Exploring the interplay between psychotic experiences, functional somatic symptoms and health anxiety in childhood and adolescence - A longitudinal cohort study.

BACKGROUND: Similarities exist between contemporary explanatory models underlying psychosis development, functional somatic symptoms, and health anxiety. The current study aimed to examine the potential interplay between psychotic experiences (and alternate measures of anomalous self-experiences and aberrant attribution of salience) and functional somatic symptoms on the outcome of health anxiety in youths. METHODS: In a prospective general-population birth cohort, the Copenhagen Child Cohort 2000 (CCC2000), data from two time-points were available for 1122 individuals. We assessed the associations between psychotic experiences and functional somatic symptoms with health anxiety both cross-sectionally at ages 11- and 16-years, and longitudinally from age 11 to 16. Further, we examined if there was an interaction between these two domains on the outcome of health anxiety using the interaction contrast ratio. RESULTS: Functional somatic symptoms and psychotic experiences were strongly cross-sectionally associated with health anxiety at both ages 11 and 16, even after adjustment for general psychopathology. In the longitudinal analyses, functional somatic symptoms, and psychotic experiences at age 11 were not individually associated with health anxiety at age 16 but having both functional somatic symptoms and psychotic experiences was: odds ratio 3.90, 95%CI 1.7-8.9, with suggestion of evidence for interaction beyond the additive effects. This association was attenuated after adjustment for general psychopathology: odds ratio 2.6, 95 % CI 1.0-6.4. CONCLUSION: The strong associations between the domains support the idea of possible overlapping mechanisms underlying psychotic experiences, functional somatic symptoms, and health anxiety.

Hair cortisol and self-perceived stress in adolescents with multi-system functional somatic disorders.

BACKGROUND: Long-term stress causing altered hypothalamic-pituitary-adrenal (HPA) axis dynamics with cortisol dysfunction may be involved in the pathophysiology of functional somatic disorders (FSD), but studies on adolescents with multi-system FSD are lacking. Therefore, we investigated: 1) whether hair cortisol concentration (HCC) differentiates adolescents with multi-system FSD from a) a population-based sample and b) a subgroup derived from the sample reporting a high physical symptom load, and 2) whether FSD population HCC is associated with primary symptom presentations and self-perceived stress. METHODS: We used data from a clinical sample with multi-system FSD (N = 91, age 15-19 years) and a population-based sample (N = 1,450, age 16-17 years) including a subgroup with top 10% total scores on physical symptoms (N = 147). Density plots and multiple linear regression were applied to compare HCC between groups. In the clinical sample, multiple linear regression was employed to assess the association between HCC and primary symptom clusters and self-perceived stress. RESULTS: Median HCC was lower in the clinical sample than in the population-based sample (ß = 0.80 (95%CI: 0.66, 0.97)), but not significantly different from median HCC in the derived subgroup (ß = 0.84 (95%CI: 0.66, 1.07)). In the clinical sample, HCC was not significantly associated with primary symptom clusters (F(2, 82) = 0.13, p = 0.88) or self-perceived stress (F(4, 83) = 1.18, p = 0.33). CONCLUSION: Our findings indicate that HCC is lowered in adolescents with multi-system FSD but not significantly associated with primary symptom presentations or self-perceived stress. Future studies including multiple measures of HPA axis dynamics alongside psychological measures may further elucidate the role of long-term stress in FSD. TRIAL REGISTRATION: The AHEAD study was pre-registered at ClinicalTrials.gov (NCT02346071), 26/01/2015.

Comparison of prevalence and mental health problems across symptom frequency of self-reported symptoms of binge-eating disorder in a community sample of adolescents.

OBJECTIVE: Binge-eating disorder (BED) and subthreshold BED (SBED) are prevalent in adults and associated with mental health problems including depression, non-suicidal self-injury, lower quality of life, and suicidality. There is solid evidence that binge-eating behaviors are also prevalent in adolescence, but knowledge about mental health in community adolescents with BED of different frequency thresholds is more limited. We aimed to investigate the prevalence and mental health problems associated with SBED of low frequency and/or limited duration compared with BED in a Danish community sample of adolescents. METHODS: We included 2509 adolescents who completed the online survey of the 16-17-year follow-up of the Copenhagen Child Cohort (CCC2000), including items on BED symptoms approximating the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and items on mental health and quality of life. RESULTS: The 1-year prevalence of SBED was 2.7% (95% confidence interval [CI]: 2.0%-3.3%) with a male:female ratio of 1:3.7; comparable to previous findings on BED in the same sample. SBED was also comparable to BED concerning cross-sectional associations with overall mental health problems, lower health-related quality of life, depressive symptoms, and suicidal ideation, whereas no associations were seen with non-suicidal self-injury after Holm-Bonferroni correction. In both groups, thoughts and behaviors concerning food and weight interfered significantly with daily life. DISCUSSION: SBED and BED were equally prevalent in this adolescent community sample, and similarly associated with indicators of poor mental health. The findings indicate that community adolescents reporting symptoms approximating clinical criteria of BED need intervention irrespectively of symptom frequency or duration. PUBLIC SIGNIFICANCE: This study adds knowledge to the field by comparing BED of low frequency and/or limited duration ("subthreshold BED," SBED) with full-syndrome BED in adolescents and showing that SBED in adolescence is both prevalent and associated with poor mental health to a similar extent as that of BED. Findings indicate that self-reported symptoms according to clinical criteria of SBED and BED alike constitute a public health problem and point to youngsters in need of intervention.

Predictors for and duration of hospitalization among children and adolescents with eating disorders.

OBJECTIVE: The objective of this study was to investigate the predictive value of sex, age, body mass index (BMI), Eating Disorder Examination (EDE) score, social risk factors, and psychiatric comorbidities for hospitalization and hospitalization duration among children and adolescents suffering from eating disorders. METHOD: This prospective cohort study involved 522 consecutive patients who had been referred to a specialized eating disorder unit between January 1, 2009 and December 31, 2015; participants were followed up until August 1, 2016 by medical records. We used regression analyses to evaluate the prognostic value of sex, age, BMI, EDE, eating disorder diagnoses, social risk factors, and psychiatric comorbidities concerning inpatient hospitalization and hospitalization duration. RESULTS: We found that younger age, higher EDE global score, lower BMI percentile, anorexia nervosa, a higher number of social risk factors, and the presence of diagnosed self-harm increased the odds of being hospitalized, while being female and having a comorbid autism spectrum condition increased the duration of hospitalization. No other psychiatric comorbidity was found to significantly predict hospitalization or duration of hospitalization. DISCUSSION: The odds of being hospitalized were predicted by the severity of anorexia nervosa and indicators of social risk factors in the family, whereas the duration of hospitalization was predicted by having a comorbid autism spectrum condition, indicating a difference between the factors affecting the risk of hospitalization and the factors affecting the duration of hospitalization. This calls for further exploration of tailored treatments for eating disorders. PUBLIC SIGNIFICANCE STATEMENT: This study finds that hospitalization for an eating disorder is predicted by the severity of the illness, self-harm, and social risk factors. Duration of hospitalization is predicted by having a comorbid autism spectrum condition. These findings indicate that the treatment of eating disorders may require different treatment approaches depending on the presentation of the individual patient to reduce both the need for hospitalization and the length of inpatient stay.

Anorexia nervosa in pregnancy and the post-partum period.

Anorexia nervosa (AN) is a mental disorder with the greatest incidence amongst women of the childbearing age. The prevalence of AN in pregnancy is marginal, yet the risk of exacerbation or reactivation is significant. Adverse perinatal complications of mental and physical nature pertain to both mother and child and through early diagnosis and monitoring during the perinatal period manageable. This preview describes the importance of enabling optimal perinatal care through a multidisciplinary management team.

Infancy weight faltering and childhood neurodevelopmental disorders: a general population birth-cohort study.

While it is known that intrauterine growth restriction is associated with later mental disorders, it is still unclear whether similar associations exists for postnatal weight faltering, also known as 'failure to thrive' in infancy. This study examined the potential connection between infancy weight faltering and mental disorders diagnosed in childhood focusing specifically on neurodevelopmental disorders. The Copenhagen Child Cohort (CCC2000) was used to explore weight gain in infancy assessed by community health nurses. Data from the Danish national registries were used to quantify ICD-10 mental disorders diagnosed between birth and 12 years of age, as well as potential child and family confounders. Of 4.476 children with sufficient weight data, 339 (7.3%) children were diagnosed with a mental disorder in childhood. Both any (weight gain < -1SD) and severe infancy weight faltering (weight gain < -2SD) were associated with psychomotor delays, while severe infancy weight faltering was also associated with intellectual impairments. Notably, no significant associations were found between weight faltering and autism spectrum disorders or attention deficit hyperactivity disorders. Weight faltering in infancy may be an early marker of neurodevelopmental delays. This possibility should be considered when assessing infants with slow weight gain, to early identification and treatment of co-occurring neurodevelopmental disorders.

A psychometric investigation of the multiple-choice version of Animated Triangles Task to measure Theory of Mind in adolescence.

The Animated Triangles Task (AT) is commonly used to measure Theory of Mind (ToM). AT can be scored by clinicians based on participants' verbal responses (AT-verbal) or using a multiple-choice paradigm (AT-MCQ). This study aimed to evaluate the validity of the less time-consuming AT-MCQ. To do this, we examined agreement and correlations between the AT-MCQ and the original AT-verbal scores in 1546 adolescents from a population-based sample. As a supplementary analysis of known-groups validity, we examined if AT-MCQ was as sensitive as AT-verbal in detecting ToM-limitations in 54 adolescents with autism spectrum disorder (ASD), using register-data. The agreement between AT-verbal and AT-MCQ varied markedly across test items. Scores on the two scoring methods were weakly correlated. Both scoring methods weakly detected differences between adolescents with and without ASD in this population-based sample. Most participants had appropriate responses on both AT-MCQ and AT-verbal, which yielded overall acceptable agreement. However, the feasibility of using either scoring methods to measure ToM-limitations in adolescents from the general population is questionable.

Smoking in pregnancy is associated with increased adiposity and retinal arteriolar wall-to-lumen ratio in adolescence: The Copenhagen Child Cohort Study 2000.

PURPOSE: To investigate the association between prenatal exposures and anthropometric data and cardiovascular risk factors including retinal arteriolar wall-to-lumen ratio in adolescence. METHODS: This longitudinal observational study included all 1445 adolescents from the Copenhagen Child Cohort 2000 who attended the 2016-2017 examination. Outcome measures included retinal arteriolar wall-to-lumen ratio, height, body mass index, waist-to-hip ratio, body composition measured by bioimpedance, and blood pressure. Information on prenatal exposures (birth weight, gestational age, maternal smoking during pregnancy) as well as sex, parental age, household income and parental educational levels were obtained from national registries. Associations between exposures and outcome measures were analyzed using general linear models. RESULTS: Maternal smoking during pregnancy was associated with a higher retinal arteriolar wall-to-lumen ratio (0.004 or 1.9%, P = 0.009) at age 16/17 years, an association driven exclusively by the female participants (0.008 or 3.7%, P < 0.0001). Maternal smoking during pregnancy was also associated to higher body-mass index (1.43 kg/m2, P < 0.0001), waist-to-hip ratio (0.02, P < 0.0001) and fat mass index (0.93 kg/m2, P < 0.0001). Birth weight, gestational age, and parental age had no detectable impact on retinal arteriolar wall-to-lumen ratios. CONCLUSION: Prenatal exposure to tobacco smoking is associated with a higher risk of obesity and, predominantly in girls, to a greater retinal arteriolar wall thickness, which suggests that maternal smoking may induce an unfavorable cardiovascular and metabolic risk profile in the child.

Cone photoreceptor density in the Copenhagen Child Cohort at age 16-17 years.

PURPOSE: To examine cone density in relation to gestational and morphological parameters in the Copenhagen Child Cohort (CCC2000). METHODS: The macula was imaged using adaptive optics in 1,296 adolescents aged 16-17 years. Axial length and distance visual acuity were determined. Absolute and angular cone photoreceptor density were analysed for an 80 × 80-pixel area, 2 degrees temporal to the fovea. Association with axial length was analysed with linear regression. Correlation with visual acuity was described with a Pearson correlation coefficient. Associations of cone density with gestational parameters, maternal smoking, sex and age were analysed using multiple regression adjusted for axial length. RESULTS: Mean absolute cone density was 30,007 cones/mm2 (SD ± 3,802) and mean angular cone density was 2,383 cones/deg2 (SD ± 231). Peri- and postnatal parameters, sex and age had no statistically significant effect on cone density (p > 0.05). Absolute cone density decreased with longer axial length (-2,855 cones/mm2 per mm or -9.7% per mm, p < 0.0001). For angular density, which included a correction for the geometrical enlargement of the eye with axial length, a decrease with axial length was detectable, but it was small (-20 cones/deg2 per mm or -0.84% per mm, p = 0.009). CONCLUSIONS: The decrease in cone density per unit solid angle with increasing axial length was small, less than 1 percent per mm, indicating that expansion of the posterior pole during the development of refraction takes place without a clinically significant loss of cones. Perinatal parameters, within the spectrum presented by the study population, had no detectable effect on cone density.

Precursors of self-reported subclinical hypomania in adolescence: A longitudinal general population study.

Symptoms of subclinical hypomania (SHM) are common in the general population of adolescents and young adults. SHM are most often transient yet might be risk markers of later bipolar disorder. The current study aimed to assess the clinical correlates of SHM at age 11 in the general population, examine the continuity of SHM from age 11-age 16 and explore the clinical precursors of age 16 SHM. As part of the Copenhagen Child Cohort 2000, 1,632 preadolescents participated in the examination of SHM and various clinical correlates at age 11, 893 were re-assessed for SHM at age 16 years. At age 11, SHM, psychotic experiences and depressive symptoms were assessed by semi-structured psychopathological interviews. Furthermore, the participants were diagnostically assessed by the Development and Well-Being Assessment and interviewed about sleep length. At age 16, SHM was assessed by self-report, using the Hypomania Checklist-32. Cannabis use occurring at age 15 or earlier was assessed at age 16. At age 11, SHM was associated with depressive disorders (Relative Risk [RR] = 2.96 [95% CI 1.26-6.96]), interview-based depressive symptoms (RR = 9.22 [5.93-14.34]), neurodevelopmental disorders (RR = 2.94 [1.66-5.20]), psychotic experiences (RR = 4.51 [2.90-7.01]) and insufficient sleep (RR = 2.10 [1.28-3.43]. In the longitudinal analyses, age 16 SHM was preceded by age 11 SHM (RR = 1.89 [1.02-3.49]), psychotic experiences (RR = 2.06, [1.28-3.33]), emotional disorders (RR = 1.77, [1.02-3.09]) and cannabis use (RR = 3.14, [1.93-5.10]), after mutual adjustment and adjustment for sex, and sociodemographic factors. In conclusion, age 11 SHM was statistically significantly associated with other types of psychopathology in cross-sectional analyses and showed some continuity with later self-reported SHM at age 16. Particularly early psychotic experiences and cannabis use stood out as independent precursors of self-reported SHM and might constitute important risk markers for the development of future SHM and bipolar disorder. An important potential caveat of the current study includes the self-report assessment of SHM.

Incidence of cilioretinal arteries in 11- to 12-year-old children and association with maternal smoking during pregnancy: the Copenhagen Child Cohort 2000 Eye Study.

PURPOSE: To estimate the incidence of cilioretinal arteries in a Danish child cohort and associations with birth parameters. METHODS: The population-based Copenhagen Child Cohort 2000 Eye Study examined 1406 children aged 11-12 years. Colour fundus images of both eyes were graded for cilioretinal arteries in the three categories large temporal (defined as supplying the central macula), small temporal and nasal. Data on maternal smoking during pregnancy, gestational ageand birth weight were obtained from the Danish Medical Birth Registry. RESULTS: A total of 463/1338 (35%) children were found to have one or more cilioretinal arteries per child. Large temporal cilioretinal arteries were present in 280/1338 (21%) of children and were associated with tobacco smoking during pregnancy, being present in 70/246 (28%) of children with mothers who were smoking during pregnancy, but only in 191/990 (19%) of children whose mothers did not smoke during pregnancy (p = 0.0022). After adjustments for potential confounders, the odds ratio of having one or more large temporal cilioretinal arteries was 1.72 (CI95% 1.19-2.47; p = 0.0035) in the smoking versus none smoking category. No other associations with birth parameters were found. CONCLUSION: Cilioretinal arteries were present in more than one third of 11- to 12-year-old Danish children. Large temporal cilioretinal arteries were found in one fifth of children and were associated with maternal smoking during pregnancy. This finding suggests that the intrauterine environment may have an impact on the development of retinal vessels during foetal life.

Healthcare Costs, School Performance, and Health-related Quality of Life in Adolescence Following Psychotic Experiences in Preadolescence: A Longitudinal Cohort Study.

Psychotic experiences (PEs) are common in the general population in preadolescence. The implications of PEs on socioeconomic outcomes, including educational attainment, are scarcely described. We aimed to estimate how preadolescent PEs were associated with later healthcare costs, school performance, and health-related quality of life (HRQoL) in adolescence. A total of 1607 preadolescents from the general population Copenhagen Child Cohort 2000 were assessed for PEs at age 11-12 years and followed up over 5 years using register-based data on mental and somatic healthcare costs, and school performance at age 16. Furthermore, HRQoL was assessed for a subsample of the children at age 16-17. We adjusted for perinatal and family sociodemographic adversities, prior parental mental illness and healthcare use, child IQ-estimate at age 11-12, and parent-rated general psychopathology of their child. PEs were associated with slightly poorer school performance. However, preadolescents with PEs more often reported HRQoL within the lowest 10th percentile (OR = 2.74 [95% CI 1.71-4.37]). Preadolescents who reported PEs had higher average total healthcare costs over the following 5 years. The costs for individuals with PEs were higher for mental healthcare services across primary to tertiary care, but not for somatic care. After adjustments, PEs remained independently associated with higher costs and poorer HRQoL, but not with poorer school performance. In conclusion, PEs are important in mental health screening of preadolescents and identify a group of young people with increased healthcare service-use throughout adolescence and who report poorer HRQoL in adolescence, over and above parent-rated general psychopathology of their child.

Continuity of health anxiety from childhood to adolescence and associated healthcare costs: a prospective population-based cohort study.

BACKGROUND: Severe health anxiety (HA) is characterized by excessive and impairing worry and preoccupation with health issues and can cause increased and unnecessary medical examinations. HA in childhood and adolescence is scarcely explored, hindering the potential for prevention and early intervention. METHODS: HA was assessed in 1,278 children/youths at two time points at ages 11 and 16 years in a general population-based birth cohort. Register-based data on costs related to nonhospital-based primary and secondary somatic health services were obtained over the follow-up period. The presence of functional somatic symptoms, emotional disorders and chronic somatic illness at baseline were included as covariates. RESULTS: High HA (top 10% score) at age 11 predicted high HA at age 16 (relative risk [RR] 2.03, 95% CI: 1.26-3.31). The group with persistent HA was small (n = 17, 1.3%), resulting in broad confidence intervals. The statistical effect of HA at age 11 on HA at age 16 was heavily reduced after adjustment for sex and all covariates (RR: 1.49, 95% CI: 0.85-2.60). In the adjusted model, somatic illness at age 11 (RR: 1.91, 95% CI: 1.22-2.98) and female sex (RR: 3.33, 95% CI: 2.01-5.50) were independently associated with HA at age 16. Persistent HA was associated with approximately doubled healthcare costs compared to the group with consistently low HA. Incident HA at age 16 was associated with increased costs over follow-up. The increased costs were not explained by chronic somatic illness. CONCLUSIONS: A small subgroup of children had persistent high levels of HA from late childhood to adolescence and displayed increased healthcare costs. Female sex and chronic somatic disorders at age 11 were independent risk factors of HA at age 16. These findings provide potential means of early identification and of therapeutic levers. Further intervention development and evaluation are needed.

Are theory of mind and bullying separately associated with later academic performance among preadolescents?

BACKGROUND: Bullying and poor theory of mind (ToM) are both considered to negatively impact academic performance. However, it is unclear if they have separate effects. AIM: The aim of the current study was to examine the potentially separate associations of bullying and ToM with academic performance. SAMPLE: A general population sample of 1,170 children aged 11-12 years. METHODS: Information on bullying, type of involvement (none, victim (only), bully (only), victim-bully (both)), ToM, and estimated intelligence was obtained at face-to-face assessments. Information on academic performance was obtained from Danish school registers. RESULTS: ToM was positively associated with academic performance, and involvement in bullying was negatively associated with academic performance. Academic performance differed between types of involvement in bullying. Pairwise post hoc analyses showed that in the full sample, the only significant difference was between those not involved and those involved as victim (only). This was also the case for girls. Adjusting for potential shared variance with gender, estimated intelligence and ToM being victim (only) and victim-bully (both) were negatively associated with academic performance compared to no involvement. Thus, being a victim (or victim-bully) contributes negatively to academic performance beyond the effects of ToM and intelligence, and regardless of gender. Similarly, ToM remained positively associated with academic performance after adjusting for shared variance. CONCLUSION: ToM and involvement in bullying were both separately associated with later academic performance. These results remained even after adjusting for shared variance, and for shared variance with gender and estimated IQ.

Retinal arteriolar wall-to-lumen ratios at 16-17 years in the Copenhagen Child Cohort 2000 Study.

PURPOSE: To study the thickness of retinal arteriolar walls in a population-based cohort of adolescents. METHODS: This cross-sectional, observational study included 1217 participants aged 16-17 years from the Copenhagen Child Cohort 2000 Study. The wall thickness and lumen diameter of a major branch retinal arteriole were measured using adaptive optics imaging. The wall-to-lumen ratio was analyzed in relation to blood pressure and body composition variables using a general linear model. Overall in the study population, wall-to-lumen ratio was found to decrease by 0.49% per µm increase in arteriole diameter (P < 0.0001) and all subsequent analyzes were adjusted accordingly. RESULTS: The average outer and inner arteriole diameters were 117 ±â€Š19 and 96.6 ±â€Š18 µm (mean ±â€ŠSD), corresponding to a wall-to-lumen ratio of 0.21 ±â€Š0.024. There was no detectable difference between sexes. A higher wall-to-lumen ratio was associated with a higher BMI (+0.21% per kg/m, P = 0.0018), higher body fat percentage (+0.097% per 1% increase, P = 0.0052), wider hip circumference (+1.1% per 10 cm increase, P = 0.0006), wider waist circumference (+0.92% per 10 cm increase, P = 0.0009), higher SBP in girls (+1.1% per 10 mmHg increase, P = 0.0005), longer axial length (+0.70% per mm increase, P = 0.013), and younger age (+4.9% per year younger, P < 0.0001), adjusted for arteriole diameter, age, sex, and height. CONCLUSION: A higher retinal arteriolar wall-to-lumen ratio was associated with all registered indices of body fat proportion.

Low physical activity and higher use of screen devices are associated with myopia at the age of 16-17 years in the CCC2000 Eye Study.

PURPOSE: To determine the myopia prevalence in a Danish cohort aged 16-17 years and its relation to physical activity and use of screen-based electronic devices. METHODS: The Copenhagen Child Cohort 2000 Eye Study is a prospective, population-based, observational study. Information about use of screen devices and physical activity was obtained using questionnaires. Myopia was defined as non-cycloplegic subjective spherical equivalent refraction ≤-0.50 D in right eye. RESULTS: We included 1443 participants (45% boys) with a median age (±IQR) of 16.6 years (±0.3). The prevalence of myopia was 25% (CI95% 23-28, n = 360) with no differences between sexes (p = 0.10). The odds ratio (OR) for myopia was 0.57 (CI95% 0.42-0.76, p = 0.0002) in participants physically active 3-6 hr/week (n = 502) and 0.56 (CI95% 0.42-0.76, p = 0.0002) if active >6 hr/week (n = 506), both compared with participants physically active <3 hr/week (n = 396). The use of screen devices >6 hr/day was associated with increased OR for myopia compared with screen device use <2 hr/day in both weekdays (OR = 1.95, CI95% 1.16-3.30, p = 0.012) and weekends (OR = 2.10, CI95% 1.17-3.77, p = 0.013). CONCLUSION: In this cohort of healthy 16-17-year olds, lower physical activity and more use of screen devices contributed significantly to the observed 25% prevalence of myopia with a roughly doubled risk of having myopia if physically active <3 hr/week or if using screen devices >6 hr/day. Our results support physical activity being a protective factor and near work a risk factor for myopia in adolescents.

Psychotic experiences from preadolescence to adolescence: when should we be worried about adolescent risk behaviors?

Psychotic experiences (PE), below the threshold of psychotic disorder, are common in the general population. PE are associated with risk behaviors such as suicidality, non-suicidal self-injury (NSSI) and substance use. However, PE as specific or causal phenomena of these risk behaviors are still debated. We aimed to examine the longitudinal trajectories of PE from preadolescence to adolescence and their associated risk behaviors in adolescence. A total of 1138 adolescents from the Copenhagen Child Cohort 2000 were assessed for PE and risk behaviors (NSSI, suicide ideation and -attempts and substance use) at age 11 and 16 years, along with measures of general psychopathology and depressive symptoms specifically. Self-reported impact of general psychopathology tended to be associated with more PE persistence. PE were associated with all risk behaviors in cross section at both follow-ups. Persistent PE from ages 11 to 16 and incident PE at age 16 were associated with risk behaviors at age 16, whereas remitting PE from age 11 to 16 were not. After adjustment for co-occurring depressive symptoms and general psychopathology, all associations were markedly reduced. After exclusion of preadolescents who already had expressed risk behavior at age 11, PE in preadolescence did not stand out as an independent predictor of incident adolescent risk behaviors. The current study suggests that PE in preadolescence and adolescence may not play a direct causal role regarding NSSI, suicidality, and substance use. However, PE are still useful clinical markers of severity of psychopathology and associated risk behaviors.

Five-Year Change in Choroidal Thickness in Relation to Body Development and Axial Eye Elongation: The CCC2000 Eye Study.

Purpose: We describe changes in choroidal thickness from age 11 to 16 years and its association with ocular biometrics and body development. Method: In this longitudinal, population-based observational study, choroidal thickness was measured subfoveally and 1- and 3-mm temporal thereof using enhanced depth imaging spectral domain optical coherence tomography. Analyses were stratified by sex and adjusted for age and the time of day that the scan was performed. Results: The study included 687 participants (304 boys). Median (interquartile range [IQR]) age was 11.5 (0.6) years at baseline and 16.6 (0.3) years at follow-up. Mean increase in choroidal thickness was 33, 27, and 11 µm at the three respective locations. The subfoveal choroid thickened less in eyes whose axial length increased more (boys, ß = -85 µm/mm; 95% confidence interval [CI], -104 to -66, P < 0.0001; girls, ß = -105 µm/mm; 95% CI, -121 to -89, P < 0.0001) and in eyes with a more negative refractive development (boys, 11 µm/diopters [D]; 95% CI, 4.0 to 18, P = 0.0022; girls, 22 µm/D; 95% CI, 16 to 27, P < 0.0001). Subfoveal choroidal thickness increased less in girls who underwent early puberty (Tanner stage 4 vs. 1; -39 µm' 95% CI, -72 to -5.9, P = 0.021) and who had a longer baseline axial length (ß = -8.6 µm/mm; 95% CI, -15 to -2.7, P = 0.0043), and more in girls who grew taller (ß = 0.9 µm/cm; 95% CI, 0.1 to 1.7, P = 0.026). Conclusions: The choroid increased in thickness from age 11 to 16 years. The increase was greater in girls with later sexual maturation and smaller in eyes that added more axial length and had a relatively negative refractive development.

Problems of feeding, sleeping and excessive crying in infancy: a general population study.

OBJECTIVE: To study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent-child relationship problems. DESIGN AND SETTING: Data were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs' assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent-child relationship problems. RESULTS: Combined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2-6 and 8-11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent-child relationship problems seem to be mediated by early C-RPs. CONCLUSIONS: Combined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent-child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant's sensitivity and reactions.