Lifespan influences on mid- to late-life cognitive function in a Chinese birth cohort.

OBJECTIVE: To explore factors throughout the lifespan that influence cognition in midlife to late life. METHODS: We conducted a retrospective birth cohort study of 2,062 individuals born during 1921-1954 in Beijing, China. In 2003-2005, birth records were abstracted, and participants then 50-82 years old received standardized examinations for health, cognition, and socio-environmental measures. Using cumulative logit models, we assessed adjusted relative effects of prenatal, early life, and adult factors on mid- to late-life cognition. RESULTS: Most prenatal factors were associated with mid- to late-life cognition in the unadjusted models. However, when childhood and adult factors were sequentially added to the models, the impact of prenatal factors showed successive attenuation in effect size, and became insignificant. In contrast, early life factors remained significantly associated with mid- to late-life cognition even after full life-course adjustments. Specifically, those whose fathers had laborer vs professional occupations (odds ratio [OR](Laborer) 1.74; 95% confidence interval [CI]: 1.25-2.42) had poorer cognitive outcomes, while individuals who drank milk daily in childhood (OR 0.65; 95% CI: 0.54-0.80), had more years of education (OR(10-12 years) 0.60; 95% CI: 0.45-0.81; OR(13+ yrs) 0.29; 95% CI: 0.23-0.38), and were taller adults (OR(height > or = SD) 0.65; 95% CI: 0.49-0.86) had better cognition. The high prenatal risk infants had similar patterns with a trend toward a stronger association between cognition and socioenvironmental factors. CONCLUSION: Mid- to late-life cognition is influenced by factors over the entire lifespan with the greatest impact coming from early life exposures. Nutrition, education, social, and family environment in early life may have a long-term impact on cognition in developing countries.

Goodness-of-fit for GEE: an example with mental health service utilization.

Suppose we use generalized estimating equations to estimate a marginal regression model for repeated binary observations. There are no established summary statistics available for assessing the adequacy of the fitted model. In this paper we propose a goodness-of-fit test statistic which has an approximate chi-squared distribution when we have specified the model correctly. The proposed statistic can be viewed as an extension of the Hosmer and Lemeshow goodness-of-fit statistic for ordinary logistic regression to marginal regression models for repeated binary responses. We illustrate the methods using data from a study of mental health service utilization by children. The repeated responses are a set of binary measures of service use. We fit a marginal logistic regression model to the data using generalized estimating equations, and we apply the proposed goodness-of-fit statistic to assess the adequacy of the fitted model.

Factors associated with mental health, general health, and school-based service use for child psychopathology.

OBJECTIVES: This study was designed to identify factors associated with service use for child psychopathology in three settings: mental health, general health, and school. METHODS: Subjects were 2519 children, 6 to 11 years of age, assessed in two cross-sectional Connecticut surveys in the late 1980s. Three groups of variables (sociodemographics, child's illness profile, and parental attitudes) were examined through multivariate logistic regression. RESULTS: Most sociodemographics showed moderate associations with all settings, although some previously reported effects (e.g. birth order, sibship size) were not observed. Of the illness profile measures, only Child Behavior Checklist total scores predicted use in the final model (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.1, 2.3). Health problems were associated with increased use in all settings (OR = 1.5, 95% CI = 1.3, 1.9), while academic problems were associated only with increased school service use (OR = 5.2, 95% CI = 3.9, 7.0). Parental belief that the child needed help was most strongly associated with service use (common OR for all settings = 5.3, 95% CI = 4.1, 6.8). CONCLUSIONS: Sociodemographics, parental attitudes, and children's illness profiles independently influence service use for psychopathology in school-aged children.

Bivariate logistic regression analysis of childhood psychopathology ratings using multiple informants.

A central issue in studies of risk factors for childhood psychopathology is utilization of the information obtained about the child's mental health status from multiple informants. In this paper, the authors propose a new approach to the analysis of risk factor data when the outcomes are binary ratings (presence/absence of symptoms). This new approach has several attractive features in this setting. The strategy taken is to perform a single analysis using multivariate modeling, in which simultaneous logistic regressions are conducted for the outcomes given by each of several informants. The advantages of this approach include the following: 1) it retains the complete information about case status for each informant; 2) it permits assessment of informant-risk factor interactions as well as "overall" risk factor effects; 3) it provides measures of association between the multiple informants and adjusts for the association between responses in the analysis; and 4) missing data on a subset of respondents can be incorporated in a straightforward way, permitting all subjects with at least one informant to be used in the analysis. To illustrate the methods, the authors present findings on risk factors for measures of "Internalizing" and "Externalizing" behaviors from two surveys using parent and teacher ratings of 6- to 11-year-old children in Connecticut between 1986 and 1989.

Rural-urban child psychopathology in a Northeastern U.S. state: 1986-1989.

Parent and teacher symptom reports from two epidemiological surveys of 2,519 Connecticut children were used to study rural-urban differences in childhood psychopathology. Parents and teachers of girls in cities reported elevated total disturbance and social withdrawal. Parents of urban girls also reported higher rates of behavioral disturbance. For boys, urban excesses were primarily observed in emotional disturbance. Rural-urban variation was largely associated with economic and cultural differences between sites and not with urbanization per se. Findings suggest that certain assumptions about rural-urban differences in specific forms of psychopathology, such as delinquency, should be reevaluated.

Diagnostic specificity of a brief measure of expressed emotion: a community study of children.

The association between expressed emotion (EE) and psychiatric disorders was investigated in a community survey of 108 preadolescent children. Results indicated that the two components of EE, critical comments and emotional overinvolvement, identified non-overlapping subsets of families and displayed diagnostic specificity. Significantly higher rates of disruptive behavior diagnoses were observed in children of parents who expressed high levels of criticism, while children of parents who expressed high levels of emotional overinvolvement were significantly more likely to have an anxiety disorder when compared to the remaining sample. Findings support the utility of this brief measure of EE in epidemiologic samples.

Children's mental health service needs and utilization patterns in an urban community: an epidemiological assessment.

To assess children's mental health service needs and utilization patterns for a state planning effort, a cross-sectional survey that sampled 822 children aged 6 to 11 of a metropolitan center was conducted. When reports of parents and teachers were combined, 38.5% of children were screened to be at risk of psychiatric disturbance. Only 11% of children at risk received treatment in mental health settings, fewer than in schools (37%) or medical settings (13%). The findings illustrate the importance of interagency collaboration and the need to consider reports of parents and teachers and different dimensions of psychopathology in future planning and research.

Relations over time between psychiatric and somatic disorders: the Stirling County Study.

A longitudinal study of a general population in Atlantic Canada provided information on associations between two broad categories of illness: somatic disorders and disorders involving depression and/or anxiety. Prevalence was investigated in a sample of 1,003 adults selected in 1952 and another sample of 1,094 adults selected in 1970. Using a cohort of 618 survivors from the 1952 sample who were followed up in 1968, the authors studied prevalence at the beginning and end of the 16-year period. Incidence was also investigated so that the strength of associations between prior illness of one type and subsequent illness of the other type could be assessed. Data were obtained by interviewing subjects with the same structured schedule at each time of investigation. In prevalence enumerations, psychiatric disorders were found to be significantly associated with somatic disorders. Prior somatic disorder was significantly associated with subsequent incidence of depression and/or anxiety and vice versa. The results did not, however, show one direction of influence ("psyche-to-soma" or "soma-to-psyche") to be markedly stronger than the other. The results mainly support the concept of "generalized vulnerability" and draw attention to the importance of recognizing comorbidity in diagnosis and clinical practice.

The feasibility of conducting structured diagnostic interviews with preadolescents: a community field trial of the DISC.

A field trial of the Diagnostic Interview Schedule for Children, Version R, was conducted with a sample of 144 preadolescents identified from a 1986-1987 New Haven, Connecticut, cross-sectional children's mental health survey. This report examines procedural and methodological issues pertaining to the feasibility of completing structured diagnostic interviews with young children in the community. Four topics relating to community acceptance and potential response problems are addressed: 1) participation and completion rates; 2) quality of interview response; 3) parent and child reactions to the interview; and 4) evaluation of response bias.

Loss in childhood: anxiety in adulthood.

Recent research, especially in Great Britain, has attracted interest by reporting on the relationship between maternal loss and vulnerability to depression among women. Several studies in the United States that included men have not received equal attention. The present study expands on the US work by reporting findings from the Queensbrook Study in New York City, a cross-sectional survey that provides information about the relationships between the family environment of childhood and the prevalence of psychiatric illness in adulthood. The Queensbrook survey was conducted in the mid 1960 as an urban counterpart to the Stirling County Study in rural Atlantic Canada. The data from the urban sample described here were not published earlier, and for this report we used DSM-111 criteria to develop scoring algorithme to identify depression and anxiety. We investigated several types of adverse childhood losses, not solely the death of a mother, and related them to depression and anxiety in both men and women. None of the childhood experience was significant associated with these disorders among women, nor was the death of a parent related to either type of disorder among men. However, boys who left home before 16 years of age, whose parents were divorced or separated, or who were placed in an adopted family had a threefold increase in rates of anxiety as adults. This finding of a positive association between the divorce of parents and later anxiety in men is supported by several of the other population surveys carried out in the United States.

Gilles de la Tourette's syndrome and obsessive-compulsive disorder. Evidence supporting a genetic relationship.

Previous studies have suggested that obsessive-compulsive symptoms frequently occur among patients with Gilles de la Tourette's syndrome (TS). To examine the relationship between TS and obsessive-compulsive disorder (OCD), data from all first-degree relatives of TS probands were obtained with a semistructured interview designed to collect information on the presence of TS, other tic disorders, and neuropsychiatric illnesses during the lifetime of the individual. The rate of OCD among first-degree relatives was significantly increased over estimates from the general population and a control sample of adoptive relatives. The rates of TS, OCD, and chronic multiple tics (CMT) were virtually the same in families of probands with OCD (TS +/- OCD) when compared with families of probands without OCD (TS - OCD). Finally, the frequency of OCD without TS or CMT among first-degree relatives was significantly elevated in families of both TS + OCD and TS - OCD probands, suggesting that some forms of OCD may represent an alternative expression of the factors responsible for TS and/or CMT.

Psychological consequences of infestation of the dwelling unit.

Interview data from a three-wave panel study of the impact of the residential environment upon the psychological well-being of 337 minority women were used to examine the effects of household infestation upon self-reported depression, phobic anxiety, somatization, hostility, and anomia. The findings of cross-sectional and change analyses over the three waves of data point to a stable relationship between rat infestation and a single dimension of psychological well-being, somatization.