Midlife Outcomes Research Articles

Sexual and physical abuse and depressive symptoms in the UK Biobank

BackgroundThe association between sexual and physical abuse and subsequent depression is well-established, but the associations with specific depressive symptoms and sex differences remain relatively understudied. We investigated the associations of sexual and physical abuse with depressive symptoms in men and women in a large population cohort.MethodsObservational study based on 151,396 UK Biobank participants. Exposures included self-reported experiences of childhood physical abuse and sexual abuse. Mid-life outcomes included current depressive symptoms score, individual depressive symptoms, and lifetime depression. We used logistic regression to test associations of childhood sexual/physical abuse with depressive outcomes.ResultsRecalled childhood sexual and physical abuse were both associated with current depressive symptoms score in adults. Results for individual symptoms-based analyses suggest that sexual and physical abuse are associated with all depressive symptoms, particularly suicidal behaviours. The associations between lifetime depression and sexual/physical abuse were not fully explained by current depressive symptoms score, indicating that these findings may not be fully attributable to recall bias. There was no indication of differential risk for specific depressive symptoms among men and women.ConclusionsSexual and physical abuse are robust risk factors for depression/depressive symptoms regardless of sex. Higher risk of suicidal behaviours associated with childhood sexual/physical abuse are of particular concern. Longitudinal research into sex-specific associations for individual depressive symptoms is required.

Adolescent and Childhood Obesity and Excess Morbidity and Mortality in Young Adulthood-a Systematic Review.

Rates of childhood obesity have been soaring in recent decades. The association between obesity in adulthood and excess morbidity and mortality has been readily established, whereas the association of childhood and adolescent obesity has not. The purpose of this review is to summarize existing data regarding the association of the presence of obesity in childhood/adolescence and early-onset adverse outcomes in adulthood, with specific focus on young adults under the age of 45 years. Diabetes, cancer, and cardiometabolic outcomes in midlife are closely linked to childhood and adolescent obesity. Childhood and adolescent obesity confer major risks of excess and premature morbidity and mortality, which may be evident before age 30 years in both sexes. The scientific literature is mixed regarding the independent risk of illness, which may be attributed to childhood BMI regardless of adult BMI, and additional data is required to establish causality between the two. Nonetheless, the increasing prevalence of childhood and adolescent obesity may impose an increase of disease burden in midlife, emphasizing the need for effective interventions to be implemented at a young age.

Delinquency abstainers in adolescence and educational and labor market outcomes in midlife: A population-based 25-year longitudinal study.

Research has suggested that adolescent delinquency abstainers might have unfavorable characteristics, impeding their access to peer networks. However, recent studies have emphasized the possible heterogeneity of abstainers. We know little about the long-term adaption of delinquency abstainers. We identify subtypes of delinquency abstainers and investigate subsequent adult academic careers, income levels, and possible marginalization in the labor market. We use the population-based Young in Norway Longitudinal study, where participants (N = 2,494) are followed up by surveys and registers from their teens until their mid-30s. By means of latent class analysis, abstainers were divided in three groups according to degree of social integration. Results showed that delinquency abstainers performed as well or better in adulthood than those with moderate delinquency involvement and markedly better than the highly delinquent. Lonely abstainers performed just as well as all other groups when it comes to higher education and earnings. However, they had a higher probability of marginalization in the labor market than the social abstainers. We conclude that no group fared better than delinquency abstainers with strong social ties. The outcomes of the lonely abstainers were close to those of the majority. Thus, in this cohort who came of age in the 1990s, delinquency abstainers are not particularly vulnerable, and theory about abstainers needs to be modernized. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The development of loneliness through adolescence and young adulthood: Its nature, correlates, and midlife outcomes.

Adolescence and young adulthood are characterized by substantial sociodemographic, family, social, and personality changes that may influence loneliness. Although loneliness is a public health challenge, we know little about how loneliness develops during these periods. Our study addresses this lacuna by using 4-wave longitudinal data from 3,116 Norwegians aged 13 to 31 years, making use of questionnaire (key facets and correlates of loneliness) and register linkage information (midlife outcomes). Analyses revealed that when asking directly about feeling lonely and for emotional facets, loneliness increased from early adolescence to age mid-20s, whereas social facets of loneliness declined gradually and plateaued when people had reached their mid-20s. Several predictors operated consistently across loneliness facets, whereas others operated in facet-specific ways. To illustrate, perceiving one's parents as caring, having close friends, not leaving the parental home before age 18, and reporting more agency were each associated with less loneliness across assessment modes. In contrast, when asked directly, women reported more loneliness than men at all ages, whereas men reported more social loneliness. Finally, adolescents and young adults who reported feeling lonely and/or increased in loneliness were consistently at higher risk for disability and lower income in midlife, whereas other important midlife outcomes including education, labor market inclusion, and prescriptions of antidepressants exhibited facet-specific associations. Our study is the first to provide a comprehensive picture of loneliness development throughout the second and third decade of life and highlights the multidimensionality and multidirectionality of loneliness trajectories and correlates across adolescence and early adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Forgiveness of others and subsequent health and well-being in mid-life: a longitudinal study on female nurses

BackgroundForgiveness is a concept of growing interest within psychology and of potential relevance to public health. While there has been increasing evidence suggesting positive associations between forgiveness of others and a range of psychosocial well-being and mental health outcomes, its associations with health behaviors and physical health are less clear.MethodsThis study used longitudinal data from the Nurses’ Health Study II (2008 Trauma Exposure and Post-traumatic Stress Supplementary Survey to 2015 questionnaire wave, N = 54,703), to conduct an outcome-wide analysis among a cohort of female nurses in the United States (age range: 43–64 years). The study prospectively examines the association between spiritually motivated forgiveness of others and a number of of subsequent psychosocial well-being, mental health, health behavior, and physical health outcomes in midlife. A set of linear, logistic, and Poisson regression models were used to regress each outcome on forgiveness in separate models. Sociodemographic factors, prior religious service attendance, and prior values of all outcome variables were controlled for wherever data were available. To account for multiple testing, we performed Bonferroni correction.ResultsForgiveness was associated with subsequent improved psychosocial well-being and reduced psychological distress outcomes in a monotonic pattern. For instance, the top versus bottom level of forgiveness was associated with substantially higher levels of subsequent positive affect (β = 0.18, 95% CI: 0.15, 0.21) and social integration (β = 0.15, 95% CI: 0.13, 0.17), and was inversely associated with several indicators of subsequent psychological distress such as depressive symptoms (β = − 0.16, 95% CI: − 0.19, − 0.14). However, in this sample, there was little evidence that forgiveness was associated with health behaviors or physical health outcomes.DiscussionThis study suggests that forgiveness may be a health asset for promoting population mental health and psychosocial well-being, and moreover may also be understood as a good in itself. Further investigation on the dynamics between forgiveness and physical health is warranted to explore the discrepancy between the results here and some past research.

Early predictors of mental health in mid-adulthood.

Substantial research has focused on the examination of factors that contribute to the development of psychiatric problems. However, much less is known about factors early in life that may protect from poor mental health outcomes in midlife. This study aimed to identify the extent to which a set of key perinatal demographic variables and adolescent academic performance were associated with good mental health in mid-adulthood. In a sample of 525 individuals (aged 34-44, 55.4% male) born and raised in Jerusalem, Israel (STREAM study) we attempted to differentiate those who did and did not report psychiatric symptoms in mid-adulthood. Using χ2 and regression analysis, we explored birth factors (year of birth, sex, birth weight, and number of older siblings, data on parental immigration and socioeconomic status), academic achievement in eighth grade and contemporaneous measures of lifestyle factors, personality traits, and perceived resilience. Participants with good mental health were more often male (P = .005) and had better academic performance already at adolescence than participants who reported psychiatric symptoms in midlife (P < .001). They reported fewer physical complaints (P = .008), were less likely to smoke (P = .001) and considered themselves to be more "resilient" (P < .001). The results showed that better academic performance in adolescence may be associated with better stress-coping strategies, resulting in fewer psychiatric complaints, more perceived resilience, and less stress-related behaviours in mid-adulthood. Future studies confirming this hypothesis could inform public mental health interventions.

Supplemental Material for The Development of Loneliness Through Adolescence and Young Adulthood: Its Nature, Correlates, and Midlife Outcomes

Supplemental Material for The Development of Loneliness Through Adolescence and Young Adulthood: Its Nature, Correlates, and Midlife Outcomes

MIDLIFE HEALTH FACTORS AND LATER-LIFE COGNITIVE DISEASE: RESULTS FROM THE 1998-2014 HEALTH AND RETIREMENT STUDY

Understanding lifecourse determinants of older-age health outcomes is indispensable for resources planning and optimizing public health in light of continued gains in longevity in the US and worldwide. Data increasingly points to midlife health and modifiable risk factors as critical targets for improving older-age health outcomes and mitigating potential cognitive impairment and disease. We used 16-years of biennial data (1998-2014) from the Health and Retirement Study (unweighted-n=6,724), to examine how a comprehensive battery of midlife (age 50-64 years) health measures (disability, physical function, comorbid conditions, and self-reported health) affect cognitive status (using Langa-Weir criteria: Normal, Cognitively Impaired Not Dementia (CIND), and Dementia) and death 16-years later. Additionally, we test for racial/ethnic and gender modifications in the effects of these conditions on the outcomes of interest. We used survey multinomial logistic regression models adjusting for predisposing sociodemographic factors, health-enabling economic characteristics and health behaviors. Relative risk ratios (RRR) across all unadjusted models varied from 1.36-4.84 and 1.36-3.31 for those with dementia and who died in 2014 respectively, suggesting worse health outcomes in midlife are associated with higher dementia/mortality risk in later-life. After covariates-adjustment, comorbidities (RRR=1.15[1.04,1.27]) and Self-reported Health (RRR=1.36[1.22,1.52]) were associated with CIND, and attenuation was particularly pronounced for IADLS (RRR=3.15[2.25,4.43]) and Fine Motor Skills (RRR=1.94[1.46,2.57]) for individuals with dementia in 2014. Neither sex nor race/ethnicity modified these associations. Modifying the midlife health profile of US adults can yield important public health savings and reductions in structural and social health burdens through extenuating the prevalence of dementias and reducing excess mortality.

Childhood Adoption and Mental Health in Adulthood: The Role of Gene-Environment Correlations and Interactions in the UK Biobank

BackgroundBeing adopted early in life, an indicator of exposure to early-life adversity, has been consistently associated with poor mental health outcomes in adulthood. Such associations have largely been attributed to stressful environments, e.g., exposure to trauma, abuse, or neglect. However, mental health is substantially heritable, and genetic influences may contribute to the exposure to childhood adversity, resulting in potential genetic confounding of such associations. MethodsHere, we explored associations between childhood adoption and mental health–related outcomes in midlife in 243,797 UK Biobank participants (n adopted = 3151). We used linkage disequilibrium score regression and polygenic risk scores for depressive symptoms, schizophrenia, neuroticism, and subjective well-being to address potential genetic confounding (gene-environment correlations) and gene-environment interactions. As outcomes, we explored depressive symptoms, bipolar disorder, neuroticism, loneliness, and mental health–related socioeconomic and psychosocial measures in adoptees compared with nonadopted participants. ResultsAdoptees were slightly worse off on almost all mental, socioeconomic, and psychosocial measures. Each standard deviation increase in polygenic risk for depressive symptoms, schizophrenia, and neuroticism was associated with 6%, 5%, and 6% increase in the odds of being adopted, respectively. Significant genetic correlations between adoption status and depressive symptoms, major depression, and schizophrenia were observed. No evidence for gene-environment interaction between genetic risk and adoption on mental health was found. ConclusionsThe association between childhood adoption and mental health cannot fully be attributed to stressful environments but is partly explained by differences in genetic risk between adoptees and those who have not been adopted (i.e., gene-environment correlation).

Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta-analysis.

SummaryThis study was undertaken to provide comprehensive analyses of current research developments in the field of breastfeed (BF) and metabolic‐related outcomes among women with prior gestational diabetes mellitus (GDM). Database PubMed, Embase, BIOSIS Previews, Web of Science, and Cochrane Library were searched through December 3, 2017. Odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were pooled by random‐effects model using Stata version 12.0. Twenty‐three observational studies were included in quantitative synthesis. Reduced possibility of progression to type 2 diabetes mellitus (T2DM; OR = 0.79; 95% CI, 0.68‐0.92) and pre‐DM (OR = 0.66; 95% CI, 0.51‐0.86) were found among women with longer BF of any intensity after GDM pregnancy. The positive effect of longer BF on progression to T2DM gradually became prominent with the extension of follow‐up period. Compared with women with shorter BF, those with longer BF manifested more favourable metabolic parameters, including significant lower body mass index, fasting glucose, triglyceride, and higher insulin sensitivity index. The findings support that BF may play an important role in protection against the development of T2DM‐related outcomes in midlife of women with prior GDM. However, further studies are needed to reveal the etiological mechanism.

Maternal age and cardiovascular and metabolic disease outcomes: a retrospective cohort study using data from population-based electronic medical records

Objective: To evaluate whether a woman’s age at first birth is associated with cardiovascular risk and metabolic health outcomes (cardiometabolic outcomes) by age 45.Methods: This is a retrospective, population-based cohort study that uses electronic health record data from the largest health fund in Israel. Women aged 34–39 at baseline (2004–2006) free of chronic diseases were identified as nulliparous at baseline and were followed up to 10 years (through 2016). The cohort was divided into three groups based on their age at first birth: younger parturients (ages 35–39), older parturients (ages 40–44), and never had children. The percentage of adverse pregnancy events and cardiometabolic outcomes at age 45 were compared across these three groups as well as to women in the general population. Cardiovascular risk and metabolic health outcomes were defined as: Type 2 diabetes, obesity, hypertension, cardiovascular disease, and Framingham risk score.Methods and results: Out of a group of 126,121 women aged 34–39 at baseline, 9979 were nulliparous and free of comorbidities. Over the course of the follow-up, there were 952 younger parturients and 673 older parturients who had their first birth, and 8354 women who remained persistent nulliparous. While older parturients had more adverse pregnancy events, there was no difference in rates of cardiometabolic outcomes between the two parturient groups, and they both had lower rates than the persistent nulliparous and the general population.Conclusions: Parturients free of major chronic diseases who give birth at a later age do not have increased cardiometabolic outcomes in midlife as compared to a general population of women in a large retrospective cohort. Our results may support clinicians when counseling healthy women who are seeking advice regarding delaying their first pregnancy without a tradeoff on health outcomes.

PSYCHOSOCIAL STRESSORS AND HEALTH DURING MIDIFE

Midlife is an important period in the lifecourse trajectory and heath outcomes during this period can have long-term implications into late adulthood. Hence, it is important that modifiable factors relating to these health outcomes in midlife are identified. Psychosocial stressors influence physical and mental health outcomes; these experiences may have differential impacts during midlife. Further, understanding of these associations may offer insight into how they may impact health in midlife. Thus, the objective of this symposium is to highlight the influence of psychosocial stressors on health outcomes in midlife. All of the presentations use the Midlife in the United States Study (MIDUS) to examine the influence of psychosocial stress for each respective research inquiry. Parker and colleagues examine the association between everyday discrimination and executive function, and whether this association differs by age among a racially diverse sample of adults. Nkimbeng and colleagues discuss the relationship between everyday discrimination and generalized pain among middle-aged African American adults. Nersesian and colleagues discuss the relationship between perceived neighborhood quality and loneliness among middle-aged adults. Understanding the influence of psychosocial stressors on health in midlife may be useful in informing relevant interventions to thwart the negative impact of such stressors on health during midlife.

Further analysis of the British Chinese Adoption Study (BCAS): Adult life events and experiences after international adoption

This paper seeks to contribute to debates about how people's adult lives unfold after experiencing childhood adversity. It presents analysis from the British Chinese Adoption Study: a mixed methods follow-up study of women, now aged in their 40s and early 50s, who spent their infant lives in Hong Kong orphanages and were then adopted by families in the UK in the 1960s.Sixty-eight women participated via questionnaires and face-to-face interviews. The paper draws on both quantitative analysis (using standardised measures and systematically coded data on adult life events) and qualitative analysis of interview data to identify the context and subjective meaning of the quantitative findings.We found that most of the women lived largely positive, stable, well-supported lives although punctuated by challenging periods. Using regression analysis, two variables were significantly associated with poorer mid-life functioning over and above other potential influences: a) feeling unhappy about being adopted, and b) partnership adversity after age 25. No associations were found between childhood experiences and patterns of adult adversity. Illustrations are given, based on the interviews, of the women's multi-faceted perspectives on the long-term impact of being internationally adopted and on professional support.We conclude that when early orphanage care (of reasonable quality) was followed by a good quality adoption, most women were able to negotiate the majority of later difficulties successfully. The findings suggest two important implications for understanding mid-life outcomes: a) that experiences in both childhood and adulthood should be taken into account and b) individuals' subjective views on being internationally adopted may help explain divergent outcomes within groups with similar early experiences.

Thriving in midlife: The roles of childhood nurturance and adult defense mechanisms

The current study examined whether reliance on more adaptive defense mechanisms throughout early adulthood may help explain previously documented relationships between childhood nurturance and better midlife functioning. Utilizing a unique longitudinal study, data were from age 18 through midlife (age 63) on 135 males. Childhood nurturance was assessed upon study entry and defense mechanism usage was assessed throughout earlier adulthood. Percentage of ‘engaging’ (more adaptive) vs. ‘avoidant’ (less adaptive) defenses mediated the relationship between childhood nurturance and 3 midlife outcomes: participants’ relationship quality with their children, marriage stability, and maximum earned income. Results suggest that greater childhood nurturance relates to more adaptive defensive styles in early adulthood, which is then associated with healthier midlife functioning at work and in relationships.

Children Placed In Out-of-Home Care as Midlife Adults: Are They Still Disadvantaged or Have They Caught Up With Their Peers?

International research has consistently reported that children placed in out-of-home care (OHC) have poor outcomes in young adulthood. Yet, little is known about their outcomes in midlife. Using prospective data from a cohort of more than 14,000 Swedes born in 1953, of which nearly 9% have been placed in OHC, this study examines whether there is developmental continuity or discontinuity of disadvantage reaching into middle age in OHC children, compared to same-aged peers. Outcome profiles, here conceptualized as combinations of adverse outcomes related to education, economic hardship, unemployment, and mental health problems, were assessed in 1992–2008 (ages 39–55). Results indicate that having had experience of OHC was associated with 2-fold elevated odds of ending up in the most disadvantaged outcome profile, controlling for observed confounding factors. These findings suggest that experience of OHC is a strong marker for disadvantaged outcomes also in midlife.

Long-term consequences of adolescent cannabis use: Examining intermediary processes

ABSTRACTBackground: In the United States, perceptions of marijuana’s acceptability are at an all-time high, risk perceptions among youth are low, and rates are rising among Black youth. Thus, it is imperative to increase the understanding of long-term effects of adolescent marijuana use and ways to mitigate adverse consequences. Objectives: To identify the midlife consequences of heavy adolescent marijuana use and the mechanisms driving effects among a Black, urban population. Methods: This study analyzed the propensity score-matched prospective data from the Woodlawn Study, a community cohort study of urban Black youth followed from ages 6–42. After matching the 165 adolescents who used marijuana heavily to 165 non-heavy/nonusers on background confounders to reduce selection effects (64.5% male), we tested the association of heavy marijuana use by age 16 with social, economic, and physical and psychological health outcomes in midlife and the ability of adult drug trajectories (marijuana, cocaine, and heroin use from ages 17–42) and school dropout to mediate effects. Results: Heavy adolescent marijuana use was associated with an increased risk of being poor and of being unmarried in midlife. Marijuana use also predicted lower income and greater anxious mood in midlife. Both adult drug use trajectories and school dropout significantly mediated socioeconomic effects but not marital or anxious mood outcomes. Conclusion: Heavy adolescent marijuana use seems to set Black, urban youth on a long-term trajectory of disadvantage that persists into midlife. It is critical to interrupt this long-term disadvantage through the prevention of heavy adolescent marijuana use, long-term marijuana and other drug use, and school dropout.

The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

Little is known about developmental outcomes in midlife of persons who were placed in out-of-home care (OHC) in childhood. Utilizing longitudinal Swedish data from a cohort of more than 14,000 individuals who we can follow from birth (1953) to the age of 55 (2008), this study examines midlife trajectories of social, economic, and health-related disadvantages with a specific focus on the complexity, timing, and duration of disadvantage in individuals with and without childhood experience of OHC. Roughly half of the OHC alumni did not have disadvantaged outcomes in midlife. However, experience of OHC was associated with a two-fold risk for various forms of permanent disadvantage, net of confounding factors. Implications for research, policy, and practice are discussed.

Early puberty in 11-year-old girls: Millennium Cohort Study findings

ObjectiveEarly puberty in girls is linked to some adverse outcomes in adolescence and mid-life. We address two research questions: (1) Are socioeconomic circumstances and ethnicity associated with early onset puberty?...

Work values during the transition to adulthood and mid-life satisfaction

This 25-year longitudinal study of a sample of Canadian high school seniors (N = 373) examined pathways from work values at age 18 to mid-life (age 43) career satisfaction and life satisfaction through several possible mediators: age 25 and 32 work values, months of postsecondary education (PSE) by age 25, and age 43 work rewards. Gender and parents’ PSE were also examined as influences on pathways to mid-life satisfaction. Structural equation modeling found support for one pathway beginning with intrinsic work values in high school (age 18 intrinsic work values→age 25 intrinsic work values→age 32 intrinsic work values→age 43 intrinsic work rewards→age 43 career and life satisfaction). Another pathway began with parents’ PSE (parents’ PSE→participants’ age 25 PSE→age 43 intrinsic work rewards→age 43 career and life satisfaction). Extrinsic work values from age 18 to 32 were not related to age 43 work rewards or career and life satisfaction. These findings indicate that adolescent work values matter for important mid-life outcomes, intrinsic work values are stronger predictors of adaptive outcomes than are extrinsic work values, and PSE plays a vital cross-generational role in shaping mid-life satisfaction.

Is Early Experience Destiny? Review of Research on Long-Term Outcomes following International Adoption with Special Reference to the British Chinese Adoption Study.

The pathway from adverse early experience to adulthood for internationally adopted children is complex in identifying key influences, impacts, and outcomes. This review arose from the authors' involvement in the British Chinese Adoption Study, a recent outcomes study that explored the links between early orphanage care, adoptive experiences, and midadulthood. It differs from previous reviews in focusing on a greater length of time since adoption. Both quantitative and qualitative studies were included to allow for examination of a fuller range of adult-related outcomes rather than mental health scores alone. The sampling, methods, and results of reviewed articles are summarised and a critical commentary is provided. Despite methodological differences and identified strengths and weaknesses, conclusions are drawn on the basis of the evidence available. Special attention is paid to the interpretation of negative outcomes. Findings identify areas that should be explored further in order to gain a fuller understanding of midlife outcomes of people who experienced a poor start in life followed by international adoption. Such studies help in refining lifespan developmental theories.