Prospective Community Study Research Articles

Prospective community study of family stress and anxiety in (pre)adolescents: the TRAILS study

For prevention of anxiety in children and adolescents, it is important to know whether family stress is a predictor of anxiety. We studied this in 1,875 adolescents from the Tracking Adolescents’ Individual Lives Survey (TRAILS) who were followed up for 2 years, from age 10–12 to 12–14 years. Adolescents reported anxiety and depression symptoms at both assessments, and parents reported family stress (family dysfunction and parenting stress) at the first assessment. Family dysfunction was not associated with future anxiety, whereas high parenting stress was. Furthermore, family dysfunction was more strongly associated with anxiety than with depression, whereas parenting stress was more strongly associated with depression. Level of parental psychopathology explained part of the association of family stress with anxiety. The associations were modest and the understanding of the origins of adolescents’ anxiety will require identifying other factors than family stress that account for more of the variance.

Affective Dysregulation and Reality Distortion: A 10-Year Prospective Study of Their Association and Clinical Relevance

Evidence from clinical patient populations indicates that affective dysregulation is strongly associated with reality distortion, suggesting that a process of misassignment of emotional salience may underlie this connection. To examine this in more detail without clinical confounds, affective regulation-reality distortion relationships, and their clinical relevance, were examined in a German prospective cohort community study. A cohort of 2524 adolescents and young adults aged 14-24 years at baseline was examined by experienced psychologists. Presence of psychotic experiences and (hypo)manic and depressive symptoms was assessed at 2 time points (3.5 and up to 10 years after baseline) using the Munich-Composite International Diagnostic Interview. Associations were tested between level of affective dysregulation on the one hand and incidence of psychotic experiences, persistence of these experiences, and psychotic Impairment on the other. Most psychotic experiences occurred in a context of affective dysregulation, and bidirectional dose-response was apparent with greater level of both affective dysregulation and psychotic experiences. Persistence of psychotic experiences was progressively more likely with greater level of (hypo)manic symptoms (odds ratio [OR] trend=1.51, P<.001) and depressive symptoms (OR trend=1.15, P=.012). Similarly, psychotic experiences of clinical relevance were progressively more likely to occur with greater level of affective dysregulation (depressive symptoms: OR trend=1.28, P=.002; (hypo)manic symptoms: OR trend=1.37, P=.036). Correlated genetic liabilities underlying affective and nonaffective psychotic syndromes may be expressed as correlated dimensions in the general population. Also, affective dysregulation may contribute causally to the persistence and clinical relevance of reality distortion, possibly by facilitating a mechanism of aberrant salience attribution.

Predictors of specific phobia in young women: A prospective community study

Potential predictors of incidence of specific phobia were investigated within the conceptual framework of the vulnerability–stress model. At two time points separated by approximately 17 months, a community sample of 1261 German women (18–25 years of age) completed a structured interview. A broad range of potential stress- and vulnerability-related predictors was recorded at initial assessment. The strongest predictors of incidence were: high levels of preexisting psychopathology, a lack of coping skills, and a negative cognitive style. Assessing individual differences in stress and vulnerability thus seem to offer additional information about etiology of specific phobia beyond traditional learning theory. Incorporating the role of these risk factors may be useful for identifying individuals who are at increased risk and improving measures of prevention.

Mood episodes and mood disorders: patterns of incidence and conversion in the first three decades of life

Significant questions remain regarding both the incidence patterns of mood episodes in adolescents and young adults from the community and the conversion rate from unipolar to bipolar disorders. We addressed these issues by examining data from a prospective longitudinal community study to (i) determine the cumulative incidence of mood episodes and disorders in the first three decades of life; (ii) determine the risk for first onset of depression among individuals with a previous history of hypomanic/manic episodes and vice versa; and (iii) determine the clinical and treatment characteristics of these subjects. Using the Munich-Composite International Diagnostic Interview, clinically trained interviewers assessed mood episodes and mental disorders in 3,021 community subjects (aged 14-24 at baseline and 21-34 at third follow-up). The estimated cumulative incidence at age 33 was 2.9% for manic, 4.0% for hypomanic, 29.4% for major depressive, and 19.0% for minor depressive episodes; overall, 26.0% had unipolar major depression, 4.0% bipolar depression, 1.5% unipolar mania, and 3.6% unipolar hypomania (no major depression). Overall, 0.6% and 1.8% had unipolar mania or hypomania, respectively, without indication for even minor depression. A total of 3.6% of the initial unipolar major depression cases subsequently developed (hypo)mania, with particularly high rates in adolescent onset depression (< 17 years: 9%). A total of 49.6% of the initial unipolar mania cases subsequently developed major depression and 75.6% major or minor depression. While bipolar cases had more adverse clinical and course depression characteristics and higher treatment rates than unipolar depressed cases, bipolar cases did not significantly differ in mania characteristics from unipolar mania cases. Unipolar and bipolar mood disorders are more frequent than previously thought in adolescence and young adulthood, a time period when both the recognition and the intervention rates by the healthcare system are rather low. 'Conversion' to bipolar disorder is limited in initial unipolar depression, but common in initial unipolar mania. The remaining unipolar mania cases appear to be significant in terms of clinical and course characteristics and thus require more research attention to replicate these findings.

Rates and predictors of remission in young women with specific phobia: A prospective community study

This prospective study reports rates and predictors of remission in young women with specific phobia. Data came from a prospective community study, in which German women (aged 18–25 years) completed an extended version of the Anxiety Disorders Interview Schedule (ADIS-IV-L) at two time points. Of the 137 women with specific phobia at baseline, 41.6% were partially remitted and an additional 19.0% were fully remitted at follow-up, defined as absence of any specific fears. A remitting course of specific phobia was predicted by residual protective factors at baseline, especially participants’ positive mental health and life satisfaction. Baseline levels of stress, coping skills, cognitive factors, psychopathology, and specific phobia characteristics did not predict remission. Results show that specific phobia in young women rarely takes a stable course at the full diagnostic threshold. The factors that influence remission of specific phobia are different from those that predict the incidence.

P-439 Weight Change and Mortality in a Prospective Community Study in Taiwan

P-439 Weight Change and Mortality in a Prospective Community Study in Taiwan

P4-043: No relationship between serum ferritin and cognitive status in a prospective community study of older adults

P4-043: No relationship between serum ferritin and cognitive status in a prospective community study of older adults

Bereavement related and non-bereavement related depressions: A comparative field study

Background and MethodIn the otherwise a-theoretical diagnostic manual, the DSM-III and IV bereavement exclusion for the diagnosis of major depression (MDD) stands out as the sole exception to the rule. No other life event excludes the diagnosis of any other axis I disorder. Since this diagnostic convention has important diagnostic and treatment implications, it is important to evaluate the validity of this exception. By comparing multiple features of bereavement related to non-bereavement related MDD, this prospective community study critically evaluates the validity of the bereavement exclusion. ResultsThe prevalence of conditional criteria was common in the total sample (N=685) and did not differ between bereaved and non-bereaved groups. The global ‘symptom profile’ of depressed individuals was similar in both groups. ‘Duration’ was found to be longer in the bereaved group. Among all conditional criteria required by DSM-IV to accept bereavement-related episodes under the category of MDD, only ‘marked dysfunction’ predicted treatment. Neither the ‘four conditional symptoms’ nor the ‘duration’ criterion predicted marked dysfunction. The ‘risk for recurrence’ was similar whether the first episode was bereavement related or not. Limitations‘Psychotic symptoms’ were not assessed, and ‘marked dysfunction’ was not assessed on a continuous scale. The number of DSM-IV excluded episodes was too small to allow for generalization. ConclusionOur results suggest that the conditional criteria do not seem to serve the purpose of the originators of the bereavement exclusion criteria. The ‘conditional symptoms’ and the ‘duration’ criterion seem not to be markers of severity. We propose that the descriptive and etiologically neutral approach the DSM presumes in reaching a diagnosis should be applied in the case of MDD until more convincing data point to the contrary.

Ambulance paramedics interrupt chest compressions and delay defibrillation after taking over from lay rescuers with an automatic external defibrillator

Introduction: There are no guidelines for transition of care from rescuers with AED to paramedics with ongoing CPR. After disconnection of the AED, clock time as running in the AED is not available for subsequent protocollized CPR duration, rhythm check and shock. We hypothesize that defibrillation shocks are delayed and CPR interrupted without reason after AED disconnection. Methods: This was a prospective observational community study in an area of 2.6 million inhabitants. During 16 months, all available continuous ECG recordings of AEDs and associated manual defibrillator (mDFB) recordings of out-of-hospital cardiac arrests were collected. All clock times were synchronized. We observed CPR time through the impedance signal. For shockable rhythms, we measured the duration of CPR given between the connection time of the mDFB and expected time of defibrillation of the AED. For non shockable rhythms, the expected moment of AED rhythm analysis was the endpoint of the time interval. Time available for CPR given during that time interval was set at 100%. Delay in defibrillation was the difference between expected moment of the next shock as advised by the AED and the actual shock given by paramedics. Results: Results are shown in table 1. Of the 245 cases, 73 cases had a shockable rhythm during take over, 141 a non-shockable rhythm and 31 patients had Return of Spontaneous Circulation. A shock was delivered too early or too late in 68 of 73 patients. Four patients were never defibrillated. Conclusion: Disconnection of the AED by professionals interrupts the treatment protocol of the AED, delaying time of defibrillation by almost two minutes. Premature defibrillation leads to decrease in CPR time. The optimal moment of disconnecting the AED should be described in new guidelines.

Developmental Trajectories of Adolescent Anxiety Disorder Symptoms: A 5-Year Prospective Community Study

This study prospectively examined the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents from the general population. Two cohorts of early and middle adolescents (1,318 junior high and high school students) completed the Screen for Child Anxiety Related Emotional Disorders during 5 consecutive years. The Screen for Child Anxiety Related Emotional Disorders is a questionnaire that measures self-rated child and adolescent anxiety symptoms that map onto DSM-IV-TR anxiety disorders. At the first wave of measurement, the early and middle adolescent cohorts were an average of 12 and 16 years of age, respectively. Age and sex differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of latent growth modeling. Over the course of 5 years, there was a slight decrease in the panic disorder, school anxiety, and separation anxiety disorder symptoms for all of the adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase of generalized anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys. This study replicates and extends earlier findings on the developmental trajectories of anxiety symptoms during adolescence. By using individually focused, trajectory-based analyses rather than group score differences, this study extends earlier findings and advances our understanding of age and sex differences in the development of adolescent anxiety symptoms.

Predicting Language at 2 Years of Age: A Prospective Community Study

This article responds to evidence gaps regarding language impairment identified by the US Preventive Services Task Force in 2006. We examine the contributions of putative child, family, and environmental risk factors to language outcomes at 24 months of age. A community-ascertained sample of 1720 infants who were recruited at 8 months of age were followed at ages 12 and 24 months in a prospective, longitudinal study in metropolitan Melbourne, Australia. Outcomes at 24 months were parent-reported infant communication (Communication and Symbolic Behavior Scales and MacArthur-Bates Communicative Development Inventories vocabulary production score). Putative risk factors were gender, preterm birth, birth weight, multiple birth, birth order, socioeconomic status, maternal mental health, maternal vocabulary and education, maternal age at birth of child, non-English-speaking background, and family history of speech-language difficulties. Linear regression models were fitted to total standardized Communication and Symbolic Behavior Scales and Communicative Development Inventories vocabulary production scores; a logistic regression model was fitted to late-talking status at 24 months. The regression models accounted for 4.3% and 7.0% of the variation in the 24-month Communication and Symbolic Behavior Scales and Communicative Development Inventories scores, respectively. Male gender and family history were strongly associated with poorer outcomes on both instruments. Lower Communication and Symbolic Behavior Scales scores were also associated with lower maternal vocabulary and older maternal age. Lower vocabulary production scores were associated with birth order and non-English-speaking background. When the 12-month Communication and Symbolic Behavior Scales Total score was added as a covariate in the linear regression of 24-month Communication and Symbolic Behavior Scales Total score, it was by far the strongest predictor. These early risk factors explained no more than 7% of the variation in language at 24 months. They seem unlikely to be helpful in screening for early language delay.

Smoking predicts suicidality: Findings from a prospective community study

Background The temporal relationship between smoking and suicidality is not yet clear. This article examines associations between smoking and suicidality and their temporal ordering of onset. Methods Baseline and four-year follow-up data were used from the Early Developmental Stages of Psychopathology (EDSP) study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, suicidal ideation and suicide attempts using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). Results Suicide ideation and suicide attempts were strongly associated with occasional and regular smoking and nicotine dependence at baseline (Odds ratios [OR] range from 1.4 to 16.4). In the prospective analyses, prior occasional, regular smoking and nicotine dependence increased the risk for new onset of suicide ideation (OR range from 1.5 to 2.7) and prior regular smoking and nicotine dependence increased also the risk for onset of suicide attempt(s) (OR range between 3.1 and 4.5). Pre-existing suicidality could not be shown to be associated with subsequent smoking or nicotine dependence. Associations remained stable when participants who fulfilled DSM-IV-criteria for major depression were excluded. Limitations The sample is confined to an age cohort of 14 to 24 years. No completed suicides could be observed. Conclusions The presence of associations between prior smoking and subsequent suicidality, in concert with the lack of associations between prior suicidality and subsequent smoking suggests the existence of an independent pathway from smoking to suicidality.

Abstract 17: Ambulance Paramedics Interrupt Chest Compressions And Delay Defibrillation After Taking Over From Lay Rescuers With An Automated External Defibrillator

Introduction: There are no guidelines for transition of care from rescuers with AED to paramedics with ongoing CPR. After disconnection of the AED, clock time as running in the AED is not available for subsequent protocollized CPR duration, rhythm check and shock. We hypothesize that defibrillation shocks are delayed and CPR interrupted without reason after AED disconnection. Methods: This was a prospective observational community study in an area of 2.6 million inhabitants. During 16 months, all available continuous ECG recordings of AEDs and associated manual defibrillator (mDFB) recordings of out-of-hospital cardiac arrests were collected. All clock times were synchronized. We observed CPR time through the impedance signal. For shockable rhythms, we measured the duration of CPR given between the connection time of the mDFB and expected time of defibrillation of the AED. For non shockable rhythms, the expected moment of AED rhythm analysis was the endpoint of the time interval. Time available for CPR given during that time interval was set at 100%. Delay in defibrillation was the difference between expected moment of the next shock as advised by the AED and the actual shock given by paramedics. Results: Results are shown in table 1 . Of the 245 cases, 73 cases had a shockable rhythm during take over, 141 a non-shockable rhythm and 31 patients had Return of Spontaneous Circulation. A shock was delivered too early or too late in 68 of 73 patients. Four patients were never defibrillated. Conclusion: Disconnection of the AED by professionals interrupts the treatment protocol of the AED, delaying time of defibrillation by almost two minutes. Premature defibrillation leads to decrease in CPR time. The optimal moment of disconnecting the AED should be described in new guidelines. Table 1: Shock delay and CPR interruption, devided in shockable and non shockable rhythms

Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System.

Vital registration is generally lacking in infrastructurally weak areas where health and development problems are most pressing. Health and demographic surveillance is a response to the lack of a valid information base that can provide high-quality longitudinal data on population dynamics, health, and social change to inform policy and practice. Continuous demographic monitoring of an entire geographically defined population involves a multi-round, prospective community study, with annual recording of all vital events (births, deaths, migrations). Status observations and special modules add value to particular research areas. A verbal autopsy is conducted on every death to determine its probable cause. A geographic surveillance system supports spatial analyses, and strengthens field management. Health and demographic surveillance covers the Agincourt sub-district population, sited in rural north-eastern South Africa, of some 70,000 people (nearly a third are Mozambican immigrants) in 21 villages and 11,700 households. Data enumerated are consistent or more detailed when compared with national sources; strategies to improve incomplete data, such as counts of perinatal deaths, have been introduced with positive effect. Basic characteristics: A major health and demographic transition was documented over a 12-year period with marked changes in population structure, escalating mortality, declining fertility, and high levels of temporary migration increasing particularly amongst women. A dual burden of infectious and non-communicable disease exists against a background of dramatically progressing HIV/AIDS. Health and demographic surveillance sites - fundamental to the INDEPTH Network - generate research questions and hypotheses from empirical data, highlight health, social and population priorities, provide cost-effective support for diverse study designs, and track population change and the impact of interventions over time.[image omitted].

Change in Prevalence of Psychiatric Disorders From Ages 21 to 30 in a Community Sample

The authors examined change and demonstrated variation in the prevalence of psychiatric disorders from ages 21 to 30 in a prospective community study (n = 352) using generalized estimating equations and investigated effects of past and recent psychiatric disorder on emerging adult functioning (at age 30). Results revealed significant declines in 12-month prevalence of phobia and substance use disorders from ages 21 to 30 but not in depression or posttraumatic stress disorder. Males were at significantly higher risk for lifetime substance use disorders; females were at higher risk for lifetime depression, phobia, and PTSD. Twelve-month and lifetime disorder were associated with impaired global functioning at age 30. Internalizing disorders were associated with impaired interpersonal functioning, whereas externalizing disorders were associated with impaired socioeconomic functioning. Results of this study have implications for mental health service planning in emerging adulthood.

Psychotic experiences in the general population: A twenty-year prospective community study

Purpose Recent work suggested that psychosis might be expressed at subclinical levels. However, the determinants of subclinical psychotic symptoms, the degree of continuity over the life span, and the impact on functioning remain unclear. Thus we analyzed the prevalence, determinants, patterns and impact of subclinical psychotic symptoms in a community cohort over a 20-year period. Methods The Zurich Study – a longitudinal community study – started in 1979 with a sample of 591 participants aged 20/21 years. Follow-up interviews were conducted at age 23, 28, 30, 35 and 41. Symptoms were assessed with a semi-structured interview and the SCL90-R. In this analysis, items of the SCL90-R symptom dimensions “paranoid ideation” and “psychoticism” were examined. Results Two distinct symptom dimensions of subclinical psychosis became evident, one representing schizophrenia nuclear symptoms, the other representing schizotypal signs. Cannabis use in adolescence was associated specifically with schizophrenia nuclear symptoms, whereas childhood adversity as well as chronic physical or mental disorders in parents contributed to schizotypal signs. Individuals with a persistently high level of either of the two identified symptom dimensions over 20 years experienced significant deficiencies in social achievement and functioning. Conclusions Expression of psychotic symptoms in populations is continuous and characterized by differing levels of severity and persistence. A small group of individuals displays persistence of subclinical psychotic symptoms over a period of 20 years. The causes of and pathways to clinical psychotic disorder can be studied long before the disorder becomes clinically relevant.

Incidence, Prognosis, and Risk Factors for Fatigue and Chronic Fatigue Syndrome in Adolescents: A Prospective Community Study

The objective of this study was to describe the incidence, prevalence, risk factors, and prognosis of fatigue, chronic fatigue, and chronic fatigue syndrome in 11- to 15-year-olds. A random general population sample (n = 842) of British adolescents and their parents were assessed at baseline and 4 to 6 months later. The main outcomes were fatigue, chronic fatigue, and chronic fatigue syndrome, operationally defined. The incidence over 4 to 6 months was 30.3% for fatigue, 1.1% for chronic fatigue, and 0.5% for chronic fatigue syndrome. The point prevalence was 34.1% and 38.1% for fatigue, 0.4% and 1.1% for chronic fatigue, and 0.1% and 0.5% for chronic fatigue syndrome at time 1 and time 2, respectively. Of participants who were fatigued at time 1, 53% remained fatigued at time 2. The 3 cases of chronic fatigue and 1 case of chronic fatigue syndrome at time 1 had recovered by time 2. Higher risk for development of chronic fatigue at time 2 was associated with time 1 anxiety or depression, conduct disorder, and maternal distress; in multivariate analysis, baseline anxiety or depression remained a significant predictor of chronic fatigue. Increased risk for development of fatigue at time 2 was associated with time 1 anxiety or depression, conduct disorder, and older age; in multivariate analyses, these factors and female gender all were significant predictors of fatigue. The incidence rates for chronic fatigue and chronic fatigue syndrome in this adolescent sample were relatively high, but the prognosis for these conditions was good. This prospective study provides evidence for an association between emotional/behavioral problems and subsequent onset of fatigue/chronic fatigue.

Smoking predicts suicidality: findings from a prospective community study

Smoking predicts suicidality: findings from a prospective community study

Intelligence and Other Predisposing Factors in Exposure to Trauma and Posttraumatic Stress Disorder

Prospective data on standardized measures of early predispositions would allow a strong test of hypotheses about suspected risk factors of posttraumatic stress disorder (PTSD) and exposure to traumatic events. To prospectively examine the extent to which intelligence, anxiety disorders, and conduct problems in childhood influence the risk for PTSD and for exposure to traumatic events. A longitudinal study of a randomly selected sample assessed at age 6 years and followed up to age 17 years. Samples were randomly selected from the 1983-1985 newborn discharge lists of 2 major hospitals in southeast Michigan (N=823). Cohort members with follow-up data at age 17 years (n=713; 86.6% of the initial sample). Cumulative exposure up to age 17 years of qualifying traumatic events; DSM-IV PTSD among participants who have experienced 1 or more traumatic events. Youth with teacher ratings of externalizing problems above the normal range at age 6 years were at increased risk for exposure to assaultive violence (adjusted odds ratio, 2.6; 95% confidence interval, 1.4-4.9). Youth aged 6 years with an IQ greater than 115 had decreased risk for exposure to traumatic events (adjusted odds ratio for assaultive violence, 0.3; 95% confidence interval, 0.2-0.7); a decreased risk for nonassaultive trauma (adjusted odds ratio, 0.6; 95% confidence interval, 0.3-0.9); and a decreased conditional risk for PTSD (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.9). The conditional risk for PTSD was increased for youth with anxiety disorders and teacher ratings of externalizing problems above the normal range at 6 years of age. The results of this prospective community study highlight the role of intelligence in avoidance of exposure to traumatic experiences and their PTSD effects. They underscore the need for investigating cognitive processes in persons' responses to traumatic experiences and the involvement of general intelligence in these processes.

A Prospective Community‐based Study of Gastroenterological Symptoms in School‐age Children

Current knowledge on the prevalence of common gastrointestinal (GI) problems is based on office-based samples or retrospective questionnaires, leading to possible bias and inaccurate estimates. To examine the prevalence of GI symptoms in school-age children. This is the first American prospective community study intended to assess the prevalence of common GI symptoms in children. All fourth- and fifth-grade students from a middle-size urban school were invited to participate in a prospective cohort pilot study by completing confidential weekly surveys. The survey included a set of 8 age-appropriate, validated questions assessing the presence and severity of abdominal pain, constipation, diarrhea, nausea, vomiting, chest pain, headaches and limb pain. A total of 48 children (32 boys and 16 girls) participated in the study. Data were obtained for 16 weeks on 690 (90.5%) of 768 possible children per week. Children reported at least 1 symptom in 544 (70%) children per week. Headaches were the most common complaint (55% [range, 40%-72%] children per week). Sixty percent of children (range, 46%-89%) reported at least 1 GI symptom weekly. The overall prevalence of GI symptoms was the following: abdominal pain 46% (range, 28%-72%), nausea 28% (range, 17%-59%), constipation 18% (range, 7%-39%), diarrhea 17% (range, 11%-24%) and vomiting 5% (range, 0%-13%). None of the children missed school because of persistent GI symptoms during the study. The investigation demonstrates the feasibility of prospective school studies in children. The high prevalence of GI symptoms not interfering with school attendance in children underscores the benign nature of such symptoms in most children. Gastrointestinal symptoms are common somatic complaints among school-age children.