation of the prevalence and developmental sequences of cannabis use disorder (CUD). The goal of this study was to investigate the early course of DSM-5 CUD and its overlap with DSM-IV and consumption constructs in a community-representative sample of American Indians. METHOD: Data came from the prospective, longitudinal, population-based Great Smoky Mountains Study in North Carolina (N = 1,420, including 349 American Indians). Cannabis use and disorder were assessed during yearly interviews from 9 to 16 years of age and at 19, 21, 26, and 30 years of age (up to 11 assessments per participant from 1993 through 2015). RESULTS: By 30 years of age, approximately 70% of participants had used cannabis, 34% had used cannabis daily, and 18% had met criteria for DSM-5 CUD. Approximately 1 in 4 cannabis users met criteria for CUD at some point. Those who met criteria initiated use more than 2 years previously (at 13.3 years old) compared with other users. Despite higher risks from increased poverty, American Indians' patterns of use were similar to those of the rest of the sample. Concordance between DSM-5 CUD and DSM-IV abuse or dependence was substantial but was even higher between DSM-5 CUD and daily use. CONCLUSION: It was common to have used cannabis daily or to have met criteria for DSM-5 CUD by adulthood. DSM-5 CUD was an improvement over DSM-IV diagnostic constructs by raising the threshold for diagnosis.

Early Detection and Prevention of Mental Health Problems: Developmental Epidemiology and Systems of Support.

This article reviews the role of developmental epidemiology in the prevention of child and adolescent mental disorders and the implications for systems of support. The article distinguishes between universal or primary prevention, which operates at the level of the whole community to limit risk exposure before the onset of symptoms, and secondary or targeted prevention, which operates by identifying those at high risk of developing a disorder. It discusses different aspects of time as it relates to risk for onset of disease, such as age at first exposure, duration of exposure, age at onset of first symptoms, and time until treatment. The study compares universal and targeted prevention, describing the systems needed to support each, and their unintended consequences.

The Great Smoky Mountains Study: developmental epidemiology in the southeastern United States.

AIMS: To describe the Great Smoky Mountains Study (GSMS). METHODS: GSMS is a longitudinal study of child psychiatric disorders that began in 1992 to look at need for mental health services in a rural area of the USA. Over 20 years it has expanded its range to include developmental epidemiology more generally, not only the development of psychiatric and substance abuse problems but also their correlates and predictors: family and environmental risk, physical development including puberty, stress and stress-related hormones, trauma, the impact of poverty, genetic markers, and epigenetics. Now that participants are in their 30s the focus has shifted to adult outcomes of childhood psychopathology and risk, and early physical, cognitive, and psychological markers of aging. RESULTS: This paper describes the results from over 11,000 interviews, examples of the study's contributions to science and policy, and plans for the future. CONCLUSIONS: Longitudinal studies can provide insights that aid in policy planning.

Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries.

BACKGROUND: The adult mental health consequences of childhood maltreatment are well documented. Maltreatment by peers (ie, bullying) has also been shown to have long-term adverse effects. We aimed to determine whether these effects are just due to being exposed to both maltreatment and bullying or whether bullying has a unique effect. METHODS: We used data from the Avon Longitudinal Study of Parents and Children in the UK (ALSPAC) and the Great Smoky Mountains Study in the USA (GSMS) longitudinal studies. In ALSPAC, maltreatment was assessed as physical, emotional, or sexual abuse, or severe maladaptive parenting (or both) between ages 8 weeks and 8·6 years, as reported by the mother in questionnaires, and being bullied was assessed with child reports at 8, 10, and 13 years using the previously validated Bullying and Friendship Interview Schedule. In GSMS, both maltreatment and bullying were repeatedly assessed with annual parent and child interviews between ages 9 and 16 years. To identify the association between maltreatment, being bullied, and mental health problems, binary logistic regression analyses were run. The primary outcome variable was overall mental health problem (any anxiety, depression, or self-harm or suicidality). FINDINGS: 4026 children from the ALSPAC cohort and 1420 children from the GSMS cohort provided information about bullying victimisation, maltreatment, and overall mental health problems. The ALSPAC study started in 1991 and the GSMS cohort enrolled participants from 1993. Compared with children who were not maltreated or bullied, children who were only maltreated were at increased risk for depression in young adulthood in models adjusted for sex and family hardships according to the GSMS cohort (odds ratio [OR] 4·1, 95% CI 1·5-11·7). According to the ALSPAC cohort, those who were only being maltreated were not at increased risk for any mental health problem compared with children who were not maltreated or bullied. By contrast, those who were both maltreated and bullied were at increased risk for overall mental health problems, anxiety, and depression according to both cohorts and self-harm according to the ALSPAC cohort compared with neutral children. Children who were bullied by peers only were more likely than children who were maltreated only to have mental health problems in both cohorts (ALSPAC OR 1·6, 95% CI 1·1-2·2; p=0·005; GSMS 3·8, 1·8-7·9, p<0·0001), with differences in anxiety (GSMS OR 4·9; 95% CI 2·0-12·0), depression (ALSPAC 1·7, 1·1-2·7), and self-harm (ALSPAC 1·7, 1·1-2·6) between the two cohorts. INTERPRETATION: Being bullied by peers in childhood had generally worse long-term adverse effects on young adults' mental health. These effects were not explained by poly-victimisation. The findings have important implications for public health planning and service development for dealing with peer bullying. FUNDING: Wellcome Trust, Medical Research Council, Economic and Social Research Council, National Institute of Mental Health, the National Institute on Drug Abuse, NARSAD (Early Career Award), and the William T Grant Foundation.

Adult Functional Outcomes of Common Childhood Psychiatric Problems: A Prospective, Longitudinal Study.

IMPORTANCE: Psychiatric problems are among the most common health problems of childhood. OBJECTIVE: To test whether these health problems adversely affect adult functioning even if the problems themselves do not persist. DESIGN, SETTING, AND PARTICIPANTS: Prospective, population-based study of 1420 participants from 11 predominantly rural counties of North Carolina who were assessed with structured interviews up to 6 times during childhood (9-16 years of age, for a total 6674 observations) for common psychiatric diagnoses and subthreshold psychiatric problems. The period for this study was from 1993 to 2010. MAIN OUTCOMES AND MEASURES: A total of 1273 participants were assessed 3 times during young adulthood (19, 21, and 24-26 years of age, for a total of 3215 observations) for adverse outcomes related to health, the legal system, personal finances, and social functioning. RESULTS: Participants with a childhood disorder had 6 times higher odds (odds ratio [OR], 5.9 [95% CI, 3.6-9.7]) of at least 1 adverse adult outcome (ie, indicator) compared with those with no history of psychiatric problems and 9 times higher odds (OR, 8.7 [95% CI, 4.3-17.8]) of 2 or more such indicators (1 indicator: 59.5% vs 19.9% [P < .001]; ≥ 2 indicators: 34.2% vs 5.6% [P < .001]). These associations persisted after statistically controlling for childhood psychosocial hardships and adult psychiatric problems. Risk was not limited to those who received a diagnosis; participants with subthreshold psychiatric problems had 3 times higher odds (OR, 2.9 [95% CI, 1.8-4.8]) of adult adverse outcomes and 5 times higher odds (OR, 5.1 [95% CI, 2.4-10.7]) of 2 or more outcomes (1 indicator: 41.9% vs 19.9% [P < .001]; ≥ 2 indicators: 23.2% vs 5.6% [P < .001]). The best diagnostic predictor of adverse outcomes was cumulative childhood exposure to psychiatric disorders. CONCLUSIONS AND RELEVANCE: Common, typically moderately impairing, childhood psychiatric problems are associated with a disrupted transition to adulthood even if the problems do not persist into adulthood and even if the problems are subthreshold. Such problems provide a potential target for public health efforts to ameliorate adult suffering and morbidity.

Normative Irritability in Youth: Developmental Findings From the Great Smoky Mountains Study.

OBJECTIVE: The goal of this study is to examine the developmental epidemiology of normative irritability and its tonic and phasic components in a longitudinal community sample of youth. METHOD: Eight waves of data from the prospective, community Great Smoky Mountains Study (6,674 assessments of 1,420 participants) were used, covering children in the community 9 to 16 years of age. Youth and 1 parent were interviewed using the Child and Adolescent Psychiatric Assessment to assess tonic (touchy/easily annoyed, irritable mood, angry or resentful) and phasic (temper tantrums or anger outbursts) components of irritability, including frequency, duration, onset, and cross-context variability. RESULTS: At any given point in childhood/adolescence, 51.4% (standard error [SE] = 1.4) of participants reported phasic irritability, 28.3% (SE = 1.2) reported tonic irritability, and 22.8% (SE = 1.1) reported both. These prevalence levels decreased with age but did not vary by sex. The overlap between tonic and phasic irritability was high (odds ratio = 5.8, 95% CI = 3.3-10.5, p < .0001), with little evidence of tonic occurring without phasic irritability. Both tonic and phasic irritability predicted one another over time, supporting both heterotypic and homotypic continuity. Low levels of either tonic or phasic irritability increased risk for disrupted functioning including service use, school suspensions, parental burden, and emotional symptoms both concurrently and at 1-year follow-up. CONCLUSION: Irritability is relatively common, decreases with age but does not vary by sex, and at almost any level is associated with increased risk of disrupted functioning. Its relative components frequently overlap, although irritable outbursts are more common than irritable mood. Irritability appears to be a high-priority transdiagnostic marker for screening children in need of clinical attention.

Increase in untreated cases of psychiatric disorders during the transition to adulthood.

OBJECTIVE: During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood. METHODS: In a prospective, population-based study, participants were assessed up to four times in adolescence (ages 13-16; 3,983 observations of 1,297 participants, 1993-2000) and three times in young adulthood (ages 19, 21, and 24-26; 3,215 observations of 1,273 participants, 1999-2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months. RESULTS: During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease included a near-complete drop in use of educational and vocational services as well as declines in use of specialty behavioral services. Young adults most frequently accessed services in specialty behavioral or general medical settings. Males, African Americans, participants with substance dependence, and participants living independently were least likely to get treatment. For cases of psychiatric disorders among young adults, insurance and poverty status were unrelated to likelihood of service use. CONCLUSIONS: Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents. Public policy must address gaps in service use during the transition to adulthood.