Trajectories Of Psychopathology Research Articles

Regulatory problems and developmental psychopathology within the first 2 years of living—a nested in cohort population-based study

BackgroundInfancy regulatory problems (RP) of sleep, feeding and eating, and excessive crying are thought to play a key role in the development of psychopathology in childhood, but knowledge of the early trajectories is limited.ObjectiveTo explore RP at ages 8–11 months and the associations with mental health problems at 1½ years, and assess the influences of maternal mental health problems and relationship problems.MethodsRP was explored in a nested in-cohort sample (N = 416) drawn from a community-based cohort (N = 2,973). Cohort children were examined by community health nurses, using a mental health screening, which included seven items of RP. Follow-up at 1½ years included diagnostic assessment according to the International Classification of Diseases, ICD-10, and the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood: Revised edition, DC:0-3R. Data analyses included logistic regression models and analyses of the mediation effect of maternal mental health and relationship problems.ResultsRP of sleep were associated with a 2-fold increased risk of child mental disorder specifically sleep disorders, adjusted odds ratio (OR) 9.3 [95% confidence interval (CI): 2.0–42.9], disorders of behavior and emotions, adjusted OR 2.9 (95% CI: 1.0–8.4), and DC:0-3R regulatory disorders, adjusted OR 2.7 (95% CI: 1.0–7.5). Children with RP of feeding and eating showed an increased risk of overall mental disorder, adjusted OR 1.4 (95% CI: 0.7–2.4), and specifically, feeding and eating disorders, adjusted OR 6.0 (95% CI: 1.6–21.7), disorders of behavior and emotions, adjusted OR 2.2 (95% CI: 0.9–5.8), as well as DC:0-3R regulatory disorders, adjusted OR 1.6 (1.0–7.5). RP of emotional regulation were associated with increased risk of any mental disorder, adjusted OR 1.5 (1.0–2.4), and specifically behavioral and emotional disorders, adjusted OR 2.2 (95% CI: 0.9–5.9) and DC:0-3R relationship disorders, adjusted OR 1.8 (95% CI: 0.9–3.8). The mediation effect of maternal mental health problems and relationship problems ranged between 0% and 48%.ConclusionRP at ages 8–11 months is associated with increased risk of ICD-10 and DC:0-3R disorders at 1½ years. Study findings highlight a group of vulnerable infants in need of preventive intervention to break the early trajectories of psychopathology.

Cohort Profile: The China Severe Trauma Cohort (CSTC).

We sought to establish a prospective hospital-based cohort, featuring detailed multidimensional data of trauma patients with active follow-ups, which can be a reliable data source for all studies focusing on the effects or underlying mechanistic pathways of environmental and biological factors on multiple interested trauma-related outcomes, particularly the incidence and trajectory of trauma-related psychopathology, in a Chinese population. The China Severe Trauma Cohort (CSTC) enrolled all traumatized individuals aged 12 to 80 years admitted to the Trauma Center of West China Hospital between March 1st, 2020 and July 8th, 2022. The bio-sample and detailed questionnaire data were collected at recruitment, and phone/internet follow-ups were scheduled at 1, 3, 6, and 12 months after the baseline. Long-term health outcomes are planned to be obtained from administrative databases through data linkage. A total of 2,500 trauma patients were enrolled (response rate = 87.1%) with an average age of 46.01 years, and most of the participants were males (62.6%). The proportions of participants with blood and fecal sample collected at baseline were 93.8% and 66.3%, respectively. As of August 31st, 2022, the follow-up rate was 90.0%, 77.0%, 76.5%, and 89.0% for 1-, 3-, 6-, and 12-month follow-ups, respectively. Fall/wrench (47.6%) and traffic accident (26.2%) were the top causes of current trauma. The most common psychopathology at recruitment was sleep disturbance (39.4%), followed by depression (22.6%), anxiety (18.2%), and acute stress reaction (7.8%), all of which showed recovering trajectories during the follow-up period, particularly the first 3 months after baseline. CSTC provides a platform with multidimensional data to study both short-term and long-term trauma-related health consequences, prompting early identification and intervention for individuals with high risk of health decline after trauma exposures.

20-Year trajectories of six psychopathological dimensions in patients with first-episode psychosis: Could they be predicted?

Patients with first-episode psychoses (FEP) exhibit heterogeneity in clinical manifestations and outcomes. This study investigated the long-term trajectories of six key psychopathological dimensions (reality-distortion, negative, disorganization, catatonia, mania and depression) in patients diagnosed with FEP.A total of 243 patients were followed up for 20 years and the trajectories of the dimensions were analysed using growth mixture modelling. These dimensions showed varied course patterns, ranging from two to five trajectories. Additionally, the study examined the predictive value of different factors in differentiating between the long-term trajectories.The exposome risk score showed that familial load, distal and intermediate risk factors, acute psychosocial stressors and acute onset were significant predictors for differentiating between long-term psychopathological trajectories. In contrast, polygenic risk score, duration of untreated psychosis and duration of untreated illness demonstrated little or no predictive value.The findings highlight the importance of conducting a multidimensional assessment not only at FEP but also during follow-up to customize the effectiveness of interventions. Furthermore, the results emphasize the relevance of assessing premorbid predictors from the onset of illness. This may enable the identification of FEP patients at high-risk of poor long-term outcomes who would benefit from targeted prevention programs on specific psychopathological dimensions.

Endocannabinoids, cortisol, and development of post-traumatic psychopathological trajectories

ObjectiveOur prior published work using the 2-factor model of PTSD identified four subgroups of trauma survivors on average 6 months following trauma: Resilient, Dysphoria, High Comorbid, and Severe Comorbid. Some findings indicate that low and high cortisol responses may increase risk for the development of PTSD and depression respectively, yet ways in which cortisol interacts with other physiological systems to enhance risk is unclear. This study examined the role of circulating eCBs in the development of previously identified psychopathological trajectories that is differentiated by cortisol in traumatically injured adults (N = 169). MethodsCirculating concentrations of eCBs, 2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (AEA) were measured during post-injury hospitalization and on average 6 months following trauma. Differences in 2-AG and AEA among the subgroups were tested using multivariate ANCOVA. ResultsDysphoria (with highest cortisol levels) and High Comorbid subgroups exhibited higher post-injury AEA compared to the Resilient group. Dysphoria subgroup showed a significant decline in AEA by 6 months compared to Resilient and High Comorbid subgroups. ConclusionChange in AEA over time in individuals with high post-injury cortisol may serve as a buffer against risk for severe psychopathology. Assessing AEA and cortisol levels concurrently across time may serve as indicators of risk.

Trajectories of psychopathology among young people related to outcomes in young adulthood

Abstract What does young adulthood look like for individuals who had mental health problems across childhood? Using the Growing Up in Ireland cohort (born in 1998 and studied from ages 9 to 20) we explored the association between mental health problems between ages 9 and 13, and subsequent poor outcomes in the same individuals at ages 17-20. We consider educational/economic outcomes, health service use, poor mental and physical health, social isolation, substance abuse, and subjective wellbeing in young adults. In a previous study that used latent class modelling, we identified four groups which captured mental health in a general population sample of children. Between ages 9 and 13, children could be grouped into: a low symptoms group (∼65%), an ‘externalising’ group with ADHD or conduct symptoms (∼20%), an ‘internalising’ group with depressive, anxiety or peer issues (∼10%), or a group showing many combined mental health symptoms (∼2%). All mental health problem groups had elevated odds across all 7 adverse outcomes in young adulthood. The 5 areas of young adult functioning most related to childhood mental health were: education/economics, subjective wellbeing, mental health, social isolation and substance abuse. Poor educational/economic outcomes were as likely as poor mental health (OR ∼ 2) in individuals with childhood psychopathology. The 3 childhood problem groups showed different risk profiles in young adulthood. For instance, the childhood internalising group had lower odds of substance abuse than all other groups, but had the highest odds of poor physical health by adulthood. Findings point to the need for a wider range of preventative supports for children and adolescents with a history of mental health problems, beyond just mental health support. These include interventions to improve physical health, treat substance abuse, reduce social isolation, and improve adverse educational and economic outcomes.

10.G. Workshop: Investigating risk and protective factors for youth mental health using population-based datasets

Abstract Mental health problems are increasing among young people both in Ireland and worldwide and the causes of this increase are not known. This workshop will focus on large population based datasets which provide recent and comprehensive information on the mental health of young people, including the Growing Up in Ireland study, the Planet Youth study and the ALSPAC cohort. We will present recent data on prevalence of mental health disorders among adolescents and we will present data on possible risk factors and protective factors for mental health problems in youth. We will focus on the possible role played by the COVID pandemic in this observed increase. We will also present data relating to substance use including cannabis use and diet . We will explore trajectories of psychopathology between childhood and adolescence and incidence and persistence of psychotic experiences in youth. This workshop will be a chance to bring together researchers and clinicians working in this important area to discuss the issue of youth mental health which will have importance not just for Ireland but for other countries worldwide. Key messages • An increase in mental health problems among young people has been observed over recent years but the causes for this increase are not known. • There is an urgent need to identify risk and protective factors for mental health problems among youth and how these are changing over time.

Decoding anxiety-impulsivity subtypes in preadolescent internalising disorders: findings from the Adolescent Brain Cognitive Development study.

Internalising disorders are highly prevalent emotional dysregulations during preadolescence but clinical decision-making is hampered by high heterogeneity. During this period impulsivity represents a major risk factor for psychopathological trajectories and may act on this heterogeneity given the controversial anxiety-impulsivity relationships. However, how impulsivity contributes to the heterogeneous symptomatology, neurobiology, neurocognition and clinical trajectories in preadolescent internalising disorders remains unclear. The aim was to determine impulsivity-dependent subtypes in preadolescent internalising disorders that demonstrate distinct anxiety-impulsivity relationships, neurobiological, genetic, cognitive and clinical trajectory signatures. We applied a data-driven strategy to determine impulsivity-related subtypes in 2430 preadolescents with internalising disorders from the Adolescent Brain Cognitive Development study. Cross-sectional and longitudinal analyses were employed to examine subtype-specific signatures of the anxiety-impulsivity relationship, brain morphology, cognition and clinical trajectory from age 10 to 12 years. We identified two distinct subtypes of patients who internalise with comparably high anxiety yet distinguishable levels of impulsivity, i.e. enhanced (subtype 1) or decreased (subtype 2) compared with control participants. The two subtypes exhibited opposing anxiety-impulsivity relationships: higher anxiety at baseline was associated with higher lack of perseverance in subtype 1 but lower sensation seeking in subtype 2 at baseline/follow-up. Subtype 1 demonstrated thicker prefrontal and temporal cortices, and genes enriched in immune-related diseases and glutamatergic and GABAergic neurons. Subtype 1 exhibited cognitive deficits and a detrimental trajectory characterised by increasing emotional/behavioural dysregulations and suicide risks during follow-up. Our results indicate impulsivity-dependent subtypes in preadolescent internalising disorders and unify past controversies about the anxiety-impulsivity interaction. Clinically, individuals with a high-impulsivity subtype exhibit a detrimental trajectory, thus early interventions are warranted.

Identifying multilevel predictors of trajectories of psychopathology and resilience among juvenile offenders: A machine learning approach.

Mental ill health is more common among juvenile offenders relative to adolescents in general. Little is known about individual differences in their long-term psychological adaptation and its predictors from multiple aspects of their life. This study aims to identify heterogeneous trajectories of probable psychiatric conditions and their predictors. Participants included 574 juvenile offenders who were first convicted for serious crimes and without detention history. The participants were assessed at 11 timepoints over seven years (2000-2010). Growth mixture modeling revealed the same three trajectories for both probable anxiety and probable depression: stable low trajectory (75.96%; 75.78%), stable high trajectory (15.16%; 10.98%), and recovery (8.89%, 13.24%). Least absolute shrinkage and selection operator (LASSO) logistic regression identified three multilevel predictors for memberships of different trajectories. Risk factors against stable low trajectory lay within personal (e.g., neuroticism), relationship (e.g., parental hostility), and contextual levels (e.g., chaotic neighborhood). Resilience factors for stable low trajectory included strong work orientation and low education level of father. Recovery was predicted by Black race, self-identity, high education level of father, and nonincarcerated sentencing. Our findings suggest that both psychopathology and psychological resilience could be predicted by multiple personal, relationship, and contextual factors in the social ecology of juvenile offenders.

How brain structure relates to psychopathology across diagnoses in pre‐adolescents

Using data from the federal government's Adolescent Brain Cognitive Development (ABCD) study, researchers have identified specific brain structure features that might contribute to transdiagnostic (across diagnostic categories) psychopathology development in preadolescence. The study found that children with smaller total brain volume and surface area may be vulnerable to persistent general psychopathology during preadolescence. “Cortical thinning reflective of pruning and myelination in sensorimotor and temporal brain regions specifically may protect against increases in internaliz‐ing, but not general psychopathology, during preadolescence,” according to the study. In general, structural neural alterations have been associated with the “p factor” (higher “p” scores are associated with developmental problems and other issues, but not specifically related to diagnoses). However, less is known about how the brain al‐terations relate within time in an individual, especially during preadolescence, when many neurodevelopmental changes are taking place. This study looked at the trajectory of the p factor and specific forms of psychopathology over 2 years in 9,220 preadolescents (aged 9–10 years at baseline). The study found that smaller volume and surface area of the brain, but not thickness, were associated with higher p factor scores which persisted over time in between‐person (how individuals differ) but not within‐person (how change occurs in a particular individual) p factor scores. “Lower baseline cortical thickness was associated with steeper decreases in internalizing psychopathology, which was driven by lower thickness within sensorimotor and temporal regions.” [Romer, A. L., Ren, B., Pizzagalli, D. A. (2023, Feb 9). Brain structure relations with psychopathology trajectories in the Adolescent Brain Cognitive Development Study. J Am Acad Child Adolesc Psychiatry, S0890‐8567(23)00057‐6. http://doi.org/10.1016/j.jaac.2023.02.002.]

Developmental Trajectories of Internalizing and Externalizing Symptoms in Youth and Associated Gender Differences: A Directed Network Perspective.

Psychopathology in youth is highly prevalent and associated with psychopathology in adulthood. However, the developmental trajectories of psychopathology symptoms, including potential gender differences, are markedly underspecified. The present study employed a directed network approach to investigate longitudinal relationships and gender differences among eight transdiagnostic symptom domains across three years, in a homogenous age sample of youth participants (n = 6,414; mean baseline age = 10.0years; 78.6% White; Adolescent Brain Cognitive Development study). Anxious/depressed problems and aggressive behaviors were central symptoms and most predictive of increases in other symptom clusters at later timepoints. Rule-breaking behaviors, aggressive behaviors, and withdrawn/depressed problems emerged as bridge symptoms between externalizing and internalizing problems. Results supported cascade models in which externalizing problems predicted future internalizing problems, but internalizing problems also significantly predicted future externalizing problems, which is contrary to cascade models. Network structure, symptom centrality, and patterns of bridge symptoms differed between female and male participants, suggesting gender differences in the developmental trajectories of youth psychopathology. Results provide new insights into symptom trajectories and associated gender differences that may provide promising pathways for understanding disorder (dis)continuity and co-occurrence. The central and bridge symptoms identified here may have important implications for screening and early intervention for youth psychopathology.

Caregiver emotion regulation predicts trajectories of psychopathology during pediatric cancer treatment.

Elevated child and caregiver psychopathology are observed in families of children with cancer, with a subset developing clinically significant symptoms. This study examines whether caregivers' resting respiratory sinus arrhythmia (RSA) and observed emotion regulation (ER) are protective against caregiver and child psychopathology during the first year of pediatric cancer treatment. Primary caregivers of children recently diagnosed with cancer (N = 159; child Mage = 5.6 years; children 48% male, 52% female) completed 12 monthly questionnaires. At Month 3, primary caregivers were interviewed about their experiences of emotions, and their resting RSA was measured. Data were analyzed using multilevel models. Observed ER was associated with lower caregiver anxiety, depression, and posttraumatic stress symptoms (PTSS) 1 year postdiagnosis but was not associated with children's symptoms. Resting RSA had a significant positive association with child depression/anxiety at the start of treatment and Month 12 child PTSS. Findings suggest that caregivers would benefit from interventions to manage their negative emotions at the start of cancer treatment. Additionally, caregivers who are more physiologically regulated may be more attuned to their children's negative emotions. Our findings highlight the importance of taking a multimethod approach to understanding how ER impacts functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The 3-year effects of a personality-targeted prevention program on general and specific dimensions of psychopathology

This study aimed to examine the effect of a personality-targeted prevention program (Preventure) on trajectories of general and specific dimensions of psychopathology from early- to mid-adolescence. Australian adolescents (N = 2190) from 26 schools participated in a cluster randomized controlled substance use prevention trial. This study compared schools allocated to deliver Preventure (n = 13 schools; n = 466 students; Mage = 13.42 years), a personality-targeted selective intervention, with a control group (n = 7 schools; n = 235 students, Mage = 13.47 years). All participants were assessed for psychopathology symptoms at baseline, 6-, 12-, 24- and 36-months post-baseline. Outcomes were a general psychopathology factor and four specific factors: fear, distress, alcohol use/harms and conduct/inattention), extracted from a higher-order model. Participants who screened as ‘high-risk’ on at least one of four personality traits (negative thinking, anxiety sensitivity, impulsivity and sensation seeking) were included in intention-to-treat analyses. Intervention effects were examined using multi-level mixed models accounting for school-level clustering. Among high-risk adolescents, growth in general psychopathology was slower in the Preventure group compared to the control group (b = −0.07, p = 0.038) across the three years. After controlling for effects on general psychopathology, there were no significant, additional effects on the lower order factors. This study provides evidence for the effectiveness of a selective personality-targeted intervention in altering trajectories of general psychopathology during adolescence. This finding represents impacts on multiple symptom domains and highlights the potential for general psychopathology as an intervention target.

Neurobiological Clusters Are Associated With Trajectories of Overall Psychopathology in Youth

BackgroundIntegrating multiple neuroimaging modalities to identify clusters of individuals and then associating these clusters with psychopathology is a promising approach for understanding neurobiological mechanisms that underlie psychopathology and the extent to which these features are associated with clinical symptoms. MethodsWe leveraged neuroimaging data from T1-weighted, diffusion-weighted, and resting-state functional magnetic resonance images from the Adolescent Brain Cognitive Development (ABCD) Study (N = 8035) and used similarity network fusion and spectral clustering to identify subgroups of participants. We examined neuroimaging measures as a function of clustering profiles using 1, 2, or 3 imaging modalities (i.e., data combinations), calculated the stability of the clustering assignment in each respective data combination, and compared the consistency of clusters across different data combinations. We then compared the extent to which clusters were associated with overall psychopathology at the baseline assessment and at 2 yearly follow-up visits. ResultsEach data combination resulted in optimal clusters ranging from 2 to 4 subgroups for each data combination. Clusters were stable across subsampling of the ABCD Study cohort. Widespread structural measures (surface area, fractional anisotropy, and mean diffusivity) were important features contributing to clustering across different data combinations. Five of the seven data combinations were associated with overall psychopathology, both at baseline and over time (d = 0.08–0.41). Generally, lower global cortical volume and surface area, widespread reduced fractional anisotropy, and increased radial diffusivity were associated with increased overall psychopathology. ConclusionsProfiles constructed from neuroimaging data combinations are associated with concurrent and future psychopathology trajectories.

Emotion regulation as a predictor of patterns of change in behavior problems in previously institutionalized youth.

Longitudinal trajectories of psychopathology in previously institutionalized (PI) youth were identified and biobehavioral emotion regulation processes were examined as developmental mechanisms that predict these trajectories. Mental health data were collected from PI (N = 132) and nonadopted (NA; N = 175) youth across four time points (participant age ranged from 7- to 21-year-old). Using semiparametric group-based methods, the probability that each individual belonged to a distinct group that followed a specific pattern of behavior across time was estimated. We then tested whether unique aspects of emotion regulation (global, observed, and biological) were differentially associated with membership in externalizing and internalizing trajectory groups using multinomial logistic regression models. Four externalizing trajectories were identified for the PI and NA groups. For PI youth, global, observed, and biological emotion regulation processes were uniquely predictive of more adaptive externalizing trajectories. For NA youth, only parent-reported global emotion regulation was predictive of externalizing patterns. Three internalizing trajectories were identified for PI and NA youth. Generally, only parent-reported global emotion regulation predicted internalizing group membership for both PI and NA youth. Results suggest that biobehavioral emotion regulation processes may be particularly important predictors and potential points of intervention when targeting trajectories of externalizing behaviors in PI children.

Effectiveness of a transdiagnostic emotion regulation training in an at-risk sample: a randomized-controlled trial of group-based training versus self-help bibliotherapy.

Subclinical psychotic, depression, and anxiety symptoms form a transdiagnostic 'at-risk state' for the development of mental disorders. Emotion regulation has been identified as a transdiagnostic factor relevant to the formation of these symptoms that can be successfully addressed in clinical interventions. Here, we tested whether a group-based emotion regulation training would be effective in reducing distress and at preventing the transition to mental disorders in an at-risk sample. Participants with distressing subclinical psychotic, depression, or anxiety symptoms (n=138) were randomly allocated to either the 8-week group-based affect regulation training (ART; Springer, New York) or an 8-week self-help bibliotherapy (BT). They underwent biweekly measurements during the intervention, as well as at a six- and 12-month follow-up. In an exploratory analysis, we tested whether the ART would be superior to BT in preventing the transition to any mental disorder at 12-month follow-up. We also tested for differences in trajectories of psychopathology and emotion regulation (via questionnaires) and emotion regulation in daily life (via the experience-sampling method). Participants in the ART condition showed a greater improvement of emotion regulation in daily life than those with BT, but the ART was not superior over BT in preventing the transition to mental disorders. There were significant longitudinal reductions from pre- to post-intervention for general psychopathology and symptoms but no superiority of the ART over BT. Despite its efficacy in improving emotion regulation skills, the ART does not produce effects on psychopathology that justify its recommendation over self-help approaches.

Trajectories of Psychopathology and Dysregulation 2-4 Years following Adolescent Bariatric Surgery.

This study examined psychopathology and weight over 4 years following bariatric surgery in adolescents with obesity, as compared to a nonsurgical group. The role of psychological dysregulation in relation to psychopathology in the 2-4 year "maintenance phase" following surgery was also examined. Adolescent participants (122 surgical and 70 nonsurgical) completed height/weight and psychopathology assessments annually for 4 years, with dysregulation assessed at Year 2. Analyses examined the association of "High" and "Low" psychopathology with weight over time using logistic regression. Mediation analyses in the surgical group examined indirect effects of dysregulation on percent weight loss through Year 4 psychopathology. There were lower odds of "High" internalizing symptoms in the surgical group versus the nonsurgical group from baseline (presurgery) to Year 4 (OR = .39; p < .001; 42.3% "High" internalizing in surgical; 66.7% in nonsurgical) and during the 2-4 year maintenance phase (OR = .35, p < .05; 35.1% "High" internalizing in surgical; 60.8% in nonsurgical). There was a significant mediation effect in the surgical group: higher dysregulation was associated with greater Year 4 internalizing symptoms (β = .41, p < .001) which in turn was associated with less Year 4 percent weight loss (β = -.27, p < .05). While the surgical group was less likely to experience internalizing symptoms, internalizing psychopathology was related to less percent weight loss in this group. Internalizing symptoms mediated the relationship between dysregulation and percent weight loss in the surgical group. Postoperative mental health follow-up is needed for adolescents into young adulthood.

The interrelations between psychological outcome trajectories and resource changes amid large-scale disasters: A growth mixture modeling analysis

Currently little is known about the interrelations between changes in psychiatric symptoms and changes in resources (personal, social, financial) amid large-scale disasters. This study investigated trajectories of psychiatric symptoms and their relationships with different patterns of changes in personal, social, and financial resources between 2020 and 2022 amid the COVID-19 pandemic. A population-representative sample (N = 1333) was recruited to complete self-report instruments at the pandemic’s acute phase (February–July 2020, T1), and again at 1-year (March–August 2021, T2) and 1.5-year (September 2021–February 2022, T3) follow-ups. Respondents reported depressive and anxiety symptoms, self-efficacy, perceived social support, and financial capacity. Growth mixture modeling (GMM) identified four trajectories of depressive and anxiety symptoms: resilience (72.39–74.19%), recovery (8.40–11.93%), delayed distress (7.20–7.35%), and chronic distress (8.33–10.20%). Four patterns were demonstrated in resource changes: persistent high resources (40.89–47.64%), resource gain (12.08–15.60%), resource loss (6.30–10.43%), and persistent low resources (28.73–36.61%). Loss and gain in financial resources characterized chronic distress and resilience, respectively. Loss in personal resources characterized delayed distress, whereas loss or no gain in social resources was related to chronic/delayed distress. Respondents in resilience were also more likely to have persistent high resources while those with delayed/chronic distress were more likely to have persistent low resources. These results provide an initial evidence base for advancing current understanding on trajectories of resilience and psychopathology in the context of resource changes during and after large-scale disasters.

Longitudinal patterns of childhood homelessness and early adolescent trajectories of internalising and externalising behaviour

BackgroundChild homelessness has been associated with elevated mental health problems during early adolescence, a period of onset for psychiatric problems. Prior literature has relied on cross-sectional studies, limiting the understanding...

Supplemental Material for Caregiver Emotion Regulation Predicts Trajectories of Psychopathology During Pediatric Cancer Treatment

Supplemental Material for Caregiver Emotion Regulation Predicts Trajectories of Psychopathology During Pediatric Cancer Treatment

Utilisation and costs of mental health-related service use among adolescents.

The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44-4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27-3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69-5.36, p<0.001]), higher impact of symptoms on adolescent's life (OR = 1.32, 95%CI = 1.19-1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05-1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12-0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02-0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04-1.07, p = 0.036). The impact of mental health problems on adolescents' daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.