Transition to parenthood and mental health at 30 years: a prospective comparison of mothers and fathers in a large Brazilian birth cohort.

Parenthood represents a major biological, social and environmental life change. Mental health disorders are common in parents and impact both the parent and their offspring. However, the relationship between parenthood and mental health and the direction of these effects are poorly understood. Longitudinal data from the Pelotas 1982 birth cohort, Southern Brazil, on 3701 individuals was used to investigate the association between number of children by age 30 years and mental health disorders using DSM-IV diagnoses at age 30 years, suicidal risk and the change in symptoms using repeated measures (using the SRQ-20) from age 19 to 30 years. Mothers, but not fathers, with higher number of children by age 30 years, were at a substantially increased risk of a wide range of mental health disorders compared to women with no children. There was evidence that motherhood was associated with an increase in symptoms over time rather than higher symptoms at baseline. Younger age at first child was also a risk factor for mental health disorders. Mothers, particularly those with multiple children, are at risk of a wide range of mental health disorders. The mechanisms to explain these risks are yet to be elucidated; however, the risk of mental health disorders was not replicated in fathers, which would be expected if residual confounding explained observed associations. Thus, multiparous mothers represent a high-risk group and should be prioritised for supportive interventions.

Differences in potentially preventable risk factors for stroke amongst ethnic groups

AIM: To assess the prevalence of risk factors for stroke potentially amenable to health service intervention (hypertension, diabetes, smoking, increased alcohol consumption, physical inactivity, atrial fibrillation, cardiac disease, previous TIA) in black Caribbean, black African and white population of an inner-city health authority. METHODS: A cross-sectional survey was conducted, involving 16 GP Practices serving an area with a high proportion of black residents as identified by the 1991 Census. The FHSA list for these practices was used as the sampling frame. A random sample of 8000 residents (45-74 years old) was selected for a postal survey, which collected data on age, sex, occupation and ethnic group. Responders were stratified by ethnic group. A random sample of 450 subjects in white and black Caribbean group was selected, and together with 193 black African responders invited for screening. RESULTS: There were 725 responders: 303 whites (41.8 percent), 316 black Caribbean (43.6 percent) and 106 black Africans (14.6 percent). Black Caribbeans and Africans were less likely to have a normal blood pressure than whites (OR=0.42, p=0.0001, and OR=0.39, p=0.001 respectively.) Black Caribbeans and were also less likely to have a normal ECG (OR=0.55, p=0.0011, and OR=0.41, p=0.007 respectively.) Left ventricular strain was more common in black Caribbeans (OR=15.81, p=0.008) and Africans (OR=19.97, p=0.007), ischaemic changes were more common in black Caribbeans (OR=2.8, p=0.0001) and myocardial infarction in Africans were found in the prevalence of reported risk factors, such as diabetes (5 percent, 15.2 percent, 10.4 percent respectively, p>0.00001), smoking (31.4 percent, 21 percent, 11.3 percent, p<0.00001, alcohol drinking (80.9 percent, 77.8 percent, 61.3 percent, p<0.00001) and physical activity (75.3 percent, 83.2 percent, 79.3 percent, p=0.048). No difference was found in prevalence of atrial fibrillation and previous TIA. CONCLUSION: Black Caribbeans and black Africans have significantly higher prevalence rates of the important risk factors for stroke. This may partially explain higher mortality rates for stroke in these ethnic groups. Strategies for stroke prevention will be considered in the context of the on-going study on cultural attitudes to risk factor reduction. (AU)