Development Of Mental Health Conditions Research Articles

LGBQ-affirming clinical recommendations forcompulsive sexual behavior disorder.

Since the inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases (11th ed.), there has been little effort placed into developing clinical recommendations for lesbian, gay, bisexual, and queer (LGBQ) clients with this condition. Thus, we develop preliminary clinical recommendations for mental health professionals working with LGBQ clients who may be struggling with CSBD. The present paper synthesizes the CSBD literature with advances in LGBQ-affirming care to develop assessment and treatment recommendations. These recommendations are discussed within the context of minority stress theory, which provides an empirically supported explanation for how anti-LGBQ stigma may contribute to the development of mental health conditions in LGBQ populations. Assessment recommendations are designed to assist mental health professionals in distinguishing aspects of an LGBQ client's sociocultural context from CSBD symptomology, given recent concerns that these constructs may be wrongly conflated and result in misdiagnosis. The treatment recommendations consist of broadly applicable, evidence-based principles that can be leveraged by mental health professionals of various theoretical orientations to provide LGBQ-affirming treatment for CSBD. The present article provides theoretically and empirically supported recommendations for mental health professionals who want to provide LGBQ-affirming care for CSBD. Given the preliminary nature of these recommendations, future research is needed to investigate their clinical applicability and efficacy.

Abstract P171: Patient and Interdisciplinary HIV Care Experts Illness Representations on HIV Comorbidities and Usability of a Virtual Environment as Heart Disease Prevention Education in Ethnic and Racial Sexual Minority Men With HIV

Background: Black and Latinx sexual minority men with HIV are at increased risk of CVD and have been underrepresented in clinical trials. The American Heart Association has called for an increase in interventions that focus on enhancing cardiovascular health in underserved communities by addressing social determinants and modifiable risk factors of CVD. Objective: To explore patient and HIV care experts’ perceptions about HIV comorbidities and assess usability of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV. Methods: This two-phase study is part of a pilot behavioral clinical trial informed by the American Heart Association’s metrics for cardiovascular health. Qualitative Phase 1 data were collected June 2021 to May 2022. Phase 2 data were collected August 2022 to October 2022. Using convenience sampling, we recruited a) Black and Latinx sexual minority men with HIV, and b) interdisciplinary HIV care experts. Eligibility criteria for non-HIV care experts were: 1) self-identify as gay or bisexual; 2) HIV serostatus positive; 3) ages 30 to 65; 4) access to a laptop or desktop. We explored HIV comorbidities of concern and conducted usability testing of the virtual environment. Eighty-four pages of interview data were analyzed using NVivo 12. Results: Phase 1 themes included: Mixed Perceptions about Health, High Risk for Comorbidities, and Virtual Environment Features. CVD risk factors were consistently expressed in relation to HIV, including hypertension, heart attack, stroke, and diabetes. Additionally, kidney, and liver disease were identified as important. Cancer was a common concern and so were the development of mental health conditions. All participants in Phase 2 completed the usability checklist with favorable feedback. Conclusions: We identified hypertension, diabetes, asthma, and cancer were comorbidities of concern. These findings carry significant implications for mitigating barriers to preventative health screenings in Black and Latinx sexual minority men with HIV, given shared risk factors between HIV, CVD, and cancer. We also found that usability of a virtual environment as CVD prevention education was promising as it offered anonymity and access to reliable health information that traverses geography. A virtual environment may serve as a novel modality for extending the reach of prevention education and clinical trials into the hands of ethnic and racial, sexual minoritized individuals that have been underrepresented in advancements in health equity.

Childhood adversity, allostatic load, and adult mental health: Study protocol using the Avon Longitudinal Study of Parents and Children birth cohort.

The cumulative burden of chronic stress and life events has been termed allostatic load. Elevated allostatic load indices are associated with different mental health conditions in adulthood. To date, however, the association between elevated allostatic load in childhood and later development of mental health conditions has not been investigated. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we will calculate allostatic load indices using biomarkers representing the cardiovascular, metabolic, immune, and neuroendocrine systems, at the ages of 9 and 17 years. Bivariate and multivariable logistic regression models will be used to investigate the association between allostatic load and psychiatric disorders in adulthood. Furthermore, the role of adverse childhood experiences as a modifier will be investigated. This protocol describes a strategy for investigating the association between elevated allostatic load indices in childhood at the age of 9 years old and psychiatric disorders in adulthood at 24 years old.

Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study

BackgroundMigrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. MethodsA cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. ResultsOf 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2–1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8–6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5–3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. ConclusionsMental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.

The Future Proofing Study: Design, methods and baseline characteristics of a prospective cohort study of the mental health of Australian adolescents.

The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. The FPS is an Australian school-based prospective cohort study with an embedded cluster-randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self-report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5years. The baseline cohort (N=6388, M=13.9years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps<0.05). This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence.

The Association of Grief with Mental Health and the Role of Loneliness During the COVID-19 Pandemic

Previous research found that bereavement is associated with several pathological responses affecting both physical and mental health. During the COVID-19 pandemic and the socially disruptive measures implemented, losses of close contacts have occurred under exceptional circumstances, and it is reasonable to expect that many bereaved people would be unable to overcome their loss adaptively, resulting in dysfunctional grief leading to mental health alterations. Loneliness, which has increased during the pandemic, has been identified as a significant risk factor for mental health that is common when people grieve. In this study, we aimed to gauge the effects of bereavement on mental health in the context of the COVID-19 pandemic and to explore the mediating role of loneliness on the relationship between grief and mental health alterations by surveying a representative sample of 2000 Spanish adults interviewed by phone during the pandemic (February-March 2021). Logistic regressions were performed to examine the effects of grief levels on depression, anxiety, panic attacks, post-traumatic stress disorder, substance abuse, and suicidal thoughts and behaviors. Our results confirmed that how the loss of a loved one is processed is associated with the development of mental health conditions. Dysfunctional grief was significantly associated with all mental health conditions, particularly depression (OR = 14.28) and anxiety (OR = 11.61). As predicted, loneliness accounted for a substantial percentage (8-30%) of the impact of grief on mental health outcomes.

Current State of Fluid Lipid Biomarkers for Personalized Diagnostics and Therapeutics in Schizophrenia Spectrum Disorders and Related Psychoses: A Narrative Review.

Schizophrenia spectrum disorders (SSD) are traditionally diagnosed and categorized through clinical assessment, owing to their complex heterogeneity and an insufficient understanding of their underlying pathology. However, disease progression and accurate clinical diagnosis become problematic when differentiating shared aspects amongst mental health conditions. Hence, there is a need for widely accessible biomarkers to identify and track the neurobiological and pathophysiological development of mental health conditions, including SSD. High-throughput omics applications involving the use of liquid chromatography-mass spectrometry (LC-MS) are driving a surge in biological data generation, providing systems-level insight into physiological and pathogenic conditions. Lipidomics is an emerging subset of metabolomics, largely underexplored amongst the omics systems. Lipid profiles in the brain are highly enriched with well-established functions, including maintenance, support, and signal transduction of neuronal signaling pathways, making them a prospective and exciting source of biological material for neuropsychiatric research. Importantly, changes in the lipid composition of the brain appear to extend into the periphery, as there is evidence that circulating lipid alterations correlate with alterations of psychiatric condition(s). The relative accessibility of fluid lipids offers a unique source to acquire a lipidomic “footprint” of molecular changes, which may support reliable diagnostics even at early disease stages, prediction of treatment response and monitoring of treatment success (theranostics). Here, we summarize the latest fluid lipidomics discoveries in SSD-related research, examining the latest strategies to integrate information into multi-systems overviews that generate new perspectives of SSD-related psychosis identification, development, and treatment.

How to Mitigate Risk of Premature Cardiovascular Disease Among Children and Adolescents with Mental Health Conditions.

Purpose of ReviewThe goal of this article is to characterize the myriad of ways that children with mental health conditions can be at risk for premature cardiovascular disease (CVD) and various modalities to ameliorate this risk in childhood in order to improve the life course of these children.Review FindingsChild and adolescent mental health conditions are a common yet underrecognized risk factor for premature CVD. The American Heart Association has recently included psychiatric conditions as a CVD risk factor (CVDRF) and the evidence linking childhood adversity to cardiometabolic disease. There are bidirectional and additive effects from the intrinsic emotional dysregulation and inflammatory changes from the mental health condition, the associations with risky health behaviors, and in some cases, metabolic side effects from pharmacotherapy. These pathways can be potentiated by toxic stress, a physiologic response to stressors from childhood adversity. Toxic stress is also associated with development of mental health conditions with epigenetic effects that can result in transgenerational inheritance of cardiometabolic risk. Exposure to toxic stress and mental health conditions in isolation sometimes compounded by pharmacotherapies used in treatment increase the risk of cardiometabolic diseases in childhood. The multiple pathways, which adversely influence cardiometabolic outcomes, encourage clinicians to consider strategies to mitigate these factors and justify the importance of early screening and treatment for CVDRFs.SummaryMental health, health behaviors, and environmental factors co-occur and intersect in complex pathways that can increase CVD risk over the lifespan. Early detection and response can mitigate the risks associated with premature development of CVD.

Financial Hardship Impacts Depression and Anxiety Among U.S. Patients with Sinusitis.

Mental health conditions are common in the United States, and recent efforts have examined the development of mental health conditions among patients with sinusitis. The purpose of this study was to investigate the association between depression, anxiety, and financial hardship among patients with sinusitis. Cross-sectional study using the 2018 National Health Interview Survey (NHIS). Data regarding demographics, perceived financial hardship, self-reported depression and anxiety, mental healthcare utilization, and treatment compliance were obtained. Among patients with sinusitis (N = 28 million adults), 9% reported depression and 24% reported anxiety. Sinusitis patients with depression and anxiety reported an increased severity of financial insecurity (p < 0.001). On multivariable logistic regression, worsening financial insecurity increased the odds of depression and anxiety. Patients reporting the highest financial insecurity severity had the highest odds of depression (OR = 3.88, 95% CI = 3.84-3.93, p < 0.001) and anxiety (OR = 2.09, 95% CI = 2.08-2.10, p < 0.001) among measures of financial stress. Specific financial stressors were independently associated with patient-reported depression and anxiety. Sinusitis patients with increased financial insecurity were more likely to require mental health services and treatment (p < 0.001), but were also more likely to report cost-related treatment noncompliance (p < 0.001) and reduced access to mental healthcare due to costs (p < 0.001). Perceived financial hardship is associated with self-reported depression and anxiety among patients with sinusitis. Sinusitis patients with financial hardship also face challenges in accessing and maintaining mental health services and treatment due to costs. Understanding the burden of financial insecurity on mental health and access to treatment may improve quality of care through the development of screening tools and individualized treatment strategies.

Psychological Impact of the COVID-19 Pandemic on Pregnant Women: A Scoping Review.

During the gestation period, pregnant women experience physical and psychological changes, which represent vulnerability factors that can boost the development of mental health conditions. The COVID-19 pandemic is producing new changes in the routines of the whole society, especially on lifestyle habits. The psychological impact associated with the COVID-19 pandemic and pregnant women remains unclear. A scoping review regarding the psychological impact of the COVID-19 pandemic on pregnant women was conducted. Searchers were conducted using the PubMed, Web of Science and CINAHL databases. Articles in Spanish, English and French were included. The search was conducted between November 2020 and September 2021. We identified 31 studies that evaluated 30,049 expectant mothers during the COVID-19 pandemic. Pregnant women showed high levels of anxiety and depression symptomatology. Fear of contagion and concerns regarding the health of the fetus were identified as the main variables related to psychological distress. An increase of the levels of depression, anxiety and stress during the COVID-19 pandemic amongst pregnant women has been observed. Moreover, an increased vulnerability of the fetus due to placental metabolic alterations is discussed. This review suggests that the COVID-19 pandemic is associated with a negative psychological impact on pregnant women. Thus, high levels of anxiety and depression symptoms suggest the need for a systematic approach.

Long-term Mental Health Trajectories of Injured Military Servicemembers: Comparing Combat to Noncombat Related Injuries.

We sought to quantify the impact of injury characteristics and setting on the development of mental health conditions, comparing combat to noncombat injury mechanisms. Due to advances in combat casualty care, military service-members are surviving traumatic injuries at substantial rates. The nature and setting of traumatic injury may influence the development of subsequent mental health disorders more than clinical injury characteristics. TRICARE claims data was used to identify servicemembers injured in combat between 2007 and 2011. Controls were servicemembers injured in a noncombat setting matched by age, sex, and injury severity. The rate of development, and time to diagnosis [in days (d)], of 3 common mental health conditions (post-traumatic stress disorder, depression, and anxiety) among combat-injured servicemembers were compared to controls. Risk factors for developing a new mental health condition after traumatic injury were evaluated using multivariable logistic regression that controlled for confounders. There were 3979 combat-injured servicemember and 3979 matched controls. The majority of combat injured servicemembers (n = 2524, 63%) were diagnosed with a new mental health condition during the course of follow-up, compared to 36% (n = 1415) of controls ( P < 0.001). In the adjusted model, those with combat-related injury were significantly more likely to be diagnosed with a new mental health condition [odds ratio (OR): 3.18, [95% confidence interval (CI): 2.88-3.50]]. Junior (OR: 3.33, 95%CI: 2.66-4.17) and senior enlisted (OR: 2.56, 95%CI: 2.07-3.17) servicemem-bers were also at significantly greater risk. We found significantly higher rates of new mental health conditions among servicemembers injured in combat compared to service-members sustaining injuries in noncombat settings. This indicates that injury mechanism and environment are important drivers of mental health sequelae after trauma.

PTSD in jewish holocaust survivors’ as a risk factor in the development of mental health conditions in their offspring

IntroductionTransgenerational transmission of trauma (TTT) describes the residual ‘presence of the past’ through generations. This phenomenon has an established evidence base with Holocaust survivors (HS) and their offspring, who are hypothesised to be at a greater risk of psychiatric conditions. This advanced literature review explores the relationship between Post Traumatic Stress Disorder (PTSD) in survivors and mental health conditions (MHC) in survivor’s offspring.ObjectivesThe objective is to review the literature, looking for evidence of TTT and exploring the mechanisms of action of such phenomenon.MethodsAn advanced search was performed in three databases; Medline, Ovid PsycInfo and the Yehuda Schwarzbaum Online library using the following search terms; (Post Traumatic Stress Disorder OR PTSD) AND (Holocaust OR Shoah) AND (Offspring OR Children)’. 190 articles were identified and a following 163 were excluded. 26 studies were reviewed.ResultsParental PTSD is circumstantially influential in parenting and attachment quality. Unfavourable attachments in offspring are associated with psychiatric conditions. Furthermore, poor health behaviour can be transmitted; for example, poor diet is an independent risk factor for depression. Psychopathology may pass intergenerationally; parental PTSD increases the risk of developing PTSD in response to one’s trauma. Parental PTSD can also result in impaired cortisol function and epigenetic changes.ConclusionsPTSD in HS is an important risk factor for development of MHC in offspring. However, this does not mean all offspring develop MHC. The variability in offspring proneness to psychiatric conditions may reflect specific vulnerabilities. Further research is pertinent for an understanding of TTT. The poster will discuss clinical value.

Racial and ethnic disparities in mental health care

Inequalities exist across many areas of healthcare but are particularly evident in mental health settings, where healthcare professionals can restrict choices to hospital stays and treatments. Racism, as well as socioeconomic inequalities, which more frequently affect patients from certain ethnic groups, are also risk factors for the development of mental health conditions. This article […]

Threats to Mental Health and Well-Being Associated with Climate Change

Climate change is a contributor to extreme weather events and natural disasters. The mental health effects of climate change are multifaceted, with post-traumatic stress disorder and depression predominant. This paper aims to describe the impact of climate change on mental health conditions, including risk and protective factors related to the expression of mental health conditions post-disaster, as well as a discussion of our local experience with a devastating wildfire to our region within Canada. The risk of the development of mental health conditions post-disaster is not equally distributed; research has consistently demonstrated that specific risk factors (e.g., gender, socioeconomic status and education, pre-existing mental health symptomatology), are associated with increased vulnerability to mental health conditions following natural disasters. There are multiple strategies that must be undertaken by communities to enhance adjustment and coping post-disaster, including improved access to care, inter-agency cooperation, enhanced community resiliency, and adequate preparation.

Maximizing the use of social and behavioural information from secondary care mental health electronic health records.

The contribution of social and behavioural factors in the development of mental health conditions and treatment effectiveness is widely supported, yet there are weak population level data sources on social and behavioural determinants of mental health. Enriching these data gaps will be crucial to accelerating precision medicine. Some have suggested the broader use of electronic health records (EHR) as a source of non-clinical determinants, although social and behavioural information are not systematically collected metrics in EHRs, internationally. In this commentary, we highlight the nature and quality of key available structured and unstructured social and behavioural data using a case example of value counts from secondary mental health data available in the UK from the UK Clinical Record Interactive Search (CRIS) database; highlight the methodological challenges in the use of such data; and possible solutions and opportunities involving the use of natural language processing (NLP) of unstructured EHR text. Most structured non-clinical data fields within secondary care mental health EHR data have too much missing data for adequate use. The utility of other non-clinical fields reported semi-consistently (e.g., ethnicity and marital status) is entirely dependent on treating them appropriately in analyses, quantifying the many reasons behind missingness in consideration of selection biases. Advancements in NLP offer new opportunities in the exploitation of unstructured text from secondary care EHR data particularly given that clinical notes and attachments are available in large volumes of patients and are more routinely completed by clinicians. Tackling ways to re-use, harmonize, and improve our existing and future secondary care mental health data, leveraging advanced analytics such as NLP is worth the effort in an attempt to fill the data gap on social and behavioural contributors to mental health conditions and will be necessary to fulfill all of the domains needed to inform personalized interventions.

Duck Syndrome, Social Media, and Struggling Together

Back to table of contents Previous article Next article Residents’ ForumFull AccessDuck Syndrome, Social Media, and Struggling TogetherMatthew Fadus,M.D.Matthew Fadus,Search for more papers by this authorM.D.Published Online:14 Sep 2018https://doi.org/10.1176/appi.pn.2018.9b22AbstractMatthew C. Fadus, M.D., is a third-year resident at the Medical University of South Carolina and an APA Child and Adolescent Psychiatry fellow.Ducklings don’t swim: they glide. Although their elegant swimming appears effortless, underneath the surface they frantically paddle their feet, awkwardly thrashing at the water below. In college, students can appear to glide throughout their day much like ducklings: balancing academics, internships, social obligations, and family responsibilities without a hint of struggle or distress. However, much like the thrashing of duckling feet, feelings of anxiety and self-doubt aren’t easily observed among students who appear to handle any adversity that college has thrown at them.The term “duck syndrome” has been used to describe students’ abilities to appear superficially calm while suppressing any distress, depression, or anxieties of self-doubt. It is commonly observed among adolescents and college students, particularly those in high-achieving environments. What is particularly concerning about these types of behaviors is that they can create an atmosphere that leads others to be hesitant to speak out about their own difficulties, particularly those related to mental health.The impression of achievement without struggle or effort can be intensified even further with the use of social media, which allows users to post carefully curated images to represent their lives in a way that they would want others to know it. For example, students are much more likely to post images of travel (enhanced with a filter, of course) and socializing with peers than they are to post images of their late nights in the library or the rejection letter from their long-sought-after internship. With maladaptive viewing, students may become overwhelmed with their peers’ deliberate representation of academic and social successes on social media and believe they are the only ones awkwardly paddling and struggling in college. The 2014 suicide of University of Pennsylvania freshman Madison Holleran was a disheartening contrast between reality and its representation on social media. Madison’s Instagram account remains open to public viewing to allow an appreciation of the life she lived, as well as to raise awareness about the silence and stigma associated with suicide and how life on social media may not accurately reflect the struggles that one may be going through. College is a high-risk period for the development of mental health conditions, and young men and women in their teens and 20s are already at an elevated risk regardless of college attendance. According to research reports, bipolar disorder, anxiety disorders, and schizophrenia have the highest rate of development during this vulnerable period of identity and development, and the pressures of academics, new relationships, substance use, risky behaviors, and social comparisons of college can exacerbate or trigger mental health conditions.More and more students are seeking help, and university counseling centers are struggling to keep up. Between 2009 and 2015, the number of students visiting counseling centers increased by about 30 percent on average, while enrollment in universities grew by less than 6 percent. Only half of four-year universities have an on-campus psychiatrist, and many universities have waiting periods of up to four weeks for an initial evaluation, especially around difficult times of the academic year such as midterms and finals. Although the need for increasing mental health resources is evident, a cultural shift of openness and honesty can help mitigate stigma and improve the atmosphere of many undergraduate institutions. Embracing the idea that everyone is struggling together would allow for a culture of self-reflection and transparency and promote healthy dialogue about mental health. Rather than pretending to effortlessly glide across the pond, students should feel comfortable sharing their struggles, as paddling and thrashing under the water are difficult—and even more so when you believe you are the only one doing it. ■ ISSUES NewArchived

Trajectory of achievement in primary school and development of mental health conditions in adolescence: a cohort study using linked health and education data

BackgroundLittle is known about how mental health in primary school affects subsequent adolescent mental health. This study examined the effect of education in primary school on development of mental health conditions. MethodsThis cohort study of all children in Wales between 1999 and 2014 used routine data from general practice and hospital data linked with education records held in the Secure Anonymised Information Linkage (SAIL) databank. Cox regression was used, controlling for sex, deprivation, conduct disorder, attention deficit hyperactivity disorder, and learning difficulty. FindingsHealth records of 652 903 children (319 839 boys, 307 584 girls) were linked with educational records: between the ages of 12 and 21 years, 33 498 children (5·1%) developed depression, 15 946 (2·4%) self-harmed, and 2183 (0·3%) had eating disorders. 10 458 boys (3·2%) and 23 040 girls (7·5%) had diagnosed depression during their childhood, and 10 550 boys (3·3%) and 21 278 girls (6·9%) were given an antidepressant. Children who developed depression were more likely than those not developing depression to have passed key stage 1 (age 7 years) (adjusted hazard ratio [HR] 1·19, 95% CI 1·08–1·30) but not key stage 2 (age 11) (0·76, 0·69–0·83), indicating that they were declining in primary school education. Conversely those who self-harmed (4736 boys [1·5%], 11 210 girls [3·6%]) were achieving as well as those who did not self-harm (1·02, 0·92–1·12). In children with an eating disorder, only female sex was associated with development of the disorder (10·5, 7·55–14·5), and educational achievement was not significantly different from those without the disorder (1·16, 0·82–1·63). However, at key stage 3 (age 14) children with eating disorders achieved well in secondary school (1·42, 1·2–1·7). InterpretationThe trajectory of achievement in primary school is very different for children who develop depression, self-harm, or eating disorders. Those who developed depression were deprived children declining in primary school education; those who self-harmed were deprived children improving in primary educational achievement. However, eating disorders were not associated with education or deprivation in primary school but associated with high achievement in secondary school. FundingNational Centre for Population Health and Wellbeing Research.