Intervention targets for reducing mortality between mid-adolescence and mid-adulthood: a protocol for a machine-learning facilitated systematic umbrella review.

INTRODUCTION: A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps. METHODS AND ANALYSIS: In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews. ETHICS AND DISSEMINATION: This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42022355861.

Reproductive and sexual health of Australian adolescents exposed to family and domestic violence.

BACKGROUND: There is a dearth of research investigating sexually transmitted infections (STIs) in children exposed to family and domestic violence (FDV). Further, there is no research on terminations of pregnancy in children exposed to FDV. METHODS: This retrospective cohort study used linked administrative data from Western Australia to investigate whether exposure to FDV is associated with a risk of hospitalisations for STIs and terminations of pregnancy in adolescents. This study involved children born from 1987 to 2010 whose mother was a victim of FDV. Identification of family and domestic violence was from two sources: police and hospital records. This approach provided an exposed cohort of 16 356 and a non-exposed cohort of 41 996. Dependant variables were hospitalisations for pregnancy terminations and STIs in children aged from 13 up to 18 years of age. The primary explanatory variable was exposure to FDV. Multivariable Cox regression was used to investigate the association of FDV exposure and the outcomes. RESULTS: Following adjustment for sociodemographic and clinical factors, children exposed to FDV had an increased risk of hospitalisations for STIs (HR 1.49, 95% CI 1.15 to 1.92) and terminations of pregnancy (HR 1.34, 95% CI 1.09 to 1.63) as an adolescent than non-exposed peers. CONCLUSION: Children exposed to FDV are at an increased risk of hospitalisation for STI and termination of pregnancy as an adolescent. Effective interventions are needed to support children exposed to FDV.

Examining the relationship between maternal mental health-related hospital admissions and childhood developmental vulnerability at school entry in Canada and Australia.

BACKGROUND: It is well established that maternal mental illness is associated with an increased risk of poor development for children. However, inconsistencies in findings regarding the nature of the difficulties children experience may be explained by methodological or geographical differences. AIMS: We used a common methodological approach to compare developmental vulnerability for children whose mothers did and did not have a psychiatric hospital admission between conception and school entry in Manitoba, Canada, and Western Australia, Australia. We aimed to determine if there are common patterns to the type and timing of developmental difficulties across the two settings. METHOD: Participants included children who were assessed with the Early Development Instrument in Manitoba, Canada (n = 69 785), and Western Australia, Australia (n = 19 529). We examined any maternal psychiatric hospital admission (obtained from administrative data) between conception and child's school entry, as well as at specific time points (pregnancy and each year until school entry). RESULTS: Log-binomial regressions modelled the risk of children of mothers with psychiatric hospital admissions being developmentally vulnerable. In both Manitoba and Western Australia, an increased risk of developmental vulnerability on all domains was found. Children had an increased risk of developmental vulnerability regardless of their age at the time their mother was admitted to hospital. CONCLUSIONS: This cross-national comparison provides further evidence of an increased risk of developmental vulnerability for children whose mothers experience severe mental health difficulties. Provision of preventative services during early childhood to children whose mothers experience mental ill health may help to mitigate developmental difficulties at school entry.

Exposure to family and domestic violence is associated with lower attendance and higher suspension in school children.

BACKGROUND: Exposure to family and domestic violence (FDV) in childhood can have a detrimental effect on children's health and social outcomes. However, research on the school outcomes of children exposed to FDV is scant. OBJECTIVES: To investigate the impact of FDV exposure on school attendance and suspension in Aboriginal and non-Aboriginal children. METHODS: A population-based retrospective cohort study of school children, in grade 1 to 10, born from 1993 to 2006 in Western Australia (n = 26,743) using linked administrative data. Multivariate logistic regression analysis was used to calculate odds ratios and 95% confidence intervals to determine the association with school attendance and suspension outcomes for children exposed to FDV compared to non-exposed children. RESULTS: Compared to non-exposed children, children exposed to FDV have an increase of poor school attendance: Aboriginal children adjusted odds ratio (aOR) = 1.91, 95% confidence interval (CI): 1.75-2.07, non-Aboriginal children aOR = 2.42, 95%CI: 2.12-2.75. FDV-exposed children also have an increased risk of school suspension: Aboriginal children aOR = 1.60, 95%CI: 1.47-1.74, non-Aboriginal children aOR = 2.68, 95%CI: 2.35-3.05, compared to non-exposed counterparts. CONCLUSION: Exposure to FDV is associated with an increased odds of poor school attendance and school suspension. Evidence-based and innovative strategies are needed to support children who are exposed to FDV. This involves responding in ways that does not cause further trauma to children; a restorative and trauma-informed approach is vital.

The lasting impact of family and domestic violence on neonatal health outcomes.

OBJECTIVES: To compare the health of neonates born to women who experienced family and domestic violence (FDV) 12 months prior to birth, with the health of neonates born to women with an earlier history of FDV and women with no history of FDV. METHODS: A retrospective cohort of women who experienced FDV within 12 months of birth (antenatal FDV [AFDV]) (n = 1230) was identified using data from the Western Australia (WA) Police Force Incident Management System and WA Hospital Morbidity Data Collection. Two comparison cohorts were used, the first including women with a history of FDV (HFDV) 12-60 months prior to birth (n = 1549) and the second with no history of FDV (NFDV) recorded (n = 3690). Hospital, birth, mortality, and congenital anomaly data were used in generalized linear models to examine and compare neonatal health outcomes. RESULTS: Women in the AFDV group had higher proportions of factors associated with poor neonatal outcomes including smoking (42.4%), substance use (23.0%), and mental health disorders (34.8%). Neonates born to AFDV mothers had significantly higher odds of congenital anomalies (OR: 1.51, 95% CI: 1.18-1.94), low birth weight (1.74, 1.45-2.10), and preterm birth (1.48, 1.22-1.79) compared with neonates born to NFDV mother. Neonatal health outcomes in those born to AFDV women were not significantly different from those born to HFDV women. CONCLUSIONS: Antenatal and historical FDV were associated with poor neonatal health outcomes. Additional pregnancy and social support should be offered to women who have experienced FDV during or prior to pregnancy.

Epilepsy in children exposed to family and domestic violence in the first 5 years of life.

AIM: To investigate childhood (0-18 years) hospitalisation and emergency department (ED) contacts for epilepsy in Western Australian (WA) children exposed to family and domestic violence (FDV) pre 5 years of age compared to children with no FDV exposure. METHODS: A retrospective, population-based cohort study included children born 1987-2010 who were identified as being exposed to FDV (n = 7018) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Epilepsy contact was identified in HMDC and ED Data Collection records. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval (CI) for epilepsy contact; adjustment was made for a range of demographic characteristics known to impact health outcomes. Analyses were stratified by Aboriginal and Torres Strait Islander status to account for higher rates of FDV and epilepsy hospital admissions in Aboriginal and Torres Strait Islander children. RESULTS: Children exposed to FDV had a 62% (HR 1.62, 95% CI: 1.33-1.98) increased risk of epilepsy contact than non-exposed counterparts. Furthermore, the children exposed to FDV had a 50% longer average hospital stay for epilepsy than non-exposed children (4.7 days vs. 3 days, P = 0.006). When stratified by Aboriginal status, we found that Aboriginal children exposed to FDV stayed (on average) 2 days longer in hospital for epilepsy than their non-exposed counterparts (5.1 days vs. 3.1 days, P = 0.018). CONCLUSIONS: FDV exposure in early childhood is associated with increased risk of requiring secondary health care and longer hospital stays for childhood epilepsy.

A Demographic Profile of Mothers and Their Children Who Are Victims of Family and Domestic Violence: Using Linked Police and Hospital Admissions Data.

The aim of this study was to examine the key sociodemographic characteristics of Australian mothers and their children who were victims of family and domestic violence (FDV) that resulted in the male perpetrator being criminally charged for the offense or the mother being hospitalized. A population-based retrospective cohort study using de-identified linked health and police data of mothers with children born 1987-2010 who were victims of FDV 2004-2008 was utilized. Results indicate that mothers who were identified in police data are different demographically from those identified in health data and differed again from mothers identified in both health and police data. Within Western Australia, 3% of the population identify as Aboriginal; however, 44% of mothers identified as victims in police data and 73% within the health data were Aboriginal. Of the mothers identified in police data, 30% were under 25 years of age at their first assault recorded in police data compared with 21% in those identified in both police and hospital data. Most mothers identified as victims of FDV in police data had children present at their assault (60.6%). Prevalence of FDV exposure, identified in police data, was significantly different in Aboriginal children compared with non-Aboriginal children. Aboriginal children had a 19-fold (p < .0001) increased difference in prevalence of exposure compared with their non-Aboriginal counterparts. The study reveals the challenges in identifying victims of FDV when relying on a single data source for research and highlights the need for multiple datasets when investigating FDV. The overrepresentation of Aboriginal mothers and children should be taken in the context of the long-lasting impact of colonization. As such, prevention and early intervention strategies need to be underpinned by Aboriginal communities' cultural authority.

School Readiness of Children Exposed to Family and Domestic Violence.

Children have a universal right to live free from exposure to family and domestic violence (FDV). Children exposed to FDV can experience long-term effects on their physical and psychological health and their social competencies including social, emotional, and cognitive skills and behaviours that underpin successful social adaptation and academic achievement. The aim of this study was to investigate if children exposed to FDV were more likely to be vulnerable on school readiness measures compared to those children who were not exposed. Our cohort study used de-identified individual-level administrative data of children born during 2002-2010, in Western Australia, who were identified in police and hospital records as being exposed to FDV during 2002-2015. Univariate and multivariate logistic regression was used to estimate the odds of vulnerability in Australian Early Development Census (AEDC) outcomes of children exposed to FDV compared to a non-exposed cohort. After adjusting for demographic characteristics, children exposed to FDV had higher odds than non-exposed children of being vulnerable in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Exposed children have an increased likelihood of vulnerability in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Comprehensive multiagency early intervention for children exposed to FDV is required to mitigate the impact on outcomes, and ultimately the need to prevent FDV is needed.

Children with Secondary Care Episodes for Otitis Media Have Poor Literacy and Numeracy Outcomes: A Data Linkage Study.

We examined the association between otitis media (OM) and educational attainment in a retrospective population cohort of Western Australian children who participated in the grade 3 National Assessment Program-Literacy and Numeracy in 2012 (N = 19,262). Literacy and numeracy scores were linked to administrative hospital and emergency department data to identify secondary care episodes for OM. Results of multivariate multilevel models showed that children with OM episodes had increased odds of poor performance on literacy and numeracy tests, compared to children without OM episodes (46-79% increase in odds for Aboriginal children; 20-31% increase in odds for non-Aboriginal children). There were no significant effects found for age at the first episode, nor for OM episode frequency (all ps > 0.05). Regardless of the timing or frequency of episodes, children with OM episodes are at risk of poor literacy and numeracy attainment. Aboriginal children with OM appeared to be particularly at risk of poor literacy and numeracy achievement. Intervention to reduce the prevalence of otitis media in young children, and early treatment of OM, are important for limiting the negative effects on academic outcomes.

Exposure to family and domestic violence is associated with increased childhood hospitalisations.

BACKGROUND: Children's exposure to family and domestic violence (FDV) is a global public health concern and is considered one of the most common and severe stressors children can experience. While it is acknowledged that children who are exposed to FDV have poorer general health, there is a lack of data on the outcomes of children exposed to FDV. The use of longitudinal data has been suggested as a way to gain an understanding of the impact on children's long-term outcomes. METHODS: Our cohort study used deidentified individual-level linked administrative data of children born 1987-2010, in Western Australia, who were exposed to FDV in the prenatal period (12 months prior to birth) to five years of age (early years). RESULTS: Children exposed to FDV are more likely to be hospitalised than non-exposed children. Children exposed to FDV in both the prenatal and early childhood period had a threefold increased odds of mental health hospitalisation. We found a significant increase in odds of pregnancy-related hospitalisation in FDV exposed children. When stratified by Aboriginal status, Aboriginal children had a higher proportion of hospitalisations than non-Aboriginal children. CONCLUSION: Exposed children have an increased likelihood for hospitalisation than non-exposed children. Within the exposed cohort differences were apparent between Aboriginal and non-Aboriginal children. Aboriginal children had greater odds for hospitalisation in most of the diagnostic groups compared to their non-Aboriginal counterparts. Our findings represent an important advance in the literature with respect to the burden of disease of children exposed to FDV.

Literacy and Numeracy Underachievement in Boys and Girls With ADHD.

Objective: The aim was to determine literacy and numeracy outcomes, among children with and without ADHD by gestational age and gender. Method: De-identified linked population data from the Western Australian Monitoring of Drugs of Dependence System and Western Australian Literacy and Numeracy Assessment databases, and the Midwives Notification System used information on 6,819 children with ADHD compared with 14,451 non-ADHD children. Results: A total of 23% of boys and 28% of girls with ADHD had numeracy scores below the benchmark in School Year 3, compared with 11% of children without ADHD. These differences were also evident for reading, writing, and spelling through primary school. Children with ADHD and reduced gestational age were at a greater risk of not meeting numeracy and reading benchmarks, compared with children born at term. Conclusion: Children with ADHD are disadvantaged from an early age in key areas of learning, and this risk increased with reduction in gestational age at birth.

Literacy and Numeracy Underachievement in Boys and Girls With ADHD.

Objective: To determine literacy and numeracy outcomes, among children with and without ADHD by gestational age and gender. Method: De-identified linked population data from the Western Australian Monitoring of Drug Dependence Systems, Western Australian Literacy and Numeracy Assessment database, and the Midwives Notification System used information on 6,819 children with ADHD compared with 14,451 non-ADHD children. Results: Twenty-three percent of boys and 28% of girls with ADHD had numeracy scores below the benchmark in School Year 3, compared with 11% of children without ADHD. These differences were also evident in reading, writing, and spelling through primary school. Children with ADHD and reduced gestational age were at a greater risk of not meeting numeracy and reading benchmarks, compared with children born at term. Conclusion: Children with ADHD are disadvantaged from an early age in key areas of learning, and this risk increased with reduction in gestational age at birth.

The pervasive effects of timing of parental mental health disorders on adolescent deliberate self-harm risk.

Children whose parents have mental health disorders are at increased risk for deliberate self-harm (DSH). However, the effect of timing of parental mental health disorders on adolescent DSH risk remains under-researched. The aim of this study was to investigate how parental hospital admissions for mental health disorders and/or DSH in different developmental periods impact on the child's DSH risk in adolescence. A nested case-control sample was compiled from a total population cohort sample drawn from administrative health records in Western Australia. The sample comprised 7,151 adolescents who had a DSH-related hospital admission (cases), and 143,020 matched controls who hadn't had a DSH-related hospital admission. The occurrence of parental hospital admissions related to mental health disorders and/or DSH behaviours was then analysed for the cases and controls. The timing of the parental hospital admissions was partitioned into four stages in the child's life course: (1) pre-pregnancy, (2) pregnancy and infancy, (3) childhood, and (4) adolescence. We found that adolescents of a parent with mental health and/or DSH-related hospital admissions in all developmental periods except pregnancy and infancy were significantly more likely than controls to have a DSH-related hospital admission. Compared to parental hospital admissions that occurred during childhood and adolescence, those that occurred before pregnancy conferred a higher risk for adolescent DSH: adjusted odds ratio (aOR) = 1.25 for having only one parent hospitalised and 1.66 for having both parents hospitalised for mental health disorders; aOR = 1.97 for having any parent hospitalised for DSH, all being significant at the level of p < .001. This study shows that timing is important for understanding intergenerational transmission of DSH risk. The pre-pregnancy period is as critical as period after childbirth for effective intervention targeting adult mental health disorders and DSH, highlighting the important role of adult mental health services in preventing DSH risk in future generations.

Hospitalisations for maternal assault are associated with increased risk of child protection involvement.

BACKGROUND: Previous research shows a co-occurrence between children's exposure to violence and child maltreatment. OBJECTIVE: This study examined the risk of maltreatment allegations in children whose mothers had been hospitalised due to an assault. PARTICIPANTS AND SETTING: The study used a retrospective cohort of children born in Western Australia between 1990-2009 (N = 524,534) using de-identified linked-administrative data. METHODS: Multivariate Cox regression determined the adjusted and unadjusted hazard ratios for child maltreatment allegation in children with a mother hospitalised for assault. Models were adjusted for a range of sociodemographic characteristics. RESULTS: One in five children had a maltreatment allegation following their mother's hospitalisation for assault. This increased to two in five children when the mother was assaulted in the prenatal period. Aboriginal children accounted for 57.6% of all allegations despite representing only 7.8% of the population. Children whose mother had a hospitalisation for assault were nine-times (HR = 9.20, 95%CI: 8.98-9.43) more likely to have a subsequent maltreatment allegation than children whose mother did not have a hospitalisation for assault. Following adjustment for confounding factors, both Aboriginal and non-Aboriginal children had an almost two-fold increased risk of maltreatment allegation (HR = 1.56, 95%CI: 1.43-1.70; HR = 1.93 95%CI:1.80-2.07). CONCLUSIONS: Our study shows that child maltreatment allegation is common in children following a maternal hospitalisation for assault. Targeted early intervention is required for families with young children, and pregnant women experiencing violence. Importantly service staff need awareness of the impact of violence on families and the appropriate services to refer families to.

Developmental vulnerabilities in children of chronically ill parents: a population-based linked data study.

BACKGROUND: Currently, there is mixed evidence regarding the effects on children when a parent is chronically ill. Research has also primarily been conducted with adolescent samples. This study investigated developmental vulnerabilities in young children of parents with chronic illness. METHODS: This study used linked administrative data. The study population included children born in Western Australia during 2003-2004 (n=19 071; mean age 5.5 years). The outcome measure was a score in the bottom 25% on any of the five developmental domains (physical, social, emotional, communicative and cognitive) of the Australian Early Development Census (2009 collection). Parental chronic illnesses were identified from hospital and cancer registry records, during the period from 1 year prior to the child's birth and until the end of 2009. RESULTS: Higher odds of developmental vulnerabilities in physical, social, emotional and communication domains were observed for daughters of chronically ill mothers. Sons of chronically ill mothers had increased odds of language and cognitive difficulties. Risk level increased with each additional year of exposure to maternal chronic illness. Results also indicated increased odds of developmental vulnerabilities for children of mothers experiencing multiple compared with single chronic conditions; however, results were not statistically significant (all p>0.05). No association between fathers' chronic illness and children's developmental outcomes was found. CONCLUSIONS: Maternal chronic illness is associated with an increased risk of poor developmental outcomes for children, particularly daughters. Healthcare services have an important role to play in linking families into appropriate family-centred services to best support the needs of chronically ill mothers.

Using linked data to investigate developmental vulnerabilities in children of convicted parents.

There is evidence that children of incarcerated parents are at risk of poor developmental and educational outcomes. However, much of this evidence is limited by biased samples, as studies must rely on opt-in recruitment. Administrative data present an opportunity to overcome this challenge, as they capture information on all incarcerated individuals. This study used administrative data on convictions of the parents of 19,071 children aged 5-6 years in Western Australia. Records of parental convictions (starting from 1 year prior to the child's birth) were linked to children's scores on the Australian Early Development Census, which is a teacher-reported measure of children's physical, social, emotional, communicative, and cognitive development. Logistic regression models estimated the odds of children of convicted parents being developmentally vulnerable. Models were adjusted for child, parent, and neighborhood sociodemographic factors. Compared to children in the comparison group, children whose parent had either served a community order or been incarcerated were at risk of poor development across all developmental domains, even after adjusting for sociodemographic factors. Furthermore, children of incarcerated parents had higher odds of developmental vulnerability on multiple domains compared to children of parents who had served community orders only. The results suggest that, although children of convicted parents experience a higher incidence of sociodemographic risk, their parents' criminal activity constitutes an independent risk factor for their development. Intervention to support the early development of children of convicted parents is therefore essential, and should consider the family context. (PsycINFO Database Record

School readiness of maltreated children: Associations of timing, type, and chronicity of maltreatment.

Children who have been maltreated during early childhood may experience a difficult transition into fulltime schooling, due to maladaptive development of the skills and abilities that are important for positive school adaptation. An understanding of how different dimensions of maltreatment relate to children's school readiness is important for informing appropriate supports for maltreated children. In this study, the Australian Early Development Census scores of 19,203 children were linked to information on child maltreatment allegations (substantiated and unsubstantiated), including the type of alleged maltreatment, the timing of the allegation (infancy-toddlerhood or preschool), and the total number of allegations (chronicity). Children with a maltreatment allegation had increased odds of poor school readiness in cognitive and non-cognitive domains. Substantiated maltreatment was associated with poor social and emotional development in children, regardless of maltreatment type, timing, or chronicity. For children with unsubstantiated maltreatment allegations, developmental outcomes according to the type of alleged maltreatment were more heterogeneous; however, these children were also at risk of poor school readiness irrespective of the timing and/or chronicity of the alleged maltreatment. The findings suggest that all children with maltreatment allegations are at risk for poor school readiness; hence, these children may need additional support to increase the chance of a successful school transition. Interventions should commence prior to the start of school to mitigate early developmental difficulties that children with a history of maltreatment allegations may be experiencing, with the aim of reducing the incidence of continuing difficulties in the first year of school and beyond.

The impact of child maltreatment on the risk of deliberate self-harm among adolescents: A population-wide cohort study using linked administrative records.

Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR=1.04, 95%CI: 1.00-1.08, p<.01) and children with a substantiated allegation (aHR=1.10, 95%CI: 1.06-1.15, p<.001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose-response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.

Influence of exposure to perinatal risk factors and parental mental health related hospital admission on adolescent deliberate self-harm risk.

Adolescent deliberate self-harm (DSH) has been found to be associated with a range of bio-psycho-social factors. Simultaneous investigations of these factors enable more robust estimation of the independent effect of a specific risk factor by adjusting for a more complete set of covariates. However, few studies have had the ability to examine all of these factors together. This study used the linkage of population-level de-identified data collections from government agencies to investigate a range of biological, psychological, and social risk factors and their effects on adolescent risk of DSH (with or without suicidal intent). The investigation was undertaken by progressively adjusting for plausible covariates, including fetal growth status and birth order, early familial social factors, parental hospital admissions due to psychiatric disorders or DSH, and parental all-cause death. Conditional logistic regression was used for data analysis. Children's psychiatric history was analysed to examine the extent to which it may account for the link between the risk factors and adolescent DSH risk. This study identified significant biological and perinatal social risk factors for adolescent DSH risk, including overdue birth, high birth order (≥2), single or teen/young motherhood, high neighbourhood socioeconomic disadvantage, and parental psychiatric and/or DSH-related hospital admissions. Further, parental psychiatric and/or DSH-related admissions, and children's psychiatric admissions in particular, largely attenuated the effects of the perinatal social risk factors but not the biological factors on adolescent DSH risk. These results highlight the importance of taking joint actions involving both health and social services in the prevention of adolescent DSH.

Data linkage in an established longitudinal cohort: the Western Australian Pregnancy Cohort (Raine) Study.

The Western Australian Data Linkage System is one of a few comprehensive, population-based data linkage systems worldwide, creating links between information from different sources relating to the same individual, family, place or event, while maintaining privacy. The Raine Study is an established cohort study with more than 2000 currently active participants. Individual consent was obtained from participants for information in publicly held databases to be linked to their study data. A waiver of consent was granted where it was impracticable to obtain consent. Approvals to link the datasets were obtained from relevant ethics committees and data custodians. The Raine Study dataset was subsequently linked to academic testing data collected by the Western Australian Department of Education. Examination of diet and academic performance showed that children who were predominantly breastfed for at least 6 months scored higher academically at age 10 than children who were breastfed for less than 6 months. A further study found that better diet quality at ages 1, 2 and 3 years was associated with higher academic scores at ages 10 and 12 years. Examination of nutritional intake at 14 years of age found that a better dietary pattern was associated with higher academic performance. The detailed longitudinal data collected in the Raine Study allowed for adjustment for multiple covariates and confounders. Data linkage reduces the burden on cohort participants by providing additional information without the need to contact participants. It can give information on participants who have been lost to follow-up; provide or complement missing data; give the opportunity for validation studies comparing recall of participants with administrative records; increase the population sample of studies by adding control participants from the general population; and allow for the adjustment of multiple covariates and confounders. The Raine Study dataset is extensive and detailed, and can be further improved by linking to other external data sources. By linking educational outcomes to the Raine Study database, it was shown across three different age groups that a healthy diet was consistently associated with higher academic performance.