Midlife Health Research Articles

A Detailed Biological Approach on Hormonal Imbalance Causing Depression in Critical Periods (Postpartum, Postmenopausal and Perimenopausal Depression) in Adult Women

Background:In today's global world, most women are experiencing midlife health problems which can affect their lives and mental status. Most of the diseases occurr after childbirth and during pregnancy or gestation period which can lead to severe problems such as postpartum depression (PPD), postmenopausal depression, perimenopausal depression which ultimately affects the mental health condition and develop various depressive episodes which ultimately lead to depression in women.Objective:The review paper gives the information that if there is untreated maternal depression then it can lead to anxiety, fear, negative effect on child development, disruption of the mother-infant relationship, and the occurrence of depressive symptoms in the early life of infants. Hormone levels are changed at the time of pregnancy.Methods:The data was collected by studying combination of research and review papers from different databases like PubMed, Medline, and Web of science by using search keywords like “Postpartum depression”, “Postmenopausal depression”, “Risk factors”, “Pathogenesis of PPD”, “Predictors of postpartum depression”.Results:This can lead to disrupting the quality of life of menopausal women like deficiency of nutrients, not properly regular physical activities, elevated Body Mass Index (BMI), loss of libido (loss of interest in sexual activities), due to the lack of education, and awareness among the people. Factors like increase in physical activity can naturally help in PPD condition. Mind body therapy, drug therapy and cognitive and mindfulness-based therapies help in hormonal imbalances.Conclusion:It was found that low birth weight and congenital abnormalities in babies lead to affect depression after delivery. It is recommended that health care providers and physicians are provided with information regarding factors contributing PPD and postmenopausal depression. Sleep timings and consumptions of nutraceuticals can help in natural healing with depression amongst women suffering from postpartum, postmenopausal and perimenopausal depression.

Forecasting mortality inequalities in the U.S. based on trends in midlife health

Recent literature has documented a widening gap in mortality between older individuals of high versus low socioeconomic status (SES) in the U.S. This paper investigates whether this trend will continue. We analyze the health status of successive cohorts of 54–60-year-old U.S. individuals born between 1934 and 1959 and use a rich set of health indicators to forecast life expectancies. The detailed health measures come from the longitudinal Health and Retirement Study. We find that many health indicators have worsened recently. For example, rates of obesity, diabetes, and self-reported levels of pain sharply increased between 1992 and 2016. Directly relevant for mortality, recent cohorts report lower subjective survival probabilities. Using Social Security wealth as an SES indicator, we find strong evidence for increasing health inequalities. We predict overall life expectancy to increase further; but the increase will be concentrated among higher SES individuals and mortality inequality will continue to increase.

Sexual health in parous women with a history of polycystic ovary syndrome: A national cross-sectional study in Denmark.

To examine associations between polycystic ovary syndrome (PCOS) and sexual health in midlife. We included 31645mothers from the Danish National Birth Cohort who participated in a Maternal Follow up in 2013-14. A lifetime PCOS diagnosis was self-reported. Sexual health was assessed by specific sexual problems including reduced sexual desire, insufficient lubrication, difficulty in obtaining orgasm, vaginismus and pain during intercourse within the past year. We also generated a combined outcome which was positive if the women reported one or more sexual problems. Logistic regression was used to estimate adjusted odds ratios (aOR) for sexual problems with 95% confidence intervals (CI). Participants were on average 44years old, and 920 women (2.9%) had ever had PCOS. One or more sexual problems were more often reported in women with PCOS compared with other women (42.6% versus 36.3%, aOR 1.29, 95% CI 1.13-1.48). Especially reduced sexual desire (25.6% versus 21.0%, aOR 1.29, 95% CI 1.10-1.50) and dyspareunia (11.4% versus 8.7%, aOR 1.34, 95% CI 1.09-1.66) were more frequent in women with PCOS. These associations were slightly weakened when further adjusting for mental and somatic health problems. Our data suggest that PCOS is linked to long-term impaired sexual health, especially reduced sexual desire and dyspareunia.

Associations Between Cardiorespiratory Fitness, Cardiovascular Risk, and Cognition Are Mediated by Structural Brain Health in Midlife.

BackgroundEvidence in older adults suggests that higher cardiorespiratory fitness and lower cardiovascular risk are associated with greater cognition. However, given that changes in the brain that lead to cognitive decline begin decades before the onset of symptoms, understanding the mechanisms by which modifiable cardiovascular factors are associated with brain health in midlife is critical and can lead to the development of strategies to promote and maintain brain health as we age.Methods and ResultsIn 501 middle‐aged (aged 40–65 years) adult participants of the BBHI (Barcelona Brain Health Initiative), we found differential associations among cardiorespiratory fitness, cardiovascular risk, and cognition and cortical thickness. Higher cardiorespiratory fitness was significantly associated with better visuospatial abilities and frontal loading abstract problem solving (β=3.16, P=0.049) in the older middle‐aged group (aged 55–65 years). In contrast, cardiovascular risk was negatively associated with better visuospatial reasoning and problem‐solving abilities (β=−0.046, P=0.002), flexibility (β=−0.054, P<0.001), processing speed (β=−0.115, P<0.001), and memory (β=−0.120, P<0.001). Cortical thickness in frontal regions mediated the relationship between cardiorespiratory fitness and cognition, whereas cortical thickness in a disperse network spanning multiple cortical regions across both hemispheres mediated the relationship between cardiovascular risk and cognition.ConclusionsThe relationships between modifiable cardiovascular factors, cardiorespiratory fitness, and cardiovascular risk, and cognition are present in healthy middle‐aged adults. These relationships are also mediated by brain structure highlighting a potential mechanistic pathway through which higher cardiorespiratory fitness and lower cardiovascular risk can positively impact cognitive function in midlife.

Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood. This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood. This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020. Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health. Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife. The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.

Sexual Identity and Self-Rated Health in Midlife: Evidence from the Health and Retirement Study.

Purpose: This study examined health disparities among U.S. sexual minority people in midlife—a critical life course stage that is largely overlooked in the sexual minority health literature.Methods: Data were drawn from the 2016 Health and Retirement Study. We restricted the analysis to respondents aged 50–65. The final sample consisted of 3623 respondents, including 3418 self-identified heterosexual individuals, 99 self-identified gay/lesbian individuals, 38 self-identified bisexual individuals, and 68 respondents who identified as “something else.” Ordinal logistic regression models were estimated to predict the odds of reporting better health.Results: Bisexual midlifers reported significantly worse health than their heterosexual counterparts after age, gender, and race-ethnicity are controlled for (OR=0.43, 95% CI=0.25–0.76); this health disparity is mostly explained by marital status, socioeconomic status, and health behaviors (in particular smoking and exercising). We did not find evidence of a self-rated health disadvantage among gay and lesbian midlifers relative to their heterosexual counterparts.Conclusion: These findings highlight the diversity of the sexual minority population in midlife. Public policies and programs should be designed and implemented at the interpersonal and institutional levels to eliminate health and other social disadvantages among sexual minority people, in particular bisexual people, in midlife.

Historical change in midlife health, well-being, and despair: Cross-cultural and socioeconomic comparisons.

Recent empirical evidence has documented that U.S. middle-aged adults today are reporting lower mental and physical health than same-aged peers several decades ago. Individuals who attained fewer years of education have been most vulnerable to these historical changes. One overarching question is whether this phenomenon is confined to the U.S. or whether it is transpiring across other high-income and upper-middle-income nations. To examine this question, we use nationally representative longitudinal panel data from 5 nations across different continents and cultural backgrounds (U.S., Australia, Germany, South Korea, and Mexico). Results revealed historical improvements in physical health for people in their 40s and early 50s across all five nations. Conversely, the direction of historical change in mental health vastly differed across nations. Later-born cohorts of U.S. middle-aged adults exhibit worsening mental health and cognition. Australian middle-aged adults also experienced worsening mental health with historical time. In contrast, historical improvements for mental health were observed in Germany, South Korea, and Mexico. For U.S. middle-aged adults, the protective effect of education diminished in later-born cohorts. Consistent across the other nations, individuals with fewer years of education were most vulnerable to historical declines or benefited the least from historical improvements. We discuss potential reasons underlying similarities and differences between the U.S. and other nations in these historical trends and consider the role of education. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Use of Lead-glazed Ceramics and Bone Health in Adult Women

BACKGROUND AND AIM: One of the main sources of lead (Pb) exposure in Mexico is the use of lead-glazed ceramics (PbC). Exposure to Pb is associated with a decrease in bone mineral density (BMD) and bone mass in adults. Our aim was to evaluate the association between use of PbC and bone health in adult women. METHODS: Our cross-sectional study comprised 101 women from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohort. Women reported the use of PbC (yes/no) in the past 3 months. BMD was measured by dual-energy X-ray absorptiometry and bone matrix by ultrasound (speed of sound; SOS). We used z-scores from BDM and SOS to create quantity (normal bone: both z-scores between -1 and 1; less abundant (LA): both -1; and more abundant (MA): both 1) and quality (normal bone: absolute difference between z-scores ≤.5 standard deviations (SD); rigid bone(RB): BMD .5 SD of SOS; softer bone (SB): SOS z-score .5 SD of BMD) indexes for cortical and trabecular bone. Multinomial logistic regressions (normal bone as reference outcome category) were performed to estimate the association between use of PbC and the quantity and quality of cortical and trabecular bone, adjusting for age, menopause, socioeconomic status, physical activity, body mass index and gynoid adiposity. RESULTS:Use of PbC was associated with lower odds of MA cortical bone (OR: 0.28, p=0.05 ) and marginally significant odds of cortical SB (OR: 0.31 p=0.1). Null associations were found for the rest of the bone indexes, however the direction of the estimates were opposite with trabecular bone being 1 whereas cortical bone estimates were 1. CONCLUSIONS:Findings from this pilot study suggest that use of PbC, as a proxy of lead exposure, may influence bone health in midlife and should be examined using a lead biomarker and in a larger sample. KEYWORDS: lead-glazed ceramics, bone health, women

Utilizing Principles of Life-Span Developmental Psychology to Study the Complexities of Resilience Across the Adult Life Span.

Life-span developmental psychology includes a broad array of principles that have wide application to studying adult development and aging. Three principles have guided my past, current, and future research: (a) development being a cumulative, lifelong process with no one period taking precedence; (b) multiple processes influence development (e.g., age-, pathology-, nonnormative, and mortality-related processes); and (c) development is multidirectional and multidimensional. This paper elaborates on how these principles have guided my research studying resilience to adversity across the adult life span and how my research aligns with guiding elements of resilience across definitions and literatures. I also discuss my current and future research of applying these principles to studying resilience in midlife, which emphasizes how the defining features of midlife lend themselves to examining resilience, midlife continues to not be well understood, midlife health foreshadows health in old age, and the experience of midlife will evolve in the context of an increasingly diverse society. The last section elaborates on additional directions for future research, such as the promise of intensive longitudinal research designs that incorporate qualitative approaches and examining historical changes in midlife health and well-being. In conclusion, a life-span developmental psychology framework has wide application for elucidating the nature of resilience across the adult life span through the integration of its principles with existing paradigms and research designs that blend contemporary methods with mixed methodology.

Changes in the adult consequences of adolescent mental ill-health: findings from the 1958 and 1970 British birth cohorts.

Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time. Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors. The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65-1.99), OR 1958 = 1.60 (1.43-1.79)], cohabitation [OR 1970 = 0.64 (0.59-0.70), OR 1958 = 0.79 (0.72-0.87)], and professional occupations [OR 1970 = 0.75 (0.67-0.84), OR 1958 = 1.05 (0.88-1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms. The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.

Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life.

BackgroundResearch on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities.MethodsUsing the Health and Retirement Study, we characterize the functional impairment histories of a nationally representative sample of 8464 older adults between 1994 and 2016. We employ nonparametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition.ResultsExposures to disadvantages are associated with poorer functional health in midlife and mortality. However, a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for White men and women and for Black women. The impact of educational attainment, occupation, wealth, and marriage on later-life health differs across race and gender groups.ConclusionsObserved stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.

Varieties of Financial Stressors and Midlife Health Problems.

Financial stressors such as wealth loss, indebtedness, and bankruptcy have gained the attention of public health scholars since the Great Recession. In this study, we extend this area of research by comparing the mental and physical impact of multiple financial stressors during midlife, a pivotal period in the life course for wealth accumulation and disease onset. With data from the National Longitudinal Survey of Youth 1979 (www.nlsinfo.org), an ongoing survey of adult men and women in the U.S., we used logistic regression to estimate the associations between financial stressors and the risk of a psychiatric disorder or high blood pressure diagnosis from ages 31-39 in 1996 to ages 50-59 in 2016 (N = 7,143). Financial stressors include multiple types of wealth loss, debt, and bankruptcy. Even after adjusting for a comprehensive set of confounders, many of the financial stressors we considered had similar associations with the risk of a psychiatric disorder, whereas only debt and bankruptcy were associated with the risk of high blood pressure. The best fitting models for both health outcomes included a simple indicator of indebtedness. Stock losses were not significantly associated with either health outcome. Given the recent volatility in the U.S. economy, our results highlight the potential loss of health that may occur if nothing is done to prevent economically vulnerable populations from sliding into financial crisis. Our results also emphasize the need for additional research to develop individual-level interventions to improve health among those already experiencing financial difficulties.

Trajectories of unsecured debt and health at midlife

BackgroundUnsecured debt — debt not tied to an asset — is a financial stressor that undermines health, but prior research has not investigated relationships between group-based trajectories of unsecured debt and pain and disability at midlife. MethodsUS respondents of the National Longitudinal Study of Youth-1979 cohort reported unsecured debt and income between ages 28–40. We used these measures to identify group-based trajectories of unsecured debt and unsecured debt-to-income ratio. We then used trajectory membership to predict three pain and disability-related health outcomes at age 50, adjusting for lagged health and other covariates. ResultsGroup-based trajectory models divided the sample of 7850 respondents into 6 unsecured debt trajectories and 5 unsecured debt-to-income trajectories. In fully adjusted unsecured debt models, compared to people with constant low debt, those who paid down debt over time, carried constant debt, experienced debt cycling, or accumulated debt later in life were more likely to report pain interference with activities or joint pain or stiffness at age 50 (pain interference ORs ranging from 1.33 to 1.76; joint pain or stiffness ORs ranging from 1.27 to 1.45). In fully adjusted unsecured debt-to-income models, compared to those with constant low debt, those with constant high debt or accumulating debt later in life were more likely to report pain interference or joint pain or stiffness (pain interference ORs ranging from 1.30 to 1.91; joint pain or stiffness ORs ranging from 1.19 to 1.33). ConclusionThe amount, timing, and duration of unsecured debt accumulation and repayment have important health implications and may exacerbate midlife health inequalities.

Long-term Consequences of Criminal Justice System Intervention: The Impact of Young Adult Arrest on Midlife Health Behaviors.

While there is a growing literature on the relationship between incarceration and health, few studies have expanded the investigation of criminal justice system involvement and health to include the more common intervention of arrest. This study uses a quasi-experimental design to evaluate the long-term effect of arrest in young adulthood on health behaviors in midlife for African Americans. We use propensity score matching methods and gender-specific multivariate regression analyses to equate those who did and did not incur an arrest in young adulthood from a subsample (n = 683) of the Woodlawn cohort, an African American community cohort followed from childhood into midlife. The results suggest that, for men, having been arrested in young adulthood has a direct effect on smoking, daily drinking, and risky sexual behaviors into midlife while young adult arrest does not seem to impact midlife health risk behaviors for women. This study adds health risk behaviors to the growing list of detrimental outcomes, such as crime, drug use, education, and mental health that are related to criminal justice contact for African American men, in particular.

Impact of dietary carbohydrate type and protein-carbohydrate interaction on metabolic health.

Reduced protein intake, through dilution with carbohydrate, extends lifespan and improves mid-life metabolic health in animal models. However, with transition to industrialised food systems, reduced dietary protein is associated with poor health outcomes in humans. Here we systematically interrogate the impact of carbohydrate quality in diets with varying carbohydrate and protein content. Studying 700 male mice on 33 isocaloric diets, we find that the type of carbohydrate and its digestibility profoundly shape the behavioural and physiological responses to protein dilution, modulate nutrient processing in the liver and alter the gut microbiota. Low (10%)-protein, high (70%)-carbohydrate diets promote the healthiest metabolic outcomes when carbohydrate comprises resistant starch (RS), yet the worst outcomes were with a 50:50 mixture of monosaccharides fructose and glucose. Our findings could explain the disparity between healthy, high-carbohydrate diets and the obesogenic impact of protein dilution by glucose-fructose mixtures associated with highly processed diets.

A Longitudinal Investigation Into Marital Quality as a Mediator Linking Childhood Abuse to Affective Symptoms.

Childhood abuse is positively associated with adult mental health problems and adult interpersonal relationships have been previously suggested to be a mediator. The role of marital partners, however, is less well understood. The current study will investigate marital quality as a mediator linking childhood abuse and positive and negative affective symptoms. The current study utilized 3 waves of data from the Midlife Development in the United States. Using a sample of 1,104 married adults (95.4% White), structural equation modeling examined the mediating effect of marital quality linking childhood abuse to positive and negative affective symptoms over a 20-year period. Structural equation modeling revealed that childhood abuse was inversely associated with marital quality but was not directly associated with positive or negative affective symptoms. Marital quality was positively associated with greater positive affect and negatively associated with lower negative affect over a 9-year period, controlling for prior symptoms. Tests of indirect effects indicate that marital quality mediated the relationship between childhood abuse to both positive and negative affective symptoms, fully accounting for the association. It appears that childhood abuse impacts the quality of adults' marriages, which may have significant implications for both positive and negative aspects of adult mental health. Marriages may be an important factor in understanding mental health in midlife and older adults among adults who were abused. Interventions should target the quality of adult marriages, and focusing on marital support, strain, and disagreement may be particularly effective.

Lower Cardiovascular Reactivity is Associated with More Childhood Adversity and Poorer Midlife Health: Replicated Findings from the Dunedin and MIDUS Cohorts.

Cardiovascular reactivity has been proposed as a biomarker linking childhood adversity and poorer health. The current study examined the association of childhood adversity, cardiovascular reactivity, and health in the Dunedin (n=922) and MIDUS studies (n=1,015). In both studies, participants who experienced more childhood adversity had lower cardiovascular reactivity. In addition, people with lower cardiovascular reactivity had poorer self-reported health and greater inflammation. Dunedin participants with lower cardiovascular reactivity were aging biologically faster, and MIDUS participants with lower heart rate reactivity had increased risk of early mortality. Cardiovascular reactivity was not associated with hypertension in either study. Results were partially accounted for by greater reactivity among more conscientious, less depressed, and higher-functioning participants. These results suggest that people who experienced childhood adversity have a blunted physiological response, which is associated with poorer health. The findings highlight the importance of accounting for individual differences when assessing cardiovascular reactivity using cognitive stressor tasks.

Unmet healthcare needs among midlife adults with mental distress and multiple chronic conditions

Background Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health. Objective To examine unmet healthcare needs among midlife adults (50–64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC). Methods Nationally representative data for midlife adults (50–64 years) from NHIS 2014–2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status. Results Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1–5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5–9.1), prescriptions (AOR = 4.8, 95% CI 3.9–5.9), or follow-up care (AOR = 5.0, 95% CI 3.7–6.6), and three to four times higher odds of all other types of foregone care. Conclusions Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course.

Mental health crisis in midlife – a proposed research agenda

There is a growing amount of evidence indicating increased levels of psychological distress, suicide rates and decreased well-being in midlife (age 45-55). We refer to this phenomenon as the ‘midlife mental health crisis’. As there is little empirical evidence or theoretical grounds to explain the midlife mental health crisis, we propose a research agenda. In order to facilitate further research, we consulted members of public, mental health professionals and researchers on potential reasons for the midlife mental health crisis. Subsequently, we translated those into research questions testable with the British birth cohorts. We propose a series of studies using three statistical modelling approaches: descriptive (what is the midlife mental health crisis?), predictive (who is at increased risk of experiencing the midlife mental health crisis?) and explanatory (what are the processes leading to the midlife mental health crisis?).

Midlife vascular risk factors and risk of incident dementia: Longitudinal cohort and Mendelian randomization analyses in the UK Biobank.

Midlife clustering of vascular risk factors has been associated with late-life dementia, but causal effects of individual biological and lifestyle factors remain largely unknown. Among 229,976 individuals (mean follow-up 9 years), we explored whether midlife cardiovascular health measured by Life's Simple 7 (LS7) is associated with incident all-cause dementia and whether the individual components of the score are causally associated with dementia. Adherence to the biological metrics of LS7 (blood pressure, cholesterol, glycemic status) was associated with lower incident dementia risk (hazard ratio=0.93 per 1-point increase, 95% confidence interval [CI; 0.89-0.96]). In contrast, there was no association between the composite LS7 score and the lifestyle subscore (smoking, body mass index, diet, physical activity) and incident dementia. In Mendelian randomization analyses, genetically elevated blood pressure was associated with higher risk of dementia (odds ratio=1.31 per one-standard deviation increase, 95% CI [1.05-1.60]). These findings underscore the importance of blood pressure control in midlife to mitigate dementia risk.