The effect of post-natal mental distress amongst Indian and Pakistani mothers living in England on children's behavioural outcomes.

BACKGROUND: Low socio-economic status (SES), post-natal mental distress and parenting impact child mental health and future well-being. There are unexplained differences in child mental health between South Asian ethnic minority groups living in the UK that may be due to variation in, and differential mediation of, these factors. METHODS: We used multivariate multiple regression analysis of the effect of symptoms of mental distress, socio-demographic variables and warmth of parenting on child internalizing and externalizing scores at age seven (measured in 2010) in a population cohort of English children whose mothers were of Indian (n = 211) and Pakistani (n = 260) origin. RESULTS: In the fully adjusted models the legacy of mental distress was visible for both internalizing (ß coefficient 1.52, P = 0.04) and externalizing (1.68, P = 0.01) behaviour in the Pakistani children, and on the Indian children's internalizing (2.08, P = 0.008) but not externalizing (0.84, P = 0.204) behaviour. Lower SES was associated with worse behavioural scores for the Pakistani children, and warmth of parenting on Indian children's externalizing scores. CONCLUSIONS: Symptoms of post-natal mental distress are associated with Indian and Pakistani child outcomes at age seven. The finding that warmth of parenting had a stronger association on Indian children's externalizing scores than mental distress might be explained by differences in the expression of SES on family characteristics and functioning between the two ethnic groups.

Maternal general health and children's cognitive development and behaviour in the early years: findings from the Millennium Cohort Study.

BACKGROUND: Mothers often experience physical and psychological difficulties during the post-natal period and these may continue through the early years of raising children and have negative effects on engagement and caregiving. Pathways between maternal depression, parental engagement and caregiving and children's subsequent development have been described in longitudinal studies; yet, less is known about how other aspects of maternal health may influence children's development. METHODS: A longitudinal analysis within the Millennium Cohort Study was conducted including 7906 families from England. Maternal general health and psychological well-being were assessed when their children were 9 months and 3 years old, socio-demographic characteristics were assessed at 9 months, and engagement and caregiving were assessed at 3 years. These were examined as predictors of children's learning and development and behaviour at age 5. RESULTS: There are clear associations between maternal general health and children's development with regard to both learning and development and behaviour. These effects are reduced if psychological distress is taken into account; yet, maternal general health maintains importance as a predictor for children's subsequent development. There is evidence of an association via engagement and caregiving which links maternal health to children's development and evidence of the influence of underlying socio-demographic disadvantage. CONCLUSION: General maternal health as well as psychological well-being during the early years of raising children may be influential for children's development. This study suggests the need for a broader recognition of maternal health as well as psychological well-being as a foundation for family well-being, and speaks to support for mothers in maintaining engagement and caregiving for their children during periods of ill health.

The anti-non-gal xenoantibody response to xenoantigens on gal knockout pig cells is encoded by a restricted number of germline progenitors.

Antibodies directed at non-gal xenoantigens are responsible for acute humoral xenograft rejection when gal knockout (GalTKO) pig organs are transplanted into nonhuman primates. We generated IgM and IgG gene libraries using peripheral blood lymphocytes of rhesus monkeys initiating active xenoantibody responses after immunization with GalTKO pig endothelial cells and used these libraries to identify IgV(H) genes that encode antibody responses to non-gal pig xenoantigens. Immunoglobulin genes derived from the IGHV3-21 germline progenitor encode xenoantibodies directed at non-gal xenoantigens. Transduction of GalTKO cells with lentiviral vectors expressing the porcine alpha1,3 galactosyltransferase gene responsible for gal carbohydrate expression results in a higher level of binding of 'anti-non-gal' xenoantibodies to transduced GalTKO cells expressing the gal carbohydrate, suggesting that anti-non-gal xenoantibodies cross react with carbohydrate xenoantigens. The galactosyltransferase two gene encoding isoglobotriaosylceramide synthase (iGb3 synthase) is not expressed in GalTKO pig cells. Our results demonstrate that anti-non-gal xenoantibodies in primates are encoded by IgV(H) genes that are restricted to IGHV3-21 and bind to an epitope that is structurally related to but distinct from the Gal carbohydrate.

Childhood poverty, early motherhood and adult social exclusion.

Childhood poverty and early parenthood are both high on the current political agenda. The key new issue that this research addresses is the relative importance of childhood poverty and of early motherhood as correlates of outcomes later in life. How far are the 'effects' of early motherhood on later outcomes due to childhood precursors, especially experience of childhood poverty? Subsidiary questions relate to the magnitude of these associations, the particular levels of childhood poverty that prove most critical, and whether, as often assumed, only teenage mothers are subsequently disadvantaged, or are those who have their first birth in their early twenties similarly disadvantaged? The source of data for this study is the National Child Development Study. We examine outcomes at age 33 for several domains of adult social exclusion: welfare, socio-economic, physical health, emotional well-being and demographic behaviour. We control for a wide range of childhood factors: poverty; social class of origin and of father; mother's and father's school leaving age; family structure; housing tenure; mother's and father's interest in education; personality attributes; performance on educational tests; and contact with the police by age 16. There are clear associations for the adult outcomes with age at first birth, even after controlling for childhood poverty and the other childhood background factors. Moreover, we demonstrate that the widest gulf in adult outcomes occurs for those who enter motherhood early (before age 23), though further reinforced by teenage motherhood for most adult outcomes. We also show that any experience of childhood poverty is clearly associated with adverse outcomes in adulthood, with reinforcement for higher levels of childhood poverty for a few outcomes.

Changes in rates of suicide by car exhaust asphyxiation in England and Wales.

BACKGROUND: Self-asphyxiation using car exhaust gas is a common method of suicide in England and Wales, particularly in young males. The introduction of catalytic converters has reduced the toxicity of car exhausts. The main aims of the study were: to seek evidence of a fall in car exhaust suicides in the general population and in age and gender groups; to relate any fall to changes in car exhaust systems, particularly since legislation on car exhaust emissions in 1993; and to examine rates of suicide by other methods for evidence of method substitution. METHODS: Population study in England and Wales using national suicide statistics for 1987 to 1998. RESULTS: There was a fall in suicide by car exhaust asphyxiation in all age and gender groups. This change was most marked after 1993. The overall population suicide rate (all methods) also fell but there was no overall change in suicides by young males or females. In these groups suicide by hanging increased. CONCLUSIONS: Legislation on catalytic converters appears to have contributed to a fall in car exhaust suicides. However, the effect on overall suicide rates in young people has been reduced by method substitution.

Effect of death of Diana, princess of Wales on suicide and deliberate self-harm.

BACKGROUND: The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour. AIMS: To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH). METHOD: Analysis, using Poisson regression, of the number of suicides and open verdicts ('suicides') in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992-1996. Similar analysis on DSH presentations to a general hospital. RESULTS: Suicides increased during the month following the Princess's funeral (+17.4%). This was particularly marked in females (+33.7%), especially those aged 25-44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress. CONCLUSIONS: The death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed.

Cohabitation in Western Europe.

This article examines for a range of European countries: the extent to which men and women are not forming partnerships and how this has changed over time; the number of partnerships experienced; type of first partnership in terms of whether it commences with marriage or cohabitation and, if the latter, whether it converts into marriage; as well as the duration of different types of cohabiting unions. It also includes an examination of the risk of breakdown amongst first unions that commence with cohabitation or marriage and the variations in type of first union according to background characteristics, including: educational attainment, religious observance and experience of parental divorce in childhood.

Suicide within 12 months of contact with mental health services: national clinical survey.

OBJECTIVE: To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN: National clinical survey. SETTING: England and Wales. SUBJECTS: A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. MAIN OUTCOME MEASURES: Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. RESULTS: 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. CONCLUSIONS: Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.

Mental disorder and clinical care in people convicted of homicide: national clinical survey.

OBJECTIVES: To estimate the rate of mental disorder in those convicted of homicide and to examine the social and clinical characteristics of those with a history of contact with psychiatric services. DESIGN: National clinical survey. SETTING: England and Wales. SUBJECTS: Eighteen month sample of people convicted of homicide. MAIN OUTCOME MEASURES: Offence related and clinical information collected from psychiatric court reports on people convicted of homicide. Detailed clinical data collected on those with a history of contact with psychiatric services. RESULTS: 718 homicides were reported to the inquiry between April 1996 and November 1997. Of the 500 cases for whom psychiatric reports were retrieved, 220 (44%; 95% confidence interval 40% to 48%) had a lifetime history of mental disorder, while 71 (14%; 11% to 17%) had symptoms of mental illness at the time of the homicide. Of the total sample, 102 (14%; 12% to 17%) were confirmed to have been in contact with mental health services at some time, 58 (8%; 6% to 10%) in the year before the homicide. The commonest diagnosis was personality disorder (20 cases, 22%; 13% to 30%). Alcohol and drug misuse were also common. Only 15 subjects (18%; 10% to 26%) were receiving intensive community care, and 60 (63%; 53% to 73%) were out of contact at the time of the homicide. CONCLUSIONS: There are substantial rates of mental disorder in people convicted of homicide. Most do not have severe mental illness or a history of contact with mental health services. Inquiry findings suggest that preventing loss of contact with services and improving the clinical management of patients with both mental illness and substance misuse may reduce risk, but clinical trials are needed to examine the effectiveness of such interventions.

Childbearing outside marriage in western Europe.

Across most European states in recent decades there have been significant increases in childbearing outside marriage. This article examines the extent to which women have their first child in one of four settings: prior to any partnership; in their first cohabiting partnership; in first marriage; and after a first partnership. Temporal changes in these behaviours and variation according to background characteristics of the women are also examined. For the women who had a child outside any partnership, we examine the extent to which they go on to form partnerships and how long after the birth this happens. For those who had their first child within a cohabiting union, we examine the extent to which they marry and how long after the birth this occurs. Finally, we investigate whether children born within cohabiting unions that do and do not convert into marriages are more or less likely than those born within marriage to see their parents separate.

Becoming a young parent: a longitudinal study of associated factors.

Teenage fertility rates in the UK are amongst the highest in Europe and have not altered significantly in the last 15 years, but the proportion of births outside marriage has risen rapidly. In this study we used longitudinal data from the National Child Development Study (NCDS) to investigate the social, economic and educational backgrounds of young parents. The analysis showed there to be striking variations in the probabilities of becoming young parents but not with respect to whether the child was born within or outside marriage. Young mothers and fathers were more likely to come from economically disadvantaged families and to have lower educational attainment. Teenage mothers were more likely to have mothers who had a child in her teens and were more likely to have exhibited higher levels of emotional problems particularly in adolescence. Young women whose educational attainment scores deteriorated between childhood and adolescence had particularly high probabilities of becoming young mothers. For some teenage motherhood was unintended and the result of unprotected intercourse whilst other men and women who subsequently become young parents had expressed a preference for early parenthood whilst still at school.

The long-term effects of parental divorce on the mental health of young adults: a developmental perspective.

The effects of parental divorce during childhood and adolescence on the mental health of young adults (age 23) were examined, using the National Child Development Study (NCDS), a longitudinal, multimethod, nationally representative survey of all children born in Great Britain during 1 week in 1958 (N = 17,414). Children were assessed at birth and subsequently followed up at ages 7, 11, 16, and 23 by means of maternal and child interviews, and by psychological, school, and medical assessments. Parental divorce had a moderate, long-term negative impact on adult mental health, as measured by the Malaise Inventory total score, and controlling for economic status, children's emotional problems, and school performance preceding marital dissolution. The likelihood of scoring above the clinical cutoff of the Malaise Inventory rose from 8% to 11% due to parental divorce. This indicated that the relative risk of serious emotional disorders increased in the aftermath of divorce, but that the large majority of individuals did not exhibit such risks. Path analyses revealed that the negative effects of divorce on adult mental health operated indirectly through higher emotional problems and lower levels of school achievement and family economic status at age 16. Results related to timing of divorce, remarriage, and interactions between age 7 emotional problems and divorce, and between age 7 emotional problems and child gender, are also discussed.

Parental divorce in childhood and demographic outcomes in young adulthood.

We investigated the long-term effects of parental divorce in childhood on demographic outcomes in young adulthood, using a British longitudinal national survey of children. Our analyses control for predisruption characteristics of the child and the family, including emotional problems, cognitive achievement, and socioeconomic status. The results show that by age 23, those whose parents divorced were more likely to leave home because of friction, to cohabit, and to have a child outside marriage than were those whose parents did not divorce. Young adults whose parents divorced, however, were no more or less likely to marry or to have a child in a marriage. Moreover, even in the divorced group, the great majority did not leave home because of friction or have a child outside marriage.

Longitudinal studies of effects of divorce on children in Great Britain and the United States.

National, longitudinal surveys from Great Britain and the United States were used to investigate the effects of divorce on children. In both studies, a subsample of children who were in two-parent families during the initial interview (at age 7 in the British data and at ages 7 to 11 in the U.S. data) were followed through the next interview (at age 11 and ages 11 to 16, respectively). At both time points in the British data, parents and teachers independently rated the children's behavior problems, and the children were given reading and mathematics achievement tests. At both time points in the U.S. data, parents rated the children's behavior problems. Children whose parents divorced or separated between the two time points were compared to children whose families remained intact. For boys, the apparent effect of separation or divorce on behavior problems and achievement at the later time point was sharply reduced by considering behavior problems, achievement levels, and family difficulties that were present at the earlier time point, before any of the families had broken up. For girls, the reduction in the apparent effect of divorce occurred to a lesser but still noticeable extent once preexisting conditions were considered.

Who remains childless?

Who are the men and women who are childless in their mid-30s? Life history data for a British cohort born in 1946 show that age at marriage and marital breakdown were clearly associated with childlessness. Women who were only children were more likely to be childless than those with siblings. Further, early menarcheal age, being highly qualified and having a high status occupation were indirectly related to childlessness. For men, particularly amongst those who had experienced a broken marriage, it was the most ambitious, the highly educated and those in professional occupations who were relatively more likely to be childless.

PIP: Life history data for a British cohort born in 1946 show that age at marriage and marital breakdown were clearly associated with childlessness. Women who were only children were more likely to be childless than those with siblings. Further, early menarcheal age, being highly qualified and having a high status occupation were indirectly related to childlessness. For men, particularly amongst those who had experienced a broken marriage, it was the most ambitious, the highly educated, and those in professional occupations who were relatively more likely to be childless. Amongst both men and women in intact marriages, age at marriage was the most important factor, amongst the few that could be identified, that was related to the probability of being childless at age 36. Exposure time is unlikely to be the explanation for these differences as all had been married for some 10 years or more. This suggests that social and psychological factors that promote later marriage may be part of the same set that promote more negative attitudes to childbearing.

The physical layout of psychiatric offices: a survey.

A thirty-five item questionnaire examining how psychiatric offices are arranged was randomly mailed to 255 psychiatrists from the American Psychiatric Association (A.P.A.) directory. Several trends were displayed in the manner that offices were arranged; and significant differences were found amongst various subgroups of psychiatrists.

Occupational therapy program development for medical-psychiatry units: a cognitive model.

Occupational therapy programs form an essential component of the overall treatment program on medical psychiatry units for patients with depression, physical debilitation, and cognitive dysfunction. This article outlines theoretical and practical aspects of developing an occupational therapy program for medical-psychiatric inpatients. Emphasis is placed on accurate assessment of cognitive and physical functioning to facilitate stratification of patients into appropriate therapeutic activities that are commensurate with their level of functioning. The theoretical basis and orientation of occupational therapy is also discussed vis-à-vis its relevance to the treatment of patients with concurrent medical and psychiatric illness.

The British family: contemporary trends and issues.

PIP: Trends in family characteristics in Britain are discussed using data from official and other published sources. Separate consideration is given to marriage patterns, particularly marriage age and marriage postponement; the rise in consensual unions; fertility and illegitimacy; divorce; single parent families; and location of children under age 18. The effects of the employment situation on families as well as the future of social policies are also briefly examined.^ieng

Evidence of "cross-stressor"-induced adaptive gastric cytoprotection.

Rats were given 7 days pre-treatment with either water (p.o.), 1 h immobilization or 20% ethanol (p.o.) with or without concomitant indomethacin injection. Following the pre-treatment phase, rats from each pre-treatment group were exposed to either 3 h cold-restraint stress or to 100% ethanol p.o. Results indicated that immobilization and 20% ethanol pre-treatment significantly reduced both cold-restraint stress ulcer formation and 100% ethanol-induced ulcers. Indomethacin co-treatment attenuated the reduction of ulcer formation of both pretreatments. These results suggest that "cross-stressor" adaptive cytoprotection occurs. Indomethacin abolished these effects, implicating the involvement of endogenous prostaglandins in the mediation of "cross-stressor"-induced gastric cytoprotection.