Childhood anxious/withdrawn behaviour and later anxiety disorder: a network outcome analysis of a population cohort.

BACKGROUND: Several previous studies have identified a continuity between childhood anxiety/withdrawal and anxiety disorder (AD) in later life. However, not all children with anxiety/withdrawal problems will experience an AD in later life. Previous studies have shown that the severity of childhood anxiety/withdrawal accounts for some of the variability in AD outcomes. However, no studies to date have investigated how variation in features of anxiety/withdrawal may relate to continuity prognoses. The present research addresses this gap. METHODS: Data were gathered as part of the Christchurch Health and Development Study, a 40-year population birth cohort of 1265 children born in Christchurch, New Zealand. Fifteen childhood anxiety/withdrawal items were measured at 7-9 years and AD outcomes were measured at various interviews from 15 to 40 years. Six network models were estimated. Two models estimated the network structure of childhood anxiety/withdrawal items independently for males and females. Four models estimated childhood anxiety/withdrawal items predicting adolescent AD (14-21 years) and adult AD (21-40 years) in both males and females. RESULTS: Approximately 40% of participants met the diagnostic criteria for an AD during both the adolescent (14-21 years) and adult (21-40 years) outcome periods. Outcome networks showed that items measuring social and emotional anxious/withdrawn behaviours most frequently predicted AD outcomes. Items measuring situation-based fears and authority figure-specific anxious/withdrawn behaviour did not consistently predict AD outcomes. This applied across both the male and female subsamples. CONCLUSIONS: Social and emotional anxious/withdrawn behaviours in middle childhood appear to carry increased risk for AD outcomes in both adolescence and adulthood.

Expanding the system: A brief psychosocial complex systems model of internalising disorder.

BACKGROUND: The aetiology of internalising disorders remains poorly understood. Recently, a bottom-up network perspective has suggested mental disorders are best conceptualised as emergent systems, and may be explained by mapping systems of symptoms embedded within a complex biopsychosocial environment. Under this framework, the complex system in which internalising disorders are embedded remains poorly understood. The present research outlines a brief psychosocial system of internalising disorders as a basis for future research. METHODS: A Mixed Graphical Model was fitted on 15 psychosocial variables (including depression and anxiety) collected during the Christchurch Health and Development Study, a representative population birth cohort of 1265 people born in 1977 in Christchurch, New Zealand. RESULTS: The model demonstrates that psychosocial risk factors for internalising disorders tend to be inter-related. The psychosocial system accounted for 19.9% of the variance in the diagnostic depression variable, and 5.0% of the variance in diagnostic anxiety. Most variables (10/13) were associated with depression and anxiety either directly or indirectly. LIMITATIONS: First, the estimated model is undirected, so causal directions are unspecified except for longitudinal relationships. Second, binary diagnostic variables were used for depression and anxiety, meaning the model does include symptom-level complexity. Third, the model does not account for within-person effects. CONCLUSIONS: This exploratory model may serve as a basis for the mapping of greater (bio) psychosocial complexity around internalising disorders. The model concisely demonstrates the need for researchers to "embrace complexity", but also underscores the conceptual scope that is required to do so on a broader (bio) psychosocial level.

Recruitment and retention of participants in longitudinal studies after a natural disaster.

Climate change and population growth will increase vulnerability to natural and human-made disasters or pandemics. Longitudinal research studies may be adversely impacted by a lack of access to study resources, inability to travel around the urban environment, reluctance of sample members to attend appointments, sample members moving residence and potentially also the destruction of research facilities. One of the key advantages of longitudinal research is the ability to assess associations between exposures and outcomes by limiting the influence of sample selection bias. However, ensuring the validity and reliability of findings in longitudinal research requires the recruitment and retention of respondents who are willing and able to be repeatedly assessed over an extended period of time. This study examined recruitment and retention strategies of 11 longitudinal cohort studies operating during the Christchurch, New Zealand earthquake sequence which began in September 2010, including staff perceptions of the major impediments to study operations during/after the earthquakes and respondents' barriers to participation. Successful strategies to assist recruitment and retention after a natural disaster are discussed. With the current COVID-19 pandemic, longitudinal studies are potentially encountering some of the issues highlighted in this paper including: closure of facilities, restricted movement of research staff and sample members, and reluctance of sample members to attend appointments. It is possible that suggestions in this paper may be implemented so that longitudinal studies can protect the operation of their research programmes.

Contrasting signals of cardiovascular health among natriuretic peptides in subjects without heart disease.

Natriuretic Peptides (NP) are important in maintaining normal cardiac and metabolic status and have been used to predict cardiovascular events. Whether plasma concentrations of NP products within the normal range reflect cardio-metabolic health is unknown. Plasma NTproANP, NTproBNP and NTproCNP and their bioactive counterparts were measured in a random sample of 348 community dwellers aged 49-51 yr without heart disease and associations sought with established vascular risk factors, echocardiographic indices and a genetic variant previously linked with BNP. Stratified by sex, each of ten vascular risk factors were positively associated with NTproCNP whereas associations with NTproBNP and NTproANP were all negative. In both sexes, higher plasma NTproCNP was associated with higher arterial elastance, lower LV stroke volume and lower LV end diastolic volume. Exactly opposite associations were found with plasma NTproBNP or NTproANP. Sex specific differences were identified: positive association of NTproBNP with LV end systolic volume and the negative association with LV elastance were found only in males. The genetic variant rs198358 was independently associated with NTproBNP but not with NTproANP. In conclusion, higher NTproCNP is likely to be an adaptive response to impaired LV relaxation whereas genetic factors likely contribute to higher NTproBNP and improved cardio-metabolic health at midlife.

Vitamin C Status Correlates with Markers of Metabolic and Cognitive Health in 50-Year-Olds: Findings of the CHALICE Cohort Study.

A cohort of 50-year-olds from Canterbury, New Zealand (N = 404), representative of midlife adults, undertook comprehensive health and dietary assessments. Fasting plasma vitamin C concentrations (N = 369) and dietary vitamin C intake (N = 250) were determined. The mean plasma vitamin C concentration was 44.2 µmol/L (95% CI 42.4, 46.0); 62% of the cohort had inadequate plasma vitamin C concentrations (i.e., <50 µmol/L), 13% of the cohort had hypovitaminosis C (i.e., <23 µmol/L), and 2.4% had plasma vitamin C concentrations indicating deficiency (i.e., <11 µmol/L). Men had a lower mean plasma vitamin C concentration than women, and a higher percentage of vitamin C inadequacy and deficiency. A higher prevalence of hypovitaminosis C and deficiency was observed in those of lower socio-economic status and in current smokers. Adults with higher vitamin C levels exhibited lower weight, BMI and waist circumference, and better measures of metabolic health, including HbA1c, insulin and triglycerides, all risk factors for type 2 diabetes. Lower levels of mild cognitive impairment were observed in those with the highest plasma vitamin C concentrations. Plasma vitamin C showed a stronger correlation with markers of metabolic health and cognitive impairment than dietary vitamin C.

Mean telomere length is not associated with current health status in a 50-year-old population sample.

OBJECTIVES: Telomeres are nucleoprotein complexes that cap the ends of linear chromosomes. Telomeric DNA decreases with age and shows considerable heterogeneity in the wider population. There is interest in the application of telomere length measures as a biomarker of general health or "biological age," and the possibility of using mean telomere length to gauge individual disease risk, and to promote lifestyle changes to improve health. This study examined the effectiveness of telomere length as a biomarker for an individual's current overall health status by assessing several measures of general health including SF-36v2 score, current smoking status and a comprehensive obesity phenotype. METHODS: Participants were from the Canterbury Health, Ageing and Lifecourse (CHALICE) cohort, a New Zealand population based multidisciplinary study of aging. Telomere length measurements were obtained on DNA from peripheral blood samples at age 49-51 (n = 351), using a quantitative polymerase chain reaction assay. RESULTS: No associations were found between telomere length measured at age 49-51 and any measures of current health status. The only significant association observed was between telomere length and gender, with females having longer telomere length than men. CONCLUSIONS: Our results suggest that telomere length measurements are unlikely to provide information of much predictive significance for an individual's health status.

Personality, mental health and demographic correlates of hoarding behaviours in a midlife sample.

We describe the Temperament and Character Inventory personality traits, demographic features, physical and mental health variables associated with hoarding behaviour in a random community sample of midlife participants in New Zealand. A sample of 404 midlife participants was recruited to a study of ageing. To assess hoarding behaviours participants completed the Savings Inventory-Revised (SI-R), personality was assessed by the Temperament and Character Inventory and self-reported health was measured by the Short Form-36v2 (SF-36v2). Other measures were used to assess socio-demographic variables and current mental disorders. Participants were split into four groups by SI-R total score (scores: 0-4, 5-30, 31-41 and >41). Those who scored >41 on the SI-R were classified as having pathological hoarding. Trend tests were calculated across the four hoarding groups for socio-demographic, personality, mental and physical health variables. SI-R scores ranged from 0 to 58. The prevalence of pathological hoarding was 2.5% and a further 4% reported sub-clinical symptoms of hoarding. Higher hoarding behaviour scores were related to higher Temperament and Character Inventory scores for Harm Avoidance and lower scores for Self-directedness. Persistence and Cooperativeness scores were lower too but to a lesser extent. Trend analysis revealed that those with higher hoarding behaviour scores were more likely to be single, female, unemployed, receive income support, have a lower socio-economic status, lower household income and have poorer self-reported mental health scores. Current depression rates were considerably higher in the pathological hoarding group. Increasing SI-R hoarding behaviour scores were associated with higher scores of negative affect (Harm Avoidance) and lower scores of autonomy (Self-directedness). Those with pathological hoarding or sub-clinical symptoms of hoarding also reported widespread mental and socio-economic problems. In this study it is clear to see the physical, mental and socio-economic problems experienced by those achieving the highest hoarding scores. The prevalence of pathological hoarding was 2.5%, similar to the prevalence reported by other studies. The personality traits associated with hoarding behaviours are discussed.

Temperament and character as determinants of well-being.

OBJECTIVES: We aimed to evaluate the effects of Temperament and Character Inventory (TCI) personality measures on well-being scores in a sample of 49-51 year old New Zealanders. Previous research has linked high self-directedness (SD) and low harm avoidance (HA) with well-being. We hypothesised that SD and HA would have predictive power for Warwick-Edinburgh Mental Well-being Scale (WEMWBS) well-being. We anticipated that character profiles with high SD and cooperativeness (CO) would be associated with higher well-being scores while high self transcendence (ST) scores would have less of an influence on well-being in a secular population such as New Zealand. Additionally we aimed to describe and assess the performance of a well-being measure, the WEMWBS and we intended to clarify the factors that underlie the questionnaire. METHODS: A cohort of 404 randomly selected participants in a study of ageing had WEMWBS means calculated and with principal component analysis used to investigate the factors that underlie the WEMWBS. Multiple hierarchical regression was used to predict WEMWBS scores from socio-demographic and TCI personality variables. ANOVA were used to explore the non-linear effects of personality profiles on well-being. RESULTS: Principal components analysis revealed one significant factor which explained 54.34% of the variance. After initial univariate analysis current depression, marital status and standard of living were entered at the first step of the multivariate regression. They explained 20% of the variance. In step two the seven TCI personality variables were added to the model, explaining a total of 49% (R(2) change=0.29). Low HA, high SD and the absence of current depression were the main predictors of WEMWBS scores. Character profiles featuring high SD produced significantly higher scores on the WEMWBS. Total WEMWBS scores were normally distributed, and the mean was 52.83 (95% CI 51.96-53.70). CONCLUSIONS: The key determinants of well-being were absence of current depression and personality variables, especially low HA and high SD. The WEMWBS has face validity and the New Zealand results were very similar to the UK results.

Attitudes to aging in midlife are related to health conditions and mood.

BACKGROUND: Health is an important aspect of individuals' lives as they age. The aim of this study was to examine the relationship of sociodemographic factors, diagnosed chronic health conditions, and current depression with attitudes to aging in midlife. METHODS: A cross-sectional baseline analysis was conducted on the first 300 participants from the Canterbury Health, Ageing and Life Course study in New Zealand, a stratified randomized community longitudinal study of adults recruited between 49 and 51 years. Attitudes were measured using the Attitudes to Aging Questionnaire (AAQ) and analyzed with a range of prevalent diagnosed chronic conditions, current depression, and sociodemographic variables. RESULTS: Individuals perceived their physical aging more negatively after a diagnosis of hypertension, arthritis or asthma. Diagnosed lifetime depression and anxiety, and current depression, showed strong relationships with attitudes to aging across domains. After controlling for sociodemographic factors and current depression, individuals with diagnosed hypertension, arthritis, asthma, lifetime depression or anxiety continued to report significantly more negative attitudes to aging. Current depression showed the strongest associations with attitudes to aging and mediated relationships of health on attitudes to aging. CONCLUSIONS: Physical and mental health are related to attitudes to aging. Most chronic conditions examined are significantly associated with attitudes toward aging in the physical change domain. Diagnosed lifetime depression and anxiety, and current depression, are negatively related across attitudinal domains. Individuals can feel positive about aging while experiencing poorer health, but this is more difficult in the presence of low mood.

Ongoing adverse mental health impact of the earthquake sequence in Christchurch, New Zealand.

OBJECTIVE: In September 2010 Christchurch, New Zealand, was struck by a 7.1 magnitude earthquake, followed by a prolonged sequence of significant aftershocks including a fatal aftershock in February 2011. Christchurch City has experienced widespread damage, ongoing disruption and building demolitions resulting in many difficulties for the residents of the Christchurch area. We explore what impact the earthquakes have had on the mental and physical health of a random sample of 50-year-olds who live in the Christchurch area. METHODS: The 295 participants were selected from the electoral rolls for participation in the CHALICE study, a longitudinal study of ageing. Self-reported health status was assessed using the standardised Short Form 36 version 2 health survey (SF-36v2), a 36-item questionnaire, and results from the eight subscales compared to a national health survey. Mood disorders were assessed and the results were compared to other local and national studies. RESULTS: Since the onset of the earthquakes and throughout the study period, participating middle-aged Christchurch residents have mean SF-36v2 scores significantly lower than population norms in the mental health, vitality, social functioning and role-emotional subscales (Cohen's d ranged from -0.270 to -0.357, all p < 0.001), while there was no evidence of reduced physical health. Rates of current major depressive disorder were 7.5% in the earthquake survivors compared to 5.1% and 3.7% in other historical, local and national surveys. Similarly, bipolar disorder prevalence was 2.8% in the earthquake survivors compared to 2.2% and 1.4% in other studies. CONCLUSION: Eighteen months after the first earthquake the significant adverse impact on mental health clearly continues. The ongoing provision of additional mental health services and consideration of these adverse mental health effects in relation to other social policies remains necessary and fundamental.