Depressive symptoms in adolescence and adult educational and employment outcomes: a structured life course analysis.

BACKGROUND: Depression is a common mental health disorder that often starts during adolescence, with potentially important future consequences including 'Not in Education, Employment or Training' (NEET) status. METHODS: We took a structured life course modeling approach to examine how depressive symptoms during adolescence might be associated with later NEET status, using a high-quality longitudinal data resource. We considered four plausible life course models: (1) an early adolescent sensitive period model where depressive symptoms in early adolescence are more associated with later NEET status relative to exposure at other stages; (2) a mid adolescent sensitive period model where depressive symptoms during the transition from compulsory education to adult life might be more deleterious regarding NEET status; (3) a late adolescent sensitive period model, meaning that depressive symptoms around the time when most adults have completed their education and started their careers are the most strongly associated with NEET status; and (4) an accumulation of risk model which highlights the importance of chronicity of symptoms. RESULTS: Our analysis sample included participants with full information on NEET status (N = 3951), and the results supported the accumulation of risk model, showing that the odds of NEET increase by 1.015 (95% CI 1.012-1.019) for an increase of 1 unit in depression at any age between 11 and 24 years. CONCLUSIONS: Given the adverse implications of NEET status, our results emphasize the importance of supporting mental health during adolescence and early adulthood, as well as considering specific needs of young people with re-occurring depressed mood.

Cost-Effectiveness Analysis of Smoking Cessation Interventions in the United Kingdom Accounting for Major Neuropsychiatric Adverse Events.

OBJECTIVES: Smoking is a leading cause of death worldwide. Cessation aids include varenicline, bupropion, nicotine replacement therapy (NRT), and e-cigarettes at various doses (low, standard and high) and used alone or in combination with each other. Previous cost-effectiveness analyses have not fully accounted for adverse effects nor compared all cessation aids. The objective was to determine the relative cost-effectiveness of cessation aids in the United Kingdom. METHODS: An established Markov cohort model was adapted to incorporate health outcomes and costs due to depression and self-harm associated with cessation aids, alongside other health events. Relative efficacy in terms of abstinence and major adverse neuropsychiatric events was informed by a systematic review and network meta-analysis. Base case results are reported for UK-licensed interventions only. Two sensitivity analyses are reported, one including unlicensed interventions and another comparing all cessation aids but removing the impact of depression and self-harm. The sensitivity of conclusions to model inputs was assessed by calculating the expected value of partial perfect information. RESULTS: When limited to UK-licensed interventions, varenicline standard-dose and NRT standard-dose were most cost-effective. Including unlicensed interventions, e-cigarette low-dose appeared most cost-effective followed by varenicline standard-dose + bupropion standard-dose combined. When the impact of depression and self-harm was excluded, varenicline standard-dose + NRT standard-dose was most cost-effective, followed by varenicline low-dose + NRT standard-dose. CONCLUSION: Although found to be most cost-effective, combined therapy is currently unlicensed in the United Kingdom and the safety of e-cigarettes remains uncertain. The value-of-information analysis suggested researchers should continue to investigate the long-term effectiveness and safety outcomes of e-cigarettes in studies with active comparators.

Selective solvent bar micro-extraction as a single-step approach for the measurement of Cu fractions in seawater.

Hollow fibre-supported liquid membrane was used for Cu fractionation in marine waters, using di-2-pyridylketone benzoylhydrazone (dPKBH) as a carrier due to its capacity to transport dissolved inorganic Cu at natural seawater pH. Optimized conditions were dPKBH (0.5 mmol L-1), HNO3 (0.5 mol L-1) as acceptor agent, extraction time of 120 min and stirring speed of 800 rpm. Additionally, the selectivity of the method for the extraction of the inorganic Cu fraction was validated by comparing the experimental results with theoretical data, and a mathematical model was obtained for estimation of Cu linked to dissolved organic matter. The method was applied for the measurement of Cu fractions in real seawater samples. Results were successfully compared with the reference material BCR 403 and recovery analysis in waters from the Gulf of Cádiz, showing that it could be used as a simple approach for the study of different Cu fractions in marine waters. Graphical abstract.

The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis.

Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.

Choice of Prosthetic Implant Combinations in Total Hip Replacement: Cost-Effectiveness Analysis Using UK and Swedish Hip Joint Registries Data.

BACKGROUND: Prosthetic implants used in total hip replacements (THR) have a range of bearing surface combinations (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal), head sizes (small [<36 mm in diameter] and large [≥36 mm in diameter]), and fixation techniques (cemented, uncemented, hybrid, and reverse hybrid). These can influence prosthesis survival, patients' quality of life, and healthcare costs. OBJECTIVES: To compare the lifetime cost-effectiveness of implants for patients of different age and sex profiles. METHODS: We developed a Markov model to compare the cost-effectiveness of various implants against small-head cemented metal-on-polyethylene implants. The probability that patients required 1 or more revision surgeries was estimated from analyses of more than 1 million patients in the UK and Swedish hip joint registries, for men and women younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years and older. Implant and healthcare costs were estimated from local procurement prices, national tariffs, and the literature. Quality-adjusted life-years were calculated using published utility estimates for patients undergoing THR in the United Kingdom. RESULTS: Small-head cemented metal-on-polyethylene implants were the most cost-effective for men and women older than 65 years. These findings were robust to sensitivity analyses. Small-head cemented ceramic-on-polyethylene implants were most cost-effective in men and women younger than 65 years, but these results were more uncertain. CONCLUSIONS: The older the patient group, the more likely that the cheapest implants, small-head cemented metal-on-polyethylene implants, were cost-effective. We found no evidence that uncemented, hybrid, or reverse hybrid implants were the most cost-effective option for any patient group. Our findings can influence clinical practice and procurement decisions for healthcare payers worldwide.

Solvent Bar Micro-Extraction of Heavy Metals from Natural Water Samples Using 3-Hydroxy-2-Naphthoate-Based Ionic Liquids.

Developments in the liquid micro-extraction of trace metals from aqueous phases have proven to be limited when extended from pure water to more complex and demanding matrices such as sea water or wastewater treatment effluents. To establish a system that works under such matrices, we successfully tested three task-specific ionic liquids, namely trihexyltetradecyl- phosphonium-, methyltrioctylphosphonium- and methyltrioctylammonium 3-hydroxy-2-naphthoate in two-phase solvent bar micro-extraction (SBME) experiments. We describe the influence of pH, organic additives, time, stirring rate and volume of ionic liquid for multi-elemental micro-extraction of Cu, Ag, Cd and Pb from various synthetic and natural aqueous feed solutions. Highest extraction for all metals was achieved at pH 8.0. Minimal leaching of the ionic liquids into the aqueous phase was demonstrated, with values < 30 mg L-1 DOC in all cases. Sample salinities of up to 60 g L-1 NaCl had a positive effect on the extraction of Cd, possibly due to an efficient extraction mechanism of the present chlorido complexes. In metal-spiked natural feed solutions, the selected SBME setups showed unchanged stability under all conditions tested. We could efficiently (≥85%) extract Cu and Ag from drinking water and achieved high efficacies for Ag and Cd from natural sea water and hypersaline water, respectively. The method presented here proves to be a useful tool for an efficient SBME of heavy metals from natural waters without the need to pretreat or modify the sample.

Corticosteroids in septic shock: a systematic review and network meta-analysis.

BACKGROUND: Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock. METHODS: Network meta-analysis of the data used for the recently conducted Cochrane review was performed. Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded. Network plots were created for each outcome, and all analyses were conducted using a frequentist approach assuming a random-effects model. RESULTS: Complete data from 22 studies and partial data from 1 study were included. Network meta-analysis provided no clear evidence that any intervention or treatment regimen is better than any other across the spectrum of outcomes. There was strong evidence of differential efficacy in only one area: shock reversal. Hydrocortisone boluses and infusions were more likely than methylprednisolone boluses and placebo to result in shock reversal. CONCLUSIONS: There was no clear evidence that any one corticosteroid drug or treatment regimen is more likely to be effective in reducing mortality or reducing the incidence of gastrointestinal bleeding or superinfection in septic shock. Hydrocortisone delivered as a bolus or as an infusion was more likely than placebo and methylprednisolone to result in shock reversal.

Miniaturized and direct spectrophotometric multi-sample analysis of trace metals in natural waters.

Trends in the analysis of trace metals in natural waters are mainly based on the development of sample treatment methods to isolate and pre-concentrate the metal from the matrix in a simpler extract for further instrumental analysis. However, direct analysis is often possible using more accessible techniques such as spectrophotometry. In this case a proper ligand is required to form a complex that absorbs radiation in the ultraviolet-visible (UV-Vis) spectrum. In this sense, the hydrazone derivative, di-2-pyridylketone benzoylhydrazone (dPKBH), forms complexes with copper (Cu) and vanadium (V) that absorb light at 370 and 395 nm, respectively. Although spectrophotometric methods are considered as time- and reagent-consuming, this work focused on its miniaturization by reducing the volume of sample as well as time and cost of analysis. In both methods, a micro-amount of sample is placed into a microplate reader with a capacity for 96 samples, which can be analyzed in times ranging from 5 to 10 min. The proposed methods have been optimized using a Box-Behnken design of experiments. For Cu determination, concentration of phosphate buffer solution at pH 8.33, masking agents (ammonium fluoride and sodium citrate), and dPKBH were optimized. For V analysis, sample (pH 4.5) was obtained using acetic acid/sodium acetate buffer, and masking agents were ammonium fluoride and 1,2-cyclohexanediaminetetraacetic acid. Under optimal conditions, both methods were applied to the analysis of certified reference materials TMDA-62 (lake water), LGC-6016 (estuarine water), and LGC-6019 (river water). In all cases, results proved the accuracy of the method.

Tactical aspects of a National University Taekwondo Championship in relation to round and match outcome.

The aims of this study were to analyze tactical behavior (direct attacks and indirect attacks, in addition to anticipatory, simultaneous, and posterior counterattacks) according to competition round and match, and to compare tactics of competitors (winners and nonwinners) in a university taekwondo championship. The analysis included 334 individual performances from 204 athletes over 169 bouts in the National University Championship. A 2-way repeated measure analysis of variance was conducted with "round" (at 3 levels: first, second, and third) as the within-subject factor and match outcome (at 2 levels: winning and nonwinning) as the between-subject factor. The results of this study show that tactical behavior patterns of winners and nonwinners differ. In addition, these differences vary over the course of a bout (p ≤ 0.05). Winners perform fewer direct and indirect attacks than nonwinners perform, but execute more anticipatory, simultaneous, and posterior counterattacks. In terms of tactics in each round, there are more frequent direct and anticipatory actions in the third round than in earlier rounds (p ≤ 0.05). Therefore, coaches should conduct tactical training for athletes in a variety of counterattacks, especially in the third round.

Assessment of metal and organic pollutants in combination with stable isotope analysis in tunas from the Gulf of Cadiz (east Atlantic).

Bioaccumulation patterns of heavy metals (Pb, Cd, Cr, Ni, Fe and Cu) and organic (priority and emerging) pollutants, in combination with stable isotope analysis (SIA), were assessed in muscle and liver of three tuna species from the Gulf of Cadiz (Atlantic bluefin tuna, Thunnus thynnus; Atlantic bonito, Sarda sarda, and skipjack tuna, Katsuwonus pelamis). SIA and contaminant (heavy metal and organic) profiles separately discriminated between species. There was no significant overlap between the trophic niches estimated from isotopic data, suggesting that there are diet differences which may determine differential bioaccumulation patterns. The levels of heavy metals and persistent organic pollutants in muscle of all the individuals analyzed were below the allowable limits established by the current legislation. Concentrations of most contaminants were higher in liver than in muscle, underlining the powerful detoxifying capacity of the liver in tunas. In addition to diet, other factors such as size and age (exposure time to environmental chemicals) explain differences in pollutant accumulation patterns in tissues between species, each with varying degrees of involvement depending on the pollutant class. Our results show that combining contaminant profile data with trophic features based on SIA may help understand pollutant bioaccumulation patterns in upper levels of marine food webs.

Improvement of Advanced Sample Preparation Systems for the Determination of Trace Ni in Seawater by Electro-Membranes.

Due to its important environmental role, the analysis of trace metals in natural waters is attracting increasing attention; consequently, faster and more accurate analytical methods are now needed to reach even lower limits of detection. In this work, we propose the use of electro-membrane extraction (EME) to improve analytical methods based on hollow fiber liquid phase micro-extraction (HFLPME). Specifically, an EME-based method for the determination of trace Ni in seawater has been developed, using an HFLPME system with di-2-ethylhexyl phosphoric acid (DEHPA) in kerosene as a chemical carrier, followed by instrumental determination by graphite furnace atomic absorption spectroscopy (GFAAS). Under optimum conditions, Ni was pre-concentrated 180 ± 17 times after 15 min, using sample pH = 5.5, the concentration of DEHPA 0.9 M in the liquid membranes, and 1.9 M HNO3 in the acceptor solution, as well as an electric potential of 25 V with the sample being stirred at 500 rpm. When compared with other HFLPME systems for pre-concentration of trace Ni in seawater in the absence of electric potential, the enrichment factor was improved 2.2 times, while the time of extraction was reduced an 89%. The limit of detection of the new method was 23.3 ng L-1, and both its applicability and accuracy were successfully evaluated by analyzing Ni concentration in a seawater-certified reference material (BCR-403), showing the reliability of EME for sample preparation in the determination of trace metals in marine water samples.

Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic review and network meta-analysis.

QUESTION: We compared the effectiveness of different types of parenting interventions based on an a priori taxonomy, and the impact of waitlists versus treatment as usual (TAU), in reducing child internalising problems. STUDY SELECTION AND ANALYSIS: We conducted a systematic review and network meta-analysis of published and unpublished randomised controlled trials (RCTs) until 1 October 2022 that investigated parenting interventions with children younger than 4 years. EXCLUSION CRITERIA: studies with children born preterm, with intellectual disabilities, or families receiving support for current abuse, neglect, and substance misuse. We assessed the certainty of evidence using the Confidence in Network Meta-Analysis framework. We used random-effects network meta-analysis to estimate standardised mean differences (SMDs) with 95% credible intervals (CrIs). FINDINGS: Of 20 520 citations identified, 59 RCTs (18 349 participants) were eligible for the network meta-analysis. Parenting interventions focusing on the dyadic relationship (SMD: -0.26, 95% CrI: -0.43 to -0.08) and those with mixed focus (-0.09, -0.17 to -0.02) were more effective in reducing internalising problems than TAU at the first time point available. All interventions were more effective than waitlist, which increased the risk of internalising problems compared with TAU (0.36, 0.19 to 0.52). All effects attenuated at later follow-ups. Most studies were rated as with 'high risk' or 'some concerns' using the Risk of Bias Assessment Tool V.2. There was no strong evidence of effect modification by theoretically informed components or modifiers. CONCLUSIONS: We found preliminary evidence that relationship-focused and mixed parenting interventions were effective in reducing child internalising problems, and the waitlist comparator increased internalising problems with implications for waiting times between referral and support. Considering the high risk of bias of most studies included, the findings from this meta-analysis should be interpreted with caution. PROSPERO registration number CRD42020172251.

Overviews of Reviews: Concept and Development.

BACKGROUND: In the last years, overviews of systematic reviews, or umbrella reviews, have seen a dramatic increase in their use. An overview aims to provide a summary of the included reviews and will often examine research questions beyond those addressed in the systematic reviews being synthesised. The purpose of this article is to provide some recommendations on how overviews should be conducted and reported. METHOD: A literature review was performed to identify relevant papers on both methodological and applied overviews. RESULTS: The current literature recommends carrying out overviews by following similar steps to those of systematic reviews: (a) Defining the overview research question; (b) inclusion and exclusion criteria; (c) literature search; (d) data extraction; (e) assessment of risk of bias and reporting quality; (f) overview results; and (g) reporting the overview. Of special interest is how to address dependencies between the systematic reviews. CONCLUSIONS: Overviews allow evidence to be efficiently combined from multiple systematic reviews. This offers the possibility of translating and summarizing large amounts of information. As in primary studies and systematic reviews, conducting and reporting of overviews must meet appropriate quality standards.

A liquid micro-extraction based one-step method for the chemical fractionation of copper in seawater.

In this work, the reagent Cyanex® 272 has been incorporated in a three-phase solvent bar micro-extraction system to selectively separate the inorganic and organic fractions of copper in seawater. Optimized conditions for micro-extraction of Cu fractions were 0.2 M Cyanex® 272 in the organic solution contained into the fiber pores, 0.5 M HCl as acceptor solution within the fiber, stirring rate of 500 rpm, and 60 min time of extraction, providing an enrichment factor of 51.6 ± 2.3. Experimental results for selective extraction of organic and inorganic Cu showed a good correlation with theoretical data for Cu speciation, and the relationship between enrichment factor and dissolved organic carbon (DOC) concentration in the samples was used to predict total Cu concentration. Instrumental determination of Cu presented a linear response within the range 0.1-20 µg L-1, obtaining a limit of detection of 0.03 µg L-1. Finally, the method was successfully applied to the study of Cu fractions in real seawater samples collected from the Bay of Cádiz (Spain).

Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials.

AIM: To determine how varenicline, bupropion, nicotine replacement therapy (NRT) and electronic cigarettes compare with respect to their clinical effectiveness and safety. METHOD: Systematic reviews and Bayesian network meta-analyses of randomized controlled trials, in any setting, of varenicline, bupropion, NRT and e-cigarettes (in high, standard and low doses, alone or in combination) in adult smokers and smokeless tobacco users with follow-up duration of 24 weeks or greater (effectiveness) or any duration (safety). Nine databases were searched until 19 February 2019. Primary outcomes were sustained tobacco abstinence and serious adverse events (SAEs). We estimated odds ratios (ORs) and treatment rankings and conducted meta-regression to explore covariates. RESULTS: We identified 363 trials for effectiveness and 355 for safety. Most monotherapies and combination therapies were more effective than placebo at helping participants to achieve sustained abstinence; the most effective of these, estimated with some imprecision, were varenicline standard [OR = 2.83, 95% credible interval (CrI) = 2.34-3.39] and varenicline standard + NRT standard (OR = 5.75, 95% CrI = 2.27-14.88). Estimates were higher in smokers receiving counselling than in those without and in studies with higher baseline nicotine dependence scores than in those with lower scores. Varenicline standard + NRT standard showed a high probability of being ranked best or second-best. For safety, only bupropion at standard dose increased the odds of experiencing SAEs compared with placebo (OR = 1.27, 95% CrI = 1.04-1.58), and we found no evidence of effect modification. CONCLUSIONS: Most tobacco cessation monotherapies and combination therapies are more effective than placebo at helping participants to achieve sustained abstinence, with varenicline appearing to be most effective based on current evidence. There does not appear to be strong evidence of associations between most tobacco cessation pharmacotherapies and adverse events; however, the data are limited and there is a need for improved reporting of safety data.

Examining how meta-analytic methods perform in the presence of bias: A simulation study.

Standard meta-analysis methods are vulnerable to bias from incomplete reporting of results (both publication and outcome reporting bias) and poor study quality. Several alternative methods have been proposed as being less vulnerable to such biases. To evaluate these claims independently we simulated study results under a broad range of conditions first with no bias, then introducing simulated publication bias, outcome reporting bias, and bias from poor study quality. We then implemented common and the proposed bias robust meta-analysis methods and compared the mean bias and mean squared error (MSE) for four estimates of effect and the coverage probability of seven confidence intervals. We found that no methods perform well in the presence of any substantial bias. A regression based extension to Egger's test gave an estimate of effect with lower mean bias than standard methods in the presence of publication bias or poor study quality, but had a substantially worse MSE except in very specific conditions. Coverage of all 95% confidence intervals was very poor with increasing numbers of studies in biased conditions, often falling below 50%. The Knapp-Hartung interval performed closest to nominal coverage with fewer than 10 studies in most conditions, and the Henmi-Copas interval generally performed best with more than 10 studies. There was no evidence that a multiplicative term for heterogeneity improved coverage. Multiple forms of bias remain problematic for all meta-analysis methods, with very poor performance under conceivable conditions.

Effects of Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: A Network Meta-Analysis.

Gait disturbances are common in children and adolescents with cerebral palsy (CP). Robotic-assisted gait training (RAGT) is becoming increasingly widespread, and hence it is important to examine its effectiveness. A network meta-analysis (NMA) of clinical trials comparing treatments with RAGT vs. other physical therapy treatments was carried out. This study was conducted according to the NMA version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines and following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The outcome variables used were the D and E dimensions of the Gross Motor Function Measure (GMFM), gait speed, resistance, and stride length. Among 120 records, 8 trials were included. This NMA did not find statistically significant results for any of the comparisons examined in any of the outcomes studied and the magnitude of the effect size estimates was low or very low. Our NMA results should be interpreted with caution due to the high clinical heterogeneity of the studies included.

The role of school enjoyment and connectedness in the association between depressive and externalising symptoms and academic attainment: Findings from a UK prospective cohort study.

BACKGROUND: Previous research on the relationship between children's depressive and externalising symptoms, experience of school, and academic attainment is inconclusive. The aims of this study were (i) to test bidirectional associations between children's school experience and depressive and externalising symptoms at age 10-11 and 13-14, (ii) to ascertain whether school experience age 13-14 is associated with academic attainment age 16, and (iii) to test whether school experience mediates the relationship between depressive or externalising symptoms and attainment. METHODS: Data was used from the Avon Longitudinal Study of Parents and Children (n=6,409). A cross-lagged model was used to investigate bidirectional associations between school experience (enjoyment and connectedness) and depression and externalising at age 10-11 and 13-14. The same framework was used to test if school experience aged 13-14 mediated associations of depressive and externalising symptoms with later attainment. RESULTS: Depressive and externalising symptoms at 10-11 were negatively associated with school connectedness (depressive: standardised ß=-0.06, CI: -0.11, 0.01; externalizing: ß=-0.13, CI: -0.17, -0.08), and school enjoyment at 13-14 (depressive ß=-0.04, -0.08, 0.03; externalising: ß=-0.08, CI: -0.13, -0.03). School enjoyment at 13-14 was positively associated with attainment at 16 (ß=0.10, CI: 0.04, 0.15), and partially mediated associations between depressive and externalising symptoms at 10-11 and attainment at 16 (depressive: proportion mediated 2.2%, CI: -1.5, 5.9; externalising: proportion mediated; 4.7%, CI: 0.7, 10.1,). LIMITATIONS: Results may be subject to residual confounding. CONCLUSIONS: School enjoyment is a potentially modifiable risk factor that may affect educational attainment of adolescents with depressive or externalising symptoms.

Correction: Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka.

[This corrects the article DOI: 10.1371/journal.pone.0242437.].

Depressive symptoms and academic achievement in UK adolescents: a cross-lagged analysis with genetic covariates.

BACKGROUND: The relationship between adolescent depressive symptoms and academic achievement remains poorly understood. The aim of this study was to help clarify the nature and directionality of this association. METHODS: We used a sample of 13,599 British adolescents (main sample of N=3,809 participants). We fitted cross-lagged panel models using four repeated measures of self-reported depressive symptoms and four measures of academic achievement based on British national records between 11-18 years, separately for male and female adolescents and considering polygenic risk scores (PRS) for educational attainment and depression, alongside other child and parental covariates. RESULTS: We found evidence of an overall negative association that was stronger in boys (R=-0.21, 95% CI -0.31 to -0.11) than in girls (-0.13, -0.31 to 0.05). Higher depressive symptoms were associated with lower academic achievement at a later stage up to the end of compulsory education (16 years), when the direction of the association reversed, although girls with lower achievement also appeared vulnerable to depressive symptoms at previous stages. The genetic variables derived for this study showed stronger associations for academic achievement, but the PRS for depression also showed a negative association with academic achievement in girls. Child intelligence quotient and peer victimization also showed relevant associations. LIMITATIONS: Observational design, variation around measurement times, missing data. CONCLUSIONS: Depressive symptoms and academic achievement should be considered jointly when designing school-based programmes for children and adolescents, alongside gender, child ability and school experience. Including genetic information in research can help to disentangle average from time-varying effects.