Psychiatric morbidity is related to a chain of prenatal and perinatal adversities.

BACKGROUND: Most studies on the effects of early risk factors on future mental health focus on specific obstetric complications as risk factors for specific disorders. However, obstetric complications rarely occur in isolation, and the same holds for psychiatric problems. AIMS: To study prenatal and perinatal risk factors for psychiatric multimorbidity in early adulthood and to determine whether these differ from risk factors for monomorbidity. STUDY DESIGN: Monomorbidity and multimorbidity of six types of psychiatric disorders were determined by a standardised psychiatric interview. Using univariate and multivariate logistic and ordinal logistic regression, associations of mono- and multimorbidity with prospectively collected early risk factors were examined. SUBJECTS: Two hundred and eighty-five young adults selected from a prospective birth cohort on the basis of their Obstetric Optimality Scores. OUTCOME MEASURES: Six types of psychiatric disorder and their co-occurrence. RESULTS: Monomorbidity was related to isolated early risk factors such as low birth weight or a low Apgar score, and to an accumulation of unfavourable pre- and perinatal events. Multimorbidity on the other hand, was only related to a chain of pre- and perinatal adversities. CONCLUSION: Research and prevention strategies should not focus solely on isolated early risk factors, but also on the entire pre- and perinatal situation.

Obstetric optimality and emotional problems and substance use in young adulthood.

BACKGROUND: Pregnancy and delivery are complex processes, and isolated obstetric complications rare and often accompanied or followed by a number of others. AIMS: To study the relationship between the overall obstetric situation (as opposed to single obstetric risk factors) and emotional and substance use disorders in young adulthood, and to analyse whether these links are mediated by temperaments in childhood. STUDY DESIGN: In a prospective birth cohort (n=3162), questionnaires were sent to mothers and teachers when the child was 7-10 years old, and to the children when they were 20-25 years old. SUBJECTS: Six hundred and eighty-two cohort members with complete data sets at three ages (perinatal, childhood, and young adulthood). OUTCOME MEASURES: Emotional problems and substance use in young adulthood. MAIN RESULTS: Substance use in young adulthood was predicted better by the overall obstetrical optimality score than emotional problems were. Links studied were stronger for men than for women. CONCLUSIONS: This study demonstrated the use of an aggregated obstetrical optimality score in analysing the associations between early risk factors and emotional problems and substance use in young adulthood.

Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort.

AIM: To examine effects of maternal smoking during pregnancy on academic achievement and emotional and behavioural problems during childhood. METHODS: Least squares regression was used to examine associations between maternal smoking prior to delivery and subsequent academic performance and behaviour of 1186 children aged 5.5-11 years. Crude associations were adjusted for risk factors that were significantly related to the respective outcomes. MAIN OUTCOME MEASURES: Parents and teachers were asked to indicate, on a 10-item questionnaire, whether they regarded the child as more, the same, or less shy/withdrawn (internalising), troublesome (externalising), and attention deficient than the average child. Reading, spelling, and arithmetic performance levels were assessed with short standardised Dutch tests. RESULTS: After adjustment for confounders like socio-economic status and pre- and perinatal complications, children of mothers who smoked during pregnancy showed more signs of attention deficit and displayed higher levels of troublesome (externalising) behaviour than non-cigarette-exposed children. Also, children of smoking mothers performed worse on arithmetic and spelling tasks. Spelling problems were more pronounced when the mother continued to smoke after the child's birth. Excessively withdrawn (internalising) behaviour was not related to maternal smoking but to factors like the mother's use of psychotropic drugs and bottle-instead of breastfeeding. CONCLUSION: Perinatal antecedents of internalising behaviour on the one hand and externalising behaviour, attention deficit, and learning problems on the other seem to be distinct. Only the latter are independently associated with maternal smoking during pregnancy and thus potentially amenable to early preventive effort, for instance, through continued health education emphasising the health hazards of nicotine use by pregnant women.

The neurology of learning and behavioural problems in pre-adolescent children.

OBJECTIVE: The aim of the study was to evaluate whether in pre-adolescent children specific types of minor neurological dysfunction (MND) are related to specific types of learning and behavioural problems, and whether it is the type or the severity of neurological dysfunction that matters most. METHOD: A total of 1186, 5.5-11-year-old, children were examined for the presence of clusters of signs of MND. Parents and teachers completed brief behaviour rating scales. In school-aged children (n = 580) cognitive achievement was assessed using standardized Dutch tests. Least-squares regression was used to examine neurobehavioural and neurocognitive links. RESULTS: Children with more MND clusters performed worse scholastically and had more signs of attention deficit than others. Externalizing and internalizing behaviour were only linked to specific forms of MND. CONCLUSION: Evaluation of the neurological condition of the child with learning and behavioural problems offers insight into the aetiology and pathogenesis of these problems.

Quantifying psychiatric comorbidity--lessions from chronic disease epidemiology.

BACKGROUND: Comorbidity research in psychiatric epidemiology mostly uses measures of association like odds or risk ratios to express how strongly disorders are linked. In contrast, chronic disease epidemiologists increasingly use measures of clustering, like multimorbidity (cluster) coefficients, to study comorbidity. This article compares measures of association and clustering. METHODS: Narrative review, algebraical examples, a secondary analysis of an existing dataset and a pooled analysis of published data. RESULTS: Odds and risk ratios, but the former more than the latter, confound clustering with coincidental comorbidity. Multimorbidity coefficients provide a pure estimate of clustering which is the proportion of the association between disorders that is of etiological interest. Odds and risk ratios can express comorbidity between no more than two disorders, whilst clustering coefficients, although computationally laboursome, can capture multimorbidity of any number of disorders. Cluster coefficients depend less on the prevalence of illness in study groups than measures of association. CONCLUSION: Odds and risk ratios are well suited for comorbidity research which focuses on which sets of disorders or syndromes tend to occur in combination and the implications of this for, for instance, nosological classification, a traditional interest of psychiatric epidemiology. However, the cluster coefficient is to be preferred if the interest is more aetiological, addressing for example why certain individuals are prone to multiple health problems.

Opinions about 'unexplained subfertility'.

The term 'unexplained subfertility' applies to the situation in which a couple, despite serious attempts, does not achieve pregnancy, while according to current knowledge no physiological or anatomical abnormalities can be found. In this paper, possible causes of this phenomenon are reviewed and opinions of six doctors working in the field of reproductive medicine are described. The most significant finding of this study is that all doctors hold personal views with a high level of certainty about the causes of unexplained subfertility. However, they hardly agree with each other! In conclusion, in the field of reproductive medicine there is a dangerous combination of strong personal opinions and much disagreement with regards to unexplained infertility.