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Neuropsychology

Depression in childhood ‘leads to risk factors in later life’

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Depression in childhood or adolescence is associated with higher levels of adult anxiety and substance use disorders, worse health and social functioning, less financial and educational achievement, and increased criminality.

New research, published by Elsevier, has highlighted the impact of depression between the ages of nine and 16 as being a possible risk factor in future life.

The findings are based on the Great Smoky Mountains Study, an ongoing longitudinal community-based project tracking the health of 1,420 participants from the rural US Southeast that has been ongoing since 1993.

“One in 12 children struggle with depression at some point between the ages 9 and 16, with girls more likely to be affected than boys. This is a common childhood challenge, that, unfortunately, often goes unnoticed by the adults in children’s lives, including parents, teachers, and paediatricians,” says lead author William Copeland, professor in the Department of Psychiatry at the University of Vermont.

“The literature is clear that we have effective treatments to help children who are dealing with depression. The problem is that in the real world the majority of children with depression never receive any treatment at all and have to cope with this challenge on their own. This study highlights the consequences of this unmet need.”

Children in the study were assessed for depression symptoms through interviews with the children and one of their parents up to eight times between the ages nine to 16. These same participants were then followed up to four times in young adulthood, at ages 19, 21, 25, and 30 to evaluate their mental health and their real world functioning in terms of health, wealth, crime, and social outcomes.

A diagnosis of depression in childhood was associated with a broad range of poorer wellbeing indicators in adulthood. These links between early depression and poor adult outcomes persisted after accounting for the participants’ early exposure to adversities like low socioeconomic status, family problems, abuse and bullying.

The links were strongest for children who chronically displayed high levels of depressive symptoms across childhood rather than those that happened to report symptoms at a single timepoint. This finding is consistent with the idea that persistent depressed mood, in particular, is associated with the worst long-term adult outcomes.

Co-author Iman Alaie, a PhD student in the Department of Neuroscience at Uppsala University, Sweden says: “The participants who became depressed as adolescents actually fared worse in the long term than those who had their first bout of depression already in childhood.

“From a developmental perspective, this was quite an unexpected finding given the current recognition that earlier onset of the disorder may portend poorer outcomes.”

However, the study also highlighted the importance of intervention – children who received specialty mental health services to address their mental health challenges were less likely to have worsening mental health problems, particularly anxiety, as they entered adulthood. But even here, children who received services continued to display problems in other important areas, including substance use, suggesting that childhood mental health services alone may not be a panacea against all future health problems.

“Our findings underscore the importance of timely and effective treatment, but we should also consider additional support needs during the transition to adulthood,” says Ulf Jonsson, an associate professor of child and adolescent psychiatry in the Department of Neuroscience, Uppsala University.

Overall, the study affirms the public health burden from childhood depression and depressive symptoms, especially when experienced over longer periods of time.

“When we consider the burden of depression on children, their families and school, and look at this from a public health perspective, it becomes clear that we need do a better job alleviating risk factors for childhood depression when possible, having better screening processes to detect childhood depression and to use evidence-based preventions and treatments when we see that a child is at risk for depression or has developed depression,” adds Lilly Shanahan, professor in the department of Psychology and at the Jacobs Center for Productive Youth Development at the University of Zurich, Switzerland.

Neuropsychology

Pandemic stress ‘has impaired cognitive ability’

Worry caused by the virus and lockdown has also impacted risk perception, a new study reveals

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Stress and worry from the COVID-19 pandemic may have impaired people’s cognitive abilities and altered risk perception, new research has revealed. 

The pandemic has undoubtedly tested psychological limits, and seen many people struggle with their mental health, but a new study from McGill University and The Neuro (Montreal Neurological Institute-Hospital) has revealed more of the true extent of the impact of the virus and lockdown.

In a survey of more than 1,500 Americans online from April to June 2020, participants were asked to rate their level of worry about the COVID-19 pandemic and complete an array of psychological tests to measure their basic cognitive abilities like processing and maintaining information in mind. The data was then compared to results of the same tests collected before the pandemic.

For example, participants completed an information processing test where they were asked to match pairs of digits and symbols according to a fixed rule. 

Participants’ risk attitudes were measured using an economic decision task where they made a series of hypothetical choices between a ‘certain’ option – for example, a sure win of $75 – and a ‘risky’ option – a 25 per cent chance of winning $0 and a 75 per cent chance of winning $100.

The researchers found that those who experienced more pandemic-related worry had reduced information processing speed, ability to retain information needed to perform tasks, and heightened sensitivity to the odds they were given when taking risks. 

The pandemic group also performed more poorly on the simple cognitive tasks than the pre-pandemic group. 

Additionally, participants in the last wave of data collection showed slower processing speed, lower ability to maintain goals in mind, and were more sensitive to risk than those in the first wave.

Interestingly, the study found that pandemic worry predicted individuals’ tendency to distort described risk levels: underweighting likely probabilities and overweighting unlikely probabilities. 

This suggests that worry related to COVID may have affected people’s decision-making style, which researchers point out as being crucial in influencing key decisions, such as about getting a COVID-19 vaccine.

“The basic cognitive abilities measured here are crucial for healthy daily living and decision-making,” says Kevin da Silva Castanheira, a graduate student in McGill’s Department of Psychology and the study’s first author. 

“The impairments associated with worry observed here suggest that under periods of high stress, like a global pandemic, our ability to think, plan, an evaluate risks is altered. Understanding these changes are critical as managing stressful situations often relies on these abilities.”

“The impact of stress and of worry on cognitive function are well known, but are typically studied in the laboratory setting,” says Dr Madeleine Sharp, a researcher and neurologist at The Neuro and study author. 

“Here, we were able to extend these findings by studying the effects of a real-world stressor in a large sample. 

“An important future direction will be to examine why some people are more sensitive than others to stress and to identify coping strategies that help to protect from the effects of stress.”

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Neuropsychology

‘Improve access to mental health services for young people’

Calls come after a study reveals around 80 per cent of adolescents who died by suicide, or self-harmed, sought medical help the previous year

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A “comprehensive approach” to tackling mental health in young people must be developed, and access to resources improved, after it was revealed that around 80 per cent of adolescents who died by suicide or had self-harmed sought medical help the previous year. 

The study of ten to 19-year-olds between 2003 and 2018 showed that 85 per cent of those who later took their own lives consulted with their GP or a practice nurse at least once in the preceding year. 

This figure was 75 per cent for those youngsters who harmed themselves non-fatally. 

Co-author Dr Shruti Garg, from The University of Manchester, said: “Late adolescence can be a particularly vulnerable time for young people experiencing mental health problems. 

“Improving access and provision of transition mental health services so that young people do not fall in the gap between CAMHS and adult mental health services should be a priority.”

There were lower than expected rates of diagnosis of psychiatric illness – around a third in both groups – and depression was by far the most common condition, accounting for over 54 per cent of all recorded diagnoses. 

While suicide was more common in boys, non-fatal self-harm was more common in girls. Two-thirds of adolescents who died by suicide had a history of non-fatal self-harm.

The study analysed the data of 324 adolescents who had died by suicide and 56,008 who had self-harmed, using the Clinical Practice Research Datalink, which contains interlinked general practice, hospital, and national mortality records.

Lead-author Lukasz Cybulski, a GM PSTRC PhD Fellow from the University of Manchester, said: “That most adolescents who had harmed themselves or died by suicide were known to services in the preceding year highlights how important it is to identify their pathology and adequately treat it.

“Ensuring timely access to effective treatment is a priority as we already know that people who experience psychiatric illnesses are at much higher risk of harming themselves or dying by suicide.”

Professor Nav Kapur, from The University of Manchester and another of the study’s authors, said: “Suicide and self-harm are complex behaviours with many potential causes. In young people, bullying, bereavement, health problems, and academic pressures can all be important antecedents.

“This means that a comprehensive approach to prevention is vital and one that requires coordination between families, schools, social services, and health professionals.”

The study was funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust (NCA).

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Neuropsychology

Discrimination ‘can cause mental health and behaviour issues’

The UCLA study reveals both the short- and long-term psychological and behavioural impact on young adults

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Young adults who have experienced discrimination have a higher risk of both short- and long-term psychological and behavioural problems, a new study has found. 

Researchers at UCLA examined a decade’s worth of health data on 1,834 Americans who were between 18 and 28 years old when the study began. 

They found that the effects of discrimination may be cumulative — that the greater number of incidents of discrimination someone experiences, the more their risk for mental and behavioural problems increases.

The study also suggests that the effects of discrimination in young adults are connected with disparities in care for mental health concerns and institutional discrimination in health care overall, including inequities in diagnoses, treatment and health outcomes.

Previous studies have linked discrimination — whether due to disability, racism, sexism, ageism, physical appearance or other biases — to a higher risk for mental illness, psychological distress and drug use. 

While previous research has examined the correlation in childhood or later adulthood, this new study is the first to focus on the transition to adulthood and to follow the same group of individuals over time.

“With 75 per cent of all lifetime mental health disorders presenting by age 24, the transition to adulthood is a crucial time to prevent mental and behavioural health problems,” said Yvonne Lei, a medical student at the David Geffen School of Medicine at UCLA and the study’s corresponding author.

Lei also said the findings are particularly relevant in light of the stresses young adults are facing globally today.

“The COVID-19 pandemic has brought to the forefront new mental health challenges — particularly for vulnerable populations,” she said. 

“We have the opportunity to rethink and improve mental health services to acknowledge the impact of discrimination, so we can better address it to provide more equitable care delivery.”

Researchers used data spanning 2007 to 2017 from the University of Michigan’s Transition to Adulthood Supplement of the Panel Study of Income Dynamics survey. 

Approximately 93 per cent of the people in the study reported experiencing discrimination; the most common factors they cited were age (26 per cent), physical appearance (19 per cent), sex (14 per cent) and race (13 per cent).

The analysis showed that participants who experienced frequent discrimination, defined as a few times per month or more, were roughly 25 per cent more likely to be diagnosed with a mental illness and twice as likely to develop severe psychological distress than those who had not experienced discrimination or had experienced it a few times per year or less. 

Overall, people who experienced any amount of discrimination had a 26 per cent greater risk for poor health than people who said they did not experience discrimination.

During the ten-year period, young adults in the study who had experienced multiple successive years of high-frequency discrimination showed a much more pronounced, cumulative risk for mental illness, psychological distress, drug use and worse overall health.

The findings shed light on the multidimensional impact of discrimination on mental and behavioural health and overall well-being.

“The associations we found are likely also intertwined with mental health care service disparities — including inequities in care access, provider biases and structural and institutional discrimination in health care — leading to inequities in diagnoses, treatment and outcomes,” said the study’s senior author, Dr Adam Schickedanz, an assistant professor of paediatrics at the Geffen School of Medicine.

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