Should we abandon annual physical examination? - A meta-analysis of annual physical examination and all-cause mortality in adults based on observational studies.

Several meta-analyses based on randomized clinical trials data have failed to find an association between the annual physical examination (APE) and reduced mortality; however, no comparable meta-analysis based on observational data exists. We conducted a meta-analysis of observational studies comparing APE versus non-APE in adults for all-cause mortality. English-language searches of four databases (PubMed, CINAHL, EMBASE, and Google Scholar) between the years 2000 to 2019 yielded seven observational studies that investigated APE versus non-APE in healthy adults in relation to all-cause mortality. Random effects models were used to calculate pooled hazard ratios and 95% confidence intervals (CI), and to incorporate variation between studies. During follow-up periods that ranged from two to 25 years, there were 35,055 deaths among 633,957 participants. APE was significantly associated with a 45% lower hazard of all-cause mortality, with pooled hazard ratio of 0.55 (95% CI 0.48 to 0.64, P < 0.01) for all participants. This meta-analysis of seven observational studies in the past 20 years provides evidence of an association between APE and a lower hazard of all-cause mortality, a finding that contrasts with findings based on meta-analyses of randomized clinical trials data. Nonetheless, at present the evidence available about the effectiveness or ineffectiveness of APE on all-cause mortality still needs further study.

Adherence to childhood religious affiliation and suicide intentions in women exposed to the violence of the 1994 Genocide against the Tutsi in Rwanda.

PURPOSE: To examine the association between adherence to childhood religious affiliations and serious suicide intentions in 371 women exposed to the 1994 Genocide against the Tutsi in Rwanda. METHODS: Participants were randomly sampled in 2011 from households in the Southern Province of Rwanda. Trained interviewers gathered information on socio-economic background, genocide-related trauma exposure, Major Depressive Episode (MDE) and suicide intentions (assessed with the Mini International Neuropsychiatric Interview), and Posttraumatic Stress Disorder (PTSD) (assessed with the PTSD Checklist-Civilian version). RESULTS: In this predominantly Christian sample, 62.8% (233/371) had adhered to their childhood religious affiliation. Adherence was associated with lower odds of serious suicide intentions (OR 0.321, 95% CI 0.13-0.78, P < 0.01) independent of socio-economic factors, court-designated victim status, trauma exposure, MDE, and PTSD; that association held following consideration of specific denomination. CONCLUSION: Women who adhere to their childhood religious affiliation may be less likely to have serious suicide intentions following major catastrophes. Whether that association is attributable to stronger connections with lost and remaining family and friends, or greater faith in the church as a facilitator of reconciliation and coping, requires further study.

Social context and change in suicide ideation in a community sample of youths.

PURPOSE: Adolescent suicide ideation (SI) often portends more grievous suicidal behavior; yet, long-term studies of what risk factors predict SI are limited. We employ a multi-wave longitudinal design to investigate the impact of earlier social contexts on change in SI. METHOD: A community sample of 748 youths drawn from the Children in the Community (CIC) study was first assessed with the CIC Youth SI Scale at mean age 13.7 (range 9-18) (baseline) and in two follow-ups over 10 years. GEE Poisson Regression was used to estimate SI between ages 10 and 25 (intercept set at age midpoint of 17), and to examine associations between baseline measures of parent, peer, and school social contexts and subsequent change in SI. Analyses were controlled for demographic characteristics and known risks for SI: sexual or physical abuse before age 18 (obtained by official reports) and major depressive disorder (MDD, diagnosed by psychiatric interview at baseline and follow-ups). RESULTS: SI declined significantly by age 17 with greater mother affection (ß = - 0.091, SE = 0.037), peer friendship quality (ß = - 0.115, SE = 0.034), peer social support (ß = - 0.116, SE = 0.042), and school engagement (ß = - 0.083, SE = 0.045, trend), but increased significantly with more parent punishment (ß = 0.143, SE = 0.045) and school conflict (ß = 0.168, SE = 0.042). SI associations with sexual or physical abuse (ß = 0.299, SE = 0.137) and MDD (ß = 0.777, SE = 0.130) were independent of other effects. CONCLUSIONS: Earlier social contexts influence change in SI independent of each other and of known risks for SI in community youths, and may be a resource for intervention efforts to deter future SI.

Impact of Adolescent Personality Disorders on Obesity 17 Years Later.

OBJECTIVES: To investigate associations between adolescent personality disorder (PD) and obesity 17 years later. METHODS: The Children in the Community is a longitudinal study based on a randomly sampled cohort of families, in effect since 1975. PDs were assessed in youths by self-report and mother report in 1985 to 1986, when participants were at an average age of 16 years. Obesity was assessed in 2001 to 2004 when participants were an average age of 33 years (n = 621). RESULTS: Prevalence of obesity was 16.59% (103/621) at an average age of 33 years. Prevalence of any adolescent PD was 17.55% (109/621) at an average age of 16 years. Adolescents who had any PD were 1.84 (95% confidence interval [CI] = 1.05-3.22) times as likely to be obese 17 years later after adjusting for demographic variables and known risk factors. Paranoid, histrionic, and obsessive-compulsive PDs in adolescence were significantly associated with obesity in adulthood, with odds ratios of 3.45 (95% CI = 1.46-8.17), 4.49 (95% CI = 1.91-10.53), and 6.80 (95% CI = 2.50-18.55), respectively. CONCLUSIONS: This is the first study to report a significant independent long-term association based on prospective data between adolescent PDs and adult obesity in a community-based sample. Findings will contribute to the design of preventive measures against the development of obesity.

The efficacy of religious service attendance in reducing depressive symptoms.

PURPOSE: To examine whether religiosity may help people ward off depression, we investigated the association between religious service attendance and depressive symptom scores in a community-based 30-year follow-up longitudinal study. METHODS: This study used data on 754 subjects followed over 30 years and evaluated at four time points. Linear mixed effects models were used to assess the association between religious service attendance and depressive symptoms development; frequency of attendance and age also were used as predictors. Demographic factors, life-time trauma, family socioeconomic status, and recent negative events were considered as control variables. RESULTS: Depressive symptom scores were reduced by an average of 0.518 units (95 % CI from -0.855 to -0.180, p < 0.005) each year in subjects who attended religious services as compared with subjects who did not. The more frequent the religious service attendance, the stronger the influence on depressive symptoms when compared with non-attendance. Yearly, monthly, and weekly religious service attendance reduced depression scores by 0.474 (95 % CI from -0.841 to -0.106, p < 0.01), 0.495 (95 % CI from -0.933 to -0.057, p < 0.05) and 0.634 (95 % CI from -1.056 to -0.212, p < 0.005) units on average, respectively, when compared with non-attendance after controlling for other covariates. CONCLUSION: Religious service attendance may reduce depressive symptoms significantly, with more frequent attendance having an increasingly greater impact on symptom reduction in this 30-year community-based longitudinal study.

Religiosity and longitudinal change in psychosocial functioning in adult offspring of depressed parents at high risk for major depression.

BACKGROUND: Recent findings suggest that beliefs about religious or spiritual importance or attending religious/spiritual services may protect high-risk offspring against depression. This research has not extended to examining religiosity in relation to psychosocial functioning in high-risk offspring. METHODS: Offspring selected for having a depressed parent and offspring of nondepressed parents were evaluated for lifetime major depressive disorder (MDD) in childhood and adolescence, and at 10-year (T10) and 20-year (T20) follow-ups. Relations between self-reported religiosity at T10 and longitudinal change in psychosocial function from T10 to T20 (assessed by clinical ratings on Global Assessment Scale [GAS]) were examined separately in 109 daughters and 76 sons by risk status. RESULTS: Lifetime MDD was diagnosed in 57.8% of daughters and 40.8% of sons by T20. Among daughters, only those with lifetime MDD showed improved psychosocial functioning in relation to higher level of service attendance at T10, their mean GAS score improving by 3.5 points (P = .018) over the next decade. For daughters with and without lifetime MDD, relations between higher levels of religiosity and improved psychosocial function were of greater magnitude in those with a depressed parent. Among sons, only those with lifetime MDD showed improved psychosocial function in relation to higher level of religious/spiritual importance, their mean GAS score improving by 4.6 points (P < .0001) over the next decade; that relation was of greater magnitude in sons with both lifetime MDD and a depressed parent. CONCLUSIONS: Greater improvement in psychosocial functioning in relation to religious involvement in more vulnerable offspring supports religiosity as a resilience factor.

Impact of early adolescent anxiety disorders on self-esteem development from adolescence to young adulthood.

PURPOSE: To examine the association between early adolescent anxiety disorders and self-esteem development from early adolescence through young adulthood. METHODS: Self-esteem was measured at mean ages 13, 16, and 22 for 821 participants from the Children in the Community Study, a population-based longitudinal cohort. Anxiety disorders were measured at mean age 13 years. Multilevel growth models were employed to analyze the change in self-esteem from early adolescence to young adulthood and to evaluate whether adolescent anxiety disorders predict both average and slope of self-esteem development. RESULTS: Self-esteem increased during adolescence and continued to increase in young adulthood. Girls had lower average self-esteem than boys, but this difference disappeared when examining the effect of anxiety. Adolescents with anxiety disorder had lower self-esteem, on average, compared with healthy adolescents (effect size [ES] = -.35, p < .01). Social phobia was found to have the greatest relative impact on average self-esteem (ES = -.30, p < .01), followed by overanxious disorder (ES = -.17, p < .05), and simple phobia (ES = -.17, p < .05). Obsessive compulsive-disorder (OCD) predicted a significant decline in self-esteem from adolescence to young adulthood (ß = -.1, p < .05). Separation anxiety disorder was not found to have any significant impact on self-esteem development. CONCLUSIONS: All but one of the assessed adolescent anxiety disorders were related to lower self-esteem, with social phobia having the greatest impact. OCD predicted a decline in self-esteem trajectory with age. The importance of raising self-esteem in adolescents with anxiety and other mental disorders is discussed.

The MAOA gene predicts happiness in women.

Psychologists, quality of life and well-being researchers have grown increasingly interested in understanding the factors that are associated with human happiness. Although twin studies estimate that genetic factors account for 35-50% of the variance in human happiness, knowledge of specific genes is limited. However, recent advances in molecular genetics can now provide a window into neurobiological markers of human happiness. This investigation examines association between happiness and monoamine oxidase A (MAOA) genotype. Data were drawn from a longitudinal study of a population-based cohort, followed for three decades. In women, low expression of MAOA (MAOA-L) was related significantly to greater happiness (0.261 SD increase with one L-allele, 0.522 SD with two L-alleles, P=0.002) after adjusting for the potential effects of age, education, household income, marital status, employment status, mental disorder, physical health, relationship quality, religiosity, abuse history, recent negative life events and self-esteem use in linear regression models. In contrast, no such association was found in men. This new finding may help explain the gender difference on happiness and provide a link between MAOA and human happiness.

Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort.

Hierarchical linear models were used to examine trajectories of impulsivity and capability between ages 10 and 25 in relation to suicide attempt in 770 youths followed longitudinally: intercepts were set at age 17. The impulsivity measure assessed features of urgency (e.g., poor control, quick provocation, and disregard for external constraints); the capability measure assessed aspects of self-esteem and mastery. Compared to nonattempters, attempters reported significantly higher impulsivity levels with less age-related decline, and significantly lower capability levels with less age-related increase. Independent of other risks, suicide attempt was related significantly to higher impulsivity between ages 10 and 25, especially during the younger years, and lower capability. Implications of those findings for further suicidal behavior and preventive/intervention efforts are discussed.

Earlier stress exposure and subsequent major depression in aging women.

OBJECTIVE: Despite evidence that stress exposure earlier in the life course may have long-term consequences for psychopathology, most models of vulnerability for late life depression are limited to current stressors or to retrospective reports of stress history. This study estimates the influences of earlier stressors assessed longitudinally on subsequent major depressive disorder (MDD) in women at average age 60 (range 50-75). METHOD: MDD, negative life events (NLE), and marital stress were assessed multiple times in a community-based sample of 565 women followed for three decades. Adverse events experienced in childhood also were assessed prior to outcome. RESULTS: Greater childhood adversity, earlier high levels of NLE and marital stress, and a more rapid increase in marital stress over time elevated the odds of MDD at average age 60 independent of all stressors and other salient risk factors. Childhood adversity was mediated in part by intervening risks. Prior depression, earlier poor health status, a more rapid deterioration in health with age, and current disability owing to physical problems also were related independently to later MDD. CONCLUSIONS: These findings support the enduring effects of earlier stress burden on MDD in women into old age and, in light of the increasing proportion of older women in the population, have important clinical implications for identification and treatment of those at risk for depression. Findings also underscore the need to develop resources to counteract or buffer similar stress exposure in younger generations of women.

Minor depression during adolescence and mental health outcomes during adulthood.

Data from a community-based prospective longitudinal study were used to investigate the association of minor depressive disorder during adolescence with adverse mental health outcomes during adulthood. Structured diagnostic interviews were administered to a community-based sample of 755 individuals during adolescence and adulthood. Results indicated that minor depressive disorder during adolescence was associated with elevated risk for subsequent psychiatric disorders during adulthood, including major depressive disorder, >or= 1 disruptive disorders and clinically relevant impairment after corresponding and co-occurring disorders were controlled statistically.

School climate and continuity of adolescent personality disorder symptoms.

BACKGROUND: Schools are key social contexts for shaping development and behavior in youths; yet, little is known of their influence on adolescent personality disturbance. METHOD: A community-based sample of 592 adolescents was assessed for family and school experiences, Axis I psychiatric disorders, and Axis II personality disorder (PD) symptoms, and followed into young adulthood. Multiple regression analysis was used to estimate associations between adolescent-reported school climate and young adult PD symptoms independent of age, sex, family socioeconomic status; childhood maltreatment; Axis I disorder, PD symptoms, academic grades, and parental punishment in adolescence; and four dimensions of school climate. RESULTS: Schools characterized as high in learning focus were related to cluster B (antisocial, borderline, histrionic, and narcissistic PD) symptom declines, whereas schools characterized as high in opportunities for student autonomy were related to cluster A (paranoid, schizoid, and schizotypal PD) symptom declines. In contrast, schools characterized as conflictual or supporting interpersonal informality/familiarity among students and teachers were related to increases in cluster A symptoms and cluster C (avoidant, dependent, and obsessive-compulsive PD) symptoms. CONCLUSIONS: Schools may exert both positive and negative influences on continuity of adolescent personality disturbance. The role of the school in guiding young people toward more favorable developmental pathways and alleviating personality disturbance is discussed.

Psychiatric disorders during adolescence and relationships with peers from age 17 to age 27.

OBJECTIVE: To investigate normative patterns of peer relationships from ages 17 to 27, and to examine the impact of adolescent psychiatric disorders on peer relationships. METHOD: Psychiatric disorders were measured at a mean age 16 years. At mean age 29, 200 participants completed detailed narrative interviews about their transition to adulthood. Monthly contact and conflict with peers were described in narratives covering ages 17-27. RESULTS: Adolescent psychiatric disorders did not predict the frequency of peer contact in the young adult period. However, adolescent disruptive disorders predicted greater peer conflict regardless of contact frequency. Adolescents with major depressive or substance abuse disorders and subsequent high frequency of peer contact reported elevated peer conflict during the transition to adulthood. In contrast, among study participants with frequent peer contact during this period, those with adolescent anxiety disorders reported less peer conflict than did those without such a diagnostic history. CONCLUSIONS: Adolescents with major depressive, disruptive, and substance abuse disorders may be at risk for long-term negative peer relationships, whereas those with anxiety disorders may subsequently avoid peer conflict.

Life values and mental health: A longitudinal study comparing chronically ill women to women without chronic disease.

We tested the hypothesis that among women who are chronically ill, a re-ordering of life values maintains mental health. A community-based prospective longitudinal study was conducted in which data were obtained from 601 women in 1986, when the women were with mean age 42 and again in 2003, when the women were with mean age 58. There was a significant change in life values as women aged with more change among women with chronic disease (n = 476) than those without chronic disease (n = 125). Increased valuation of intrinsic life values (health and love) and decreased valuation of extrinsic life values (power, fame and attractiveness) were associated with subsequent better mental health for women with chronic disease, but not for those without chronic disease.

Cumulative prevalence of personality disorders between adolescence and adulthood.

OBJECTIVE: To investigate the cumulative prevalence of personality disorder (PD) among adults in the community, based on prospective longitudinal data from a series of psychiatric interviews. METHOD: Psychiatric interviews were administered to a regionally representative community-based sample of 568 individuals in 1983 (mean age = 14), 1985-1986 (mean age = 16), 1991-1993 (mean age = 22), and 2001-2004 (mean age 33). RESULTS: The point prevalence of any current DSM-IV PD, including depressive PD and passive-aggressive PD, varied between 12.7% and 14.6% across the four diagnostic assessments. The cumulative prevalence of PD increased at each of the follow-up assessments. At mean age 33, the estimated lifetime prevalence of PD was 28.2%. CONCLUSION: The cumulative prevalence of PD, based on a series of interviews conducted during adolescence and adulthood, may be substantially higher than the point prevalence of current PD based on a single assessment interview.

Development and validation of a new procedure for the diagnostic assessment of personality disorder: the Multidimensional Personality Disorder Rating Scale (MPDRS).

Data from a community-based prospective longitudinal study were used to investigate the utility of a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder (PD). The Structured Clinical Interview for DSM-IV PDs (SCID-II) was administered to 154 adults. After completing the interview, an experienced clinician assessed the General Diagnostic Criteria for a PD using a structured rating scale. PD diagnoses, based solely on the rating scale data, demonstrated strong agreement with diagnoses obtained using the diagnostic thresholds for specific PDs (Kappa = 0.89). The sensitivity, specificity, predictive power, and internal reliability of the rating scale were satisfactory. PD diagnoses, based on both of the assessment procedures, were associated with substantial impairment and distress. These findings suggest that a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder may constitute a useful alternative or supplement to standard assessments of the diagnostic thresholds for specific DSM-IV PDs.

Comorbid Axis I and Axis II disorders in early adolescence: outcomes 20 years later.

CONTEXT: Although Axis II personality disorders in adolescence have been linked to psychopathology and psychosocial impairment in early adulthood, little is known about their effects over longer periods. OBJECTIVES: To evaluate and compare long-term prognoses of adolescent personality disorders and co-occurring Axis I disorders. DESIGN: Population-based longitudinal study. SETTING: Upstate New York. PARTICIPANTS: A community sample of 629 adolescents interviewed at a mean age of 13.8 years and again at a mean age of 33.2 years. MAIN OUTCOME MEASURES: Clinically assessed psychiatric disorders and self-reported attainment and function. RESULTS: Axis I (mood, anxiety, disruptive behavior, and substance use disorders) and Axis II disorders in adolescence showed risks for negative prognoses lasting 20 years. Co-occurring Axis I and Axis II disorders consistently presented the highest risk, often approximating the sum of the axis-associated risk or even several times the risk of disorders in either axis alone. CONCLUSIONS: Long-term prognoses of Axis I and Axis II disorders are of comparable magnitude and often additive when comorbid. These findings are highly relevant to the current debate over how personality disorders should be handled in DSM-V.

Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms.

Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Data are from a general population studied longitudinally between ages 10 and 36 in four assessment waves. Effects of SES-associated risks on the level of symptoms of schizotypal and borderline disorders are estimated and compared to effects on depressive symptoms. Low family SES had robust modest independent effects on both PDs over the entire age span despite substantial cumulative effects of trauma history, stressful recent life events, IQ, poor parenting, and comorbid symptoms. SES effects on depressive symptoms were generally absent, but a small "protective" effect of low SES appeared when comorbidity with PD symptoms was taken into account. Cumulatively, these risks account for developmental failures of substantial magnitude and consequence, marking the importance of understanding the remaining mechanisms of SES effects and programmatic implications for minimizing associated risk.

Parental concordance and offspring risk for anxiety, conduct, depressive, and substance use disorders.

BACKGROUND: Although parental concordance for any psychiatric disorder is known to be associated with elevated risk for offspring disorder, little evidence is currently available from prospective longitudinal studies regarding the association of parental concordance with offspring risk for anxiety, conduct, depressive, and substance use disorders. SAMPLING AND METHODS: Psychiatric interviews were conducted with 593 mothers and their biological offspring at mean offspring ages 14, 16, 22, and 33. RESULTS: Offspring risk for >or=1 psychiatric disorder was significantly greater if both parents had a lifetime history of psychiatric disorder than if only one parent had a lifetime history of disorder. Parental concordance for generalized anxiety disorder (GAD) was associated with a significant increase in offspring risk for anxiety disorders, above and beyond the risk attributable to having one affected parent. In addition, parental concordance for GAD was associated with elevated risk for offspring depressive disorders, and parental concordance for substance use disorders was associated with elevated offspring risk for conduct disorder. CONCLUSIONS: Parental concordance for GAD may be associated with elevated risk for offspring anxiety disorder, above and beyond the risk associated with having one affected parent.