Publications by authors named "George Patton"

359 Publications

A job for life: How the transition from education to employment predicts early mortality.

Lancet Reg Health Eur 2021 Apr 25;3:100057. Epub 2021 Feb 25.

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1016/j.lanepe.2021.100057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8454527PMC
April 2021

Risky youth to risky adults: Sustained increased risk of crash in the DRIVE study 13 years on.

Prev Med 2021 Sep 8;153:106786. Epub 2021 Sep 8.

Queensland University of Technology (QUT), Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Kelvin Grove, Queensland, Australia.

The objective of this study was to investigate if drivers who exhibit risky driving behaviours during youth (aged 17-24 years) have an increased risk of car crash up to 13 years later. We used data from the DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia. The data were linked with police crash, hospital and deaths data up to 2016. We analysed differences in crash associated with 13 items of risky driving behaviours using negative binominal regression models adjusted for driver demographics, driving exposure and known crash risk factors. The items were summarised in one index and grouped into quintiles for the analysis. After adjusting for confounding, drivers of the third (RR 1.16, 95% CI 1.05-1.30), fourth (RR1.22, 95% CI1.09-1.36) and fifth quintile (RR 1.36, 95% CI 1.21-1.53) had higher crash rates compared to the lowest risk-takers. Drivers with the highest scores on the risky driving measure had higher rates of crash related hospital admission or death (RR 1.92, 95% CI 1.13-3.27), crashes in wet conditions (RR 1.35,95% CI 1.05-1.73), crashes in darkness (RR 1.55, 95% CI 1.25-1.93) and head-on crashes (RR 2.14, 95% CI 1.07-4.28), compared with drivers with the lowest scores. Novice adolescent drivers who reported high levels of risky driving when they first obtained a driver licence remained at increased risk of crash well into adulthood. Measures that successfully reduce early risky driving, have the potential to substantially reduce road crashes and transport related injuries and deaths over the lifespan.
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http://dx.doi.org/10.1016/j.ypmed.2021.106786DOI Listing
September 2021

Longitudinal prediction of periconception alcohol use: a 20-year prospective cohort study across adolescence, young adulthood and pregnancy.

Addiction 2021 Sep 8. Epub 2021 Sep 8.

Murdoch Children's Research Institute, Melbourne, VIC, Australia.

Background And Aims: Alcohol consumption is common in adolescence and young adulthood and may continue into pregnancy, posing serious risk to early fetal development. We examine the frequency of periconception alcohol use (prior to pregnancy awareness) and the extent to which adolescent and young adult alcohol use prospectively predict periconception use.

Design: A longitudinal, population-based study.

Setting: Victoria, Australia.

Participants: A total of 289 women in trimester three of pregnancy (age 29-35 years; 388 pregnancies).

Measures: The main exposures were binge [≥ 4.0 standard drinks (SDs)/day] and frequent (≥ 3 days/week) drinking in adolescence (mean age = 14.9-17.4 years) and young adulthood (mean age 20.7-29.1 years). Outcomes were frequency (≥ 3 days/week, ≥ monthly, never) and quantity (≥ 4.0 SDs, ≥ 0.5 and < 4.0 SDs, none) of periconception drinking.

Findings: Alcohol use was common in young adulthood prior to pregnancy (72%) and in the early weeks of pregnancy (76%). The proportions drinking on most days and binge drinking were similar at both points. Reflecting a high degree of continuity in alcohol use behaviours, most women who drank periconceptionally had an earlier history of frequent (77%) and/or binge (85%) drinking throughout the adolescent or young adult years. Young adult binge drinking prospectively predicted periconception drinking quantity [odds ratio (OR) = 3.7, 95% confidence interval (CI) = 1.9-7.4], compared with women with no prior history. Similarly, frequent young adult drinking prospectively predicted frequent periconception drinking (OR = 30.7, 95% CI = 12.3-76.7).

Conclusions: Women who engage in risky (i.e. frequent and binge) drinking in their adolescent and young adult years are more likely to report risky drinking in early pregnancy prior to pregnancy recognition than women with no prior history of risky drinking.
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http://dx.doi.org/10.1111/add.15632DOI Listing
September 2021

Cannabis and tobacco use prior to pregnancy and subsequent offspring birth outcomes: a 20-year intergenerational prospective cohort study.

Sci Rep 2021 Aug 19;11(1):16826. Epub 2021 Aug 19.

Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.

There is increasing evidence that the life-course origins of health and development begin before conception. We examined associations between timing and frequency of preconception cannabis and tobacco use and next generation preterm birth (PTB), low birth weight (LBW) and small for gestational age. 665 participants in a general population cohort were repeatedly assessed on tobacco and cannabis use between ages 14-29 years, before pregnancy. Associations were estimated using logistic regression. Preconception parent (either maternal or paternal) daily cannabis use age 15-17 was associated with sixfold increases in the odds of offspring PTB (aOR 6.65, 95% CI 1.92, 23.09), and offspring LBW (aOR 5.84, 95% CI 1.70-20.08), after adjusting for baseline sociodemographic factors, parent sex, offspring sex, family socioeconomic status, parent mental health at baseline, and concurrent tobacco use. There was little evidence of associations with preconception parental cannabis use at other ages or preconception parental tobacco use. Findings support the hypothesis that the early life origins of growth begin before conception and provide a compelling rationale for prevention of frequent use during adolescence. This is pertinent given liberalisation of cannabis policy.
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http://dx.doi.org/10.1038/s41598-021-95460-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376878PMC
August 2021

Gender norms and the mental health of boys and young men.

Lancet Public Health 2021 08;6(8):e541-e542

Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1016/S2468-2667(21)00138-9DOI Listing
August 2021

Life-course predictors of homelessness from adolescence into adulthood: A population-based cohort study.

J Adolesc 2021 08 13;91:15-24. Epub 2021 Jul 13.

Centre for Social and Early Emotional Development, School of Psychology, Deakin University; and Centre for Adolescent Health, Murdoch Children's Research Institute, Australia.

Introduction: Internationally, the prevalence of young adult homelessness is concerning. Few data on life-course predictors from longitudinal studies exist, limiting our capacity to inform prevention strategies at the population-level.

Methods: Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; N = 927, 54% female). Participants were recruited in state-representative secondary school samples at Grade 7 (age 13, 2002), with follow-up in Grades 9 (age 15) and 11 (age 17) and at ages 21, 23 and 25. Using longitudinal path modelling, we conducted a series of analyses testing life-course predictors of young adult homelessness across multiple socializing contexts, and the interrelationships among them.

Results: The rate of young adult homelessness was 5.5%. Path modelling showed higher levels of family conflict at ages 13 and 15 uniquely predicted homelessness by age 25. This effect remained after accounting for other risk factors in peer-group (e.g., interactions with antisocial peers), school (e.g., low academic performance), and community contexts (e.g., low neighborhood attachment). Peer drug use and interaction with antisocial peers at age 15 mediated the association between family conflict at age 13 and homelessness by age 25.

Conclusions: Findings point to the vulnerability of early adolescents to family conflict. This vulnerability heightens risk for young adult homelessness. Findings strengthen the case for both primary prevention programs that build healthy relationships between family members from early on in adolescence and for investment in homelessness prevention at key developmental periods.
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http://dx.doi.org/10.1016/j.adolescence.2021.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423126PMC
August 2021

Rediscovering the mental health of populations.

World Psychiatry 2021 Jun;20(2):151-152

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1002/wps.20842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129848PMC
June 2021

Preventing postnatal depression: a causal mediation analysis of a 20-year preconception cohort.

Philos Trans R Soc Lond B Biol Sci 2021 06 3;376(1827):20200028. Epub 2021 May 3.

Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia.

Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14-29 years, 1992-2006), and again during pregnancy, two months postpartum and one year postpartum (2006-2014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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http://dx.doi.org/10.1098/rstb.2020.0028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8090815PMC
June 2021

Growth and adrenarche: findings from the CATS observational study.

Arch Dis Child 2021 Oct 30;106(10):967-974. Epub 2021 Apr 30.

Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Background: There is increasing evidence that patterns of pubertal maturation are associated with different patterns of health risk. This study aimed to explore the associations between anthropometric measures and salivary androgen concentrations in pre-adolescent children.

Methods: We analysed a stratified random sample (N=1151) of pupils aged 8-9 years old from 43 primary schools in Melbourne, Australia from the Childhood to Adolescence Transition Study. Saliva samples were assayed for dehydroepiandrosterone (DHEA), DHEA-sulfate and testosterone. Anthropometric measures included height, weight, body mass index (BMI) and waist circumference. Associations between (1) anthropometric measures and each androgen, and (2) hormone status with obesity and parental report of pubertal development were investigated using linear regression modelling with general estimating equations.

Results: Greater height, weight, BMI and waist circumference were positively associated with higher androgen concentrations, after adjusting for sex and socioeconomic status. Being overweight or obese was associated with higher testosterone and DHEA concentrations compared with the normal BMI category. Those who were obese were more likely (OR=2.7, 95% CI 1.61 to 4.43, p<0.001) to be in the top tertile of age-adjusted androgen status in both sexes.

Conclusion: This study provides clear evidence for an association between obesity and higher androgen levels in mid-childhood. The adrenal transition may be a critical time period for weight management intervention strategies in order to manage the risk for metabolic problems in later life for high-risk individuals.
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http://dx.doi.org/10.1136/archdischild-2020-319341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461445PMC
October 2021

Educational and Employment Outcomes among Young Australians with a History of Depressive Symptoms: A Prospective Cohort Study.

Int J Environ Res Public Health 2021 03 24;18(7). Epub 2021 Mar 24.

Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3052, Australia.

The aim of this study was to investigate whether depressive symptoms reported during adolescence are associated with subsequent educational and employment outcomes, including whether experiences of depressive symptoms in adolescence are associated with higher exposures to adverse psychosocial job stressors among those who were employed in emerging adulthood. We used data from the Victorian arm of the International Youth Development Study (IYDS). Multiple logistic regression analyses were used to model the association of depressive symptoms reported in 2002 (wave one) and/or 2003 (wave two) and self-reported completion of compulsory secondary schooling, employment status, and exposure to a number of psychosocial job stressors roughly a decade later (i.e., at wave three in 2014). In fully adjusted models, reporting high depressive symptoms at waves one or two (odds ratio (OR) 0.71, 95% confidence interval (CI) 0.55 to 0.92), as well as at both waves (OR 0.55, 95% CI 0.41 to 0.75) were associated with a reduced likelihood of completing secondary schooling by wave three. High depressive symptoms reported at multiple waves were also associated with a reduced likelihood of employment (OR 0.49, 95% CI 0.36 to 0.66). Amongst those employed at wave three ( = 2091; 72.5%), adolescent depressive symptoms were associated only with workplace incivility. Psychosocial job stressor exposures should be considered in the design and selection of jobs for young workers with a history of depressive symptoms in order to increase employment participation and sustainability for young people experiencing symptoms of depression.
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http://dx.doi.org/10.3390/ijerph18073376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036767PMC
March 2021

Mediation effects that emulate a target randomised trial: Simulation-based evaluation of ill-defined interventions on multiple mediators.

Stat Methods Med Res 2021 06 20;30(6):1395-1412. Epub 2021 Mar 20.

Department of Paediatrics, University of Melbourne, Melbourne, Australia.

Many epidemiological questions concern potential interventions to alter the pathways presumed to mediate an association. For example, we consider a study that investigates the benefit of interventions in young adulthood for ameliorating the poorer mid-life psychosocial outcomes of adolescent self-harmers relative to their healthy peers. Two methodological challenges arise. First, mediation methods have hitherto mostly focused on the elusive task of discovering pathways, rather than on the evaluation of mediator interventions. Second, the complexity of such questions is invariably such that there are no well-defined mediator interventions (i.e. actual treatments, programs, etc.) for which data exist on the relevant populations, outcomes and time-spans of interest. Instead, researchers must rely on exposure (non-intervention) data, that is, on mediator measures such as depression symptoms for which the actual interventions that one might implement to alter them are not well defined. We propose a novel framework that addresses these challenges by defining mediation effects that map to a target trial of hypothetical interventions targeting multiple mediators for which we simulate the effects. Specifically, we specify a target trial addressing three policy-relevant questions, regarding the impacts of hypothetical interventions that would shift the mediators' distributions (separately under various interdependence assumptions, jointly or sequentially) to user-specified distributions that can be emulated with the observed data. We then define novel interventional effects that map to this trial, simulating shifts by setting mediators to random draws from those distributions. We show that estimation using a g-computation method is possible under an expanded set of causal assumptions relative to inference with well-defined interventions, which reflects the lower level of evidence that is expected with ill-defined interventions. Application to the self-harm example in the Victorian Adolescent Health Cohort Study illustrates the value of our proposal for informing the design and evaluation of actual interventions in the future.
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http://dx.doi.org/10.1177/0962280221998409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371283PMC
June 2021

Human Papillomavirus Vaccination After COVID-19.

JNCI Cancer Spectr 2021 Apr 2;5(2):pkab011. Epub 2021 Mar 2.

Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

The current global novel coronavirus disease 2019 (COVID-19) pandemic threatens to derail the uptake of human papillomavirus (HPV) vaccination in low- and lower-middle income countries with major disruptions to routine immunization and the introduction of new vaccines delayed. This has a major impact on the World Health Organization cervical cancer elimination strategy, where it is dependent on HPV vaccination as well as cervical cancer screening and treatment. We discuss current opportunities and barriers to achieve high uptake of HPV vaccination in low- and lower-middle income countries as well as the impact of COVID-19. Implementation of 4 key recommendations for HPV vaccination in low- and lower-middle income countries is needed: increased global financial investment; improved vaccine supply and accelerated use of a single-dose schedule; education and social marketing; and adoption of universal school-based delivery. With the commitment of the global health community, the adoption of these strategies would underpin the effective elimination of cervical cancer.
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http://dx.doi.org/10.1093/jncics/pkab011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962726PMC
April 2021

Gender norms and the wellbeing of girls and boys - Author's reply.

Lancet Glob Health 2021 04;9(4):e399

Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1016/S2214-109X(20)30554-4DOI Listing
April 2021

Young-adult compared to adolescent onset of regular cannabis use: A 20-year prospective cohort study of later consequences.

Drug Alcohol Rev 2021 May 26;40(4):627-636. Epub 2021 Jan 26.

Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.

Introduction: This paper compares consequences of cannabis use initiated after high school with those of cannabis initiation in adolescence, with estimates of the proportion of adverse consequences accounted for by adult-onset and adolescent-onset cannabis users.

Methods: A state-representative sample in Victoria, Australia (n = 1792) participated in a 10-wave longitudinal study and was followed from age 15 to 35 years. Exposure variable: Patterns of cannabis use across 20 years. Outcomes at age 35: Alcohol use, smoking, illicit drug use, relationship status, financial hardship, depression, anxiety and employment status.

Results: Substantially more participants (13.6%) initiated regular use after high school (young-adult onset) than in adolescence (7.7%, adolescent onset). By the mid-30s, both young-adult and adolescent-onset regular users were more likely than minimal/non-users (63.5%) to have used other illicit drugs (odds ratio [OR] > 20.4), be a high-risk alcohol drinker (OR > 3.7), smoked daily (OR > 7.2) and less likely to be in relationships (OR < 0.4). As the prevalence of the young-adult-onset group was nearly double of the adolescent-onset group, it accounted for a higher proportion of adverse consequences than the adolescent-onset group.

Discussion And Conclusions: Cannabis users who began regular use in their teens had poorer later life outcomes than non-using peers. The larger group who began regular cannabis use after leaving high school accounted for most cannabis-related harms in adulthood. Given the legalisation of cannabis use in an increasing number of jurisdictions, we should increasingly expect harms from cannabis use to lie in those commencing use in young adulthood.
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http://dx.doi.org/10.1111/dar.13239DOI Listing
May 2021

Matching action to need: an analysis of Global Burden of Disease 2017 and population health data to focus adolescent health policy and actions in Myanmar.

Glob Health Action 2021 01;14(1):1844976

Burnet Institute , Melbourne, Australia.

: Myanmar is a country undergoing rapid transitions in health. Its national strategic policy for young people's health is being revised but there is a paucity of population data to inform local priorities and needs. : In this paper we describe a comprehensive profile of adolescent health in Myanmar to focus policy and health actions. : We used available primary data, and modelled estimates from the GBD 2017, to describe health outcomes (mortality and morbidity), health risks and determinants for adolescents in Myanmar between 1990-2017. A governance group of key stakeholders guided the framing of the study, interpretation of findings, and recommendations. : Overall health has improved for adolescents in Myanmar since 1990, however adolescent mortality remains high, particularly so for older adolescent males; all-cause mortality rate for 10-24 years was 70 per 100,000 for females and 149 per 100,000 for males (16,095 adolescent deaths in 2017). Overall, the dominant health problems were injuries for males and non-communicable disease for females in a context of ongoing burden of communicable and nutritional diseases for both sexes, and reproductive health needs for females. Health risks relating to undernutrition (thinness and anaemia) remain prevalent, with other health risks (overweight, binge alcohol use, and substance use) relatively low by global and regional standards but increasing. Gains have been made in social determinants such as adolescent fertility and modern contraception use; however, advances have been more limited in secondary education completion and engagement in employment and post education training. : These results highlight the need to focus current efforts on addressing disease and mortality experienced by adolescents in Myanmar, with a specific focus on injury, mental health and non-communicable disease.
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http://dx.doi.org/10.1080/16549716.2020.1844976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833024PMC
January 2021

Matching action to need: an analysis of Global Burden of Disease 2017 and population health data to focus adolescent health policy and actions in Myanmar.

Glob Health Action 2021 01;14(1):1844976

Burnet Institute , Melbourne, Australia.

: Myanmar is a country undergoing rapid transitions in health. Its national strategic policy for young people's health is being revised but there is a paucity of population data to inform local priorities and needs. : In this paper we describe a comprehensive profile of adolescent health in Myanmar to focus policy and health actions. : We used available primary data, and modelled estimates from the GBD 2017, to describe health outcomes (mortality and morbidity), health risks and determinants for adolescents in Myanmar between 1990-2017. A governance group of key stakeholders guided the framing of the study, interpretation of findings, and recommendations. : Overall health has improved for adolescents in Myanmar since 1990, however adolescent mortality remains high, particularly so for older adolescent males; all-cause mortality rate for 10-24 years was 70 per 100,000 for females and 149 per 100,000 for males (16,095 adolescent deaths in 2017). Overall, the dominant health problems were injuries for males and non-communicable disease for females in a context of ongoing burden of communicable and nutritional diseases for both sexes, and reproductive health needs for females. Health risks relating to undernutrition (thinness and anaemia) remain prevalent, with other health risks (overweight, binge alcohol use, and substance use) relatively low by global and regional standards but increasing. Gains have been made in social determinants such as adolescent fertility and modern contraception use; however, advances have been more limited in secondary education completion and engagement in employment and post education training. : These results highlight the need to focus current efforts on addressing disease and mortality experienced by adolescents in Myanmar, with a specific focus on injury, mental health and non-communicable disease.
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http://dx.doi.org/10.1080/16549716.2020.1844976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833024PMC
January 2021

Psychosocial interventions for self-harm in low-income and middle-income countries: systematic review and theory of change.

Soc Psychiatry Psychiatr Epidemiol 2021 Oct 4;56(10):1729-1750. Epub 2021 Jan 4.

Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, MA, USA.

Purpose: To synthesise the evidence on effectiveness, acceptability and the delivery mechanisms of psychosocial interventions for self-harm in low and middle income countries and to develop a pathway of change specific for self-harm interventions.

Method: Studies reporting one or more patient or implementation outcomes of a psychosocial intervention targeting self-harm and conducted in low- and middle-income countries were included. Taxonomy of treatment components and a theory of change map was created using information from the studies.

Results: We identified thirteen studies including nine randomised controlled trials (RCT), three non-RCTs, and a single experimental case design study. A single study using postcard contact and another using cognitive behaviour therapy (CBT) reported a reduction in self-harm attempts. Suicidal ideations were significantly reduced with CBT, volitional help sheets and postcard contact in different studies. Suicide risk assessment, problem solving and self-validation were the most frequently used elements in interventions. Goal-setting was the technique used most commonly. Cultural adaptations of psychotherapies were used in two studies. High attrition rates in psychotherapy trials, limited benefit of the delivery of treatment by non-specialist providers, and variable benefit observed using phone contact as a means to deliver intervention were other important findings.

Conclusion: There were no strong positive findings to draw definitive conclusions. Limited availability and evidence for culturally adapted interventions in self-harm, lack of evaluation of task sharing using evidence based interventions as well as a dearth in evaluation and reporting of various intervention delivery models in low- and middle-income countries were major literature gaps.
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http://dx.doi.org/10.1007/s00127-020-02005-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611648PMC
October 2021

A longitudinal analysis of puberty-related cortical development.

Neuroimage 2021 03 29;228:117684. Epub 2020 Dec 29.

School of Psychology, Deakin University, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Parkville, Australia.

The brain undergoes extensive structural changes during adolescence, concurrent to puberty-related physical and hormonal changes. While animal research suggests these biological processes are related to one another, our knowledge of brain development in humans is largely based on age-related processes. Thus, the current study characterized puberty-related changes in human brain structure, by combining data from two longitudinal neuroimaging cohorts. Beyond normative changes in cortical thickness, we examined whether individual differences in the rate of pubertal maturation (or "pubertal tempo") was associated with variations in cortical trajectories. Participants (N = 192; scans = 366) completed up to three waves of MRI assessments between 8.5 and 14.5 years of age, as well as questionnaire assessments of pubertal stage at each wave. Generalized additive mixture models were used to characterize trajectories of cortical development. Results revealed widespread linear puberty-related changes across much of the cortex. Many of these changes, particularly within the frontal and parietal cortices, were independent of age-related development. Males exhibiting faster pubertal tempo demonstrated greater thinning in the precuneus and frontal cortices than same-aged and -sex peers. Findings suggest that the unique influence of puberty on cortical development may be more extensive than previously identified, and also emphasize important individual differences in the coupling of these developmental processes.
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http://dx.doi.org/10.1016/j.neuroimage.2020.117684DOI Listing
March 2021

International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder.

Lancet Psychiatry 2021 01;8(1):76-86

Wellcome Trust, London, UK.

A major barrier to improving care effectiveness for mental health is a lack of consensus on outcomes measurement. The International Consortium for Health Outcomes Measurement (ICHOM) has already developed a consensus-based standard set of outcomes for anxiety and depression in adults (including the Patient Health Questionnaire-9, the Generalised Anxiety Disorder 7-item Scale, and the WHO Disability Schedule). This Position Paper reports on recommendations specifically for anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and young people aged between 6 and 24 years. An international ICHOM working group of 27 clinical, research, and lived experience experts formed a consensus through teleconferences, an exercise using an adapted Delphi technique (a method for reaching group consensus), and iterative anonymous voting, supported by sequential research inputs. A systematic scoping review identified 70 possible outcomes and 107 relevant measurement instruments. Measures were appraised for their feasibility in routine practice (ie, brevity, free availability, validation in children and young people, and language translation) and psychometric performance (ie, validity, reliability, and sensitivity to change). The final standard set recommends tracking symptoms, suicidal thoughts and behaviour, and functioning as a minimum through seven primarily patient-reported outcome measures: the Revised Children's Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children's Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children's Global Assessment Scale, and the Child Anxiety Life Interference Scale. The set's recommendations were validated through a feedback survey involving 487 participants across 45 countries. The set should be used alongside the anxiety and depression standard set for adults with clinicians selecting age-appropriate measures.
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http://dx.doi.org/10.1016/S2215-0366(20)30356-4DOI Listing
January 2021

Connecting ages and stages in human development.

Lancet Child Adolesc Health 2021 01;5(1):4-5

Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia.

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http://dx.doi.org/10.1016/S2352-4642(20)30345-XDOI Listing
January 2021

Self-harm in primary school-aged children: Prospective cohort study.

PLoS One 2020 30;15(11):e0242802. Epub 2020 Nov 30.

Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Introduction: No prospective studies have examined the prevalence, antecedents or concurrent characteristics associated with self-harm in non-treatment-seeking primary school-aged children.

Methods: In this cohort study from Melbourne, Australia we assessed 1239 children annually from age 8-9 years (wave 1) to 11-12 years (wave 4) on a range of health, social, educational and family measures. Past-year self-harm was assessed at wave 4. We estimated the prevalence of self-harm and used multivariable logistic regression to examine associations with concurrent and antecedent factors.

Results: 28 participants (3% of the 1059 with self-harm data; 18 girls [3%], 10 boys [2%]) reported self-harm at age 11-12 years. Antecedent (waves 1-3) predictors of self-harm were: persistent symptoms of depression (sex-age-socioeconomic status adjusted odds ratio [aOR]: 7.8; 95% confidence intervals [CI] 2.6 to 24) or anxiety (aOR: 5.1; 95%CI 2.1 to 12), frequent bullying victimisation (aOR: 24.6; 95%CI 3.8 to 158), and recent alcohol consumption (aOR: 2.9; 95%CI 1.2 to 7.1). Concurrent (wave 4) associations with self-harm were: having few friends (aOR: 8.7; 95%CI 3.2 to 24), poor emotional control (aOR: 4.2; 95%CI 1.9 to 9.6), antisocial behaviour (theft-aOR: 3.1; 95%CI 1.2 to 7.9; carrying a weapon-aOR: 6.9; 95%CI 3.1 to 15), and being in mid-puberty (aOR: 6.5; 95%CI 1.5 to 28) or late/post-puberty (aOR: 14.4; 95%CI 2.9 to 70).

Conclusions: The focus of intervention efforts aimed at preventing and reducing adolescent self-harm should extend to primary school-aged children, with a focus on mental health and peer relationships during the pubertal transition.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242802PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703962PMC
January 2021

Adolescent Health and Healthy China 2030: A Review.

J Adolesc Health 2020 11 24;67(5S):S24-S31. Epub 2020 Nov 24.

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

Purpose: This article explores differences between the current health status of adolescents and the targets set in Healthy China 2030 (HC2030).

Methods: Global and domestic policies and strategies relating to adolescent health were reviewed. Data from the Global Burden of Disease Study (1990-2016) and the Chinese National Survey on Students' Constitution and Health (1985-2014) were used to analyze time trends and geographical distributions of health indicators for adolescents aged 10-19 years in China.

Results: The Chinese government has released many health policies over the past 3 decades. In this context, there has been a major decline in all-cause mortality and stunting. However, gaps between the current health status of adolescents and the targets set in HC2030 were numerous. The prevalence of obesity and poor vision increased rapidly, and few adolescents meet the physical activity and fitness targets set in HC2030. Urban/rural differences were marked for some indicators such as obesity, whereas for other indicators (e.g., stunting), there remained notable differences across provinces.

Conclusions: Many long-standing health problems of adolescents have improved, but new problems related to noncommunicable disease risks have emerged and should be a prominent focus for policy action under HC2030.
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http://dx.doi.org/10.1016/j.jadohealth.2020.07.023DOI Listing
November 2020

Towards Comprehensive National Surveillance for Adolescent Health in China: Priority Indicators and Current Data Gaps.

J Adolesc Health 2020 11 24;67(5S):S14-S23. Epub 2020 Nov 24.

Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia.

Purpose: The purpose of the study was to propose a health indicator system responsive to current Chinese adolescent health needs and identify data gaps in current information systems.

Methods: We identified 186 keywords for adolescent health gathered from three sources: contributors to the burden of disease captured in the Global Burden of Diseases 2015, together with independent literature and expert desk reviews; major health-related policies released by the State Council of China; and global strategies issued by UN agencies over the past five years. All keywords were synthesized into indicators and ranked with core indicators identified through panel discussions and literature review. A further systematic review was conducted to identify data sources for each indicator.

Results: We identified 100 indicators which we categorized into five dimensions: health outcomes including adolescent mortality and morbidity; health knowledge, skills and risk behaviors including smoking, physical activity; demographic and socioeconomic status including education or employment; responsiveness of the health service system including the provision of health education at school; and the physical and social environments including safe drinking water, secondhand smoke exposure, injuries, and bullying. In total, 72 indicators had nationally representative data, including 22 out of 24 core indicators (91.7%), 27 out of 33 potential core indicators (81.8%), and 23 out of 43 general indicators (53.5%). A large proportion of these indicators rely solely on data from school or household surveys.

Conclusions: The proposed health indicator system has the potential to rapidly identify shifting priorities for adolescent health in China but will require greater investment in primary data collection in neglected areas.
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http://dx.doi.org/10.1016/j.jadohealth.2020.05.043DOI Listing
November 2020

Social networking and symptoms of depression and anxiety in early adolescence.

Depress Anxiety 2021 05 22;38(5):563-570. Epub 2020 Nov 22.

Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Background: Use of social networking in later childhood and adolescence has risen quickly. The consequences of these changes for mental health are debated but require further empirical evaluation.

Methods: Using data from the Childhood to Adolescence Transition Study (n = 1,156), duration of social networking use was measured annually at four time points from 11.9 to 14.8 years of age (≥1 h/day indicating high use). Cross-sectional and prospective relationships between social networking use and depressive and anxiety symptoms were examined.

Results: In adjusted (age, socioeconomic status, prior mental health history) cross-sectional analyses, females with high social networking use had greater odds of depressive (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.58-2.91) and anxiety symptoms (OR: 1.99; 95% CI: 1.32-3.00) than those that used a few minutes at most, while males with high social networking use had 1.60 greater odds of reporting depressive symptoms (95% CI: 1.09-2.35). For females, an increased odds of depressive symptoms at age 14.8 was observed for high social networking use at one previous wave and at two or three previous waves, even after adjustment (OR: 1.76; 95% CI: 1.11-2.78; OR: 2.06, 95% CI: 1.27-3.37, respectively) compared to no wave of high use.

Conclusions: Our results suggest weak to moderate increased odds of depression and anxiety in girls and boys with high social networking use versus low/normal use. These findings indicate that prevention programs for early mental health problems might benefit from targeting social networking use in early adolescence.
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http://dx.doi.org/10.1002/da.23117DOI Listing
May 2021

Social networking and symptoms of depression and anxiety in early adolescence.

Depress Anxiety 2021 05 22;38(5):563-570. Epub 2020 Nov 22.

Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Background: Use of social networking in later childhood and adolescence has risen quickly. The consequences of these changes for mental health are debated but require further empirical evaluation.

Methods: Using data from the Childhood to Adolescence Transition Study (n = 1,156), duration of social networking use was measured annually at four time points from 11.9 to 14.8 years of age (≥1 h/day indicating high use). Cross-sectional and prospective relationships between social networking use and depressive and anxiety symptoms were examined.

Results: In adjusted (age, socioeconomic status, prior mental health history) cross-sectional analyses, females with high social networking use had greater odds of depressive (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.58-2.91) and anxiety symptoms (OR: 1.99; 95% CI: 1.32-3.00) than those that used a few minutes at most, while males with high social networking use had 1.60 greater odds of reporting depressive symptoms (95% CI: 1.09-2.35). For females, an increased odds of depressive symptoms at age 14.8 was observed for high social networking use at one previous wave and at two or three previous waves, even after adjustment (OR: 1.76; 95% CI: 1.11-2.78; OR: 2.06, 95% CI: 1.27-3.37, respectively) compared to no wave of high use.

Conclusions: Our results suggest weak to moderate increased odds of depression and anxiety in girls and boys with high social networking use versus low/normal use. These findings indicate that prevention programs for early mental health problems might benefit from targeting social networking use in early adolescence.
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http://dx.doi.org/10.1002/da.23117DOI Listing
May 2021

Parental mental health before and during pregnancy and offspring birth outcomes: A 20-year preconception cohort of maternal and paternal exposure.

EClinicalMedicine 2020 Oct 12;27:100564. Epub 2020 Oct 12.

Murdoch Children's Research Institute, Melbourne, Australia.

Background: Preterm birth (PTB) and small for gestational age (SGA) are increasingly prevalent, with major consequences for health and development into later life. There is emerging evidence that some risk processes begin before pregnancy. We report on associations between maternal and paternal common mental disorders (CMD) before and during pregnancy and offspring PTB and SGA.

Methods: 398 women with 609 infants and 267 men with 421 infants were assessed repeatedly for CMD symptoms before pregnancy between age 14 and 29 and during pregnancy. Associations between preconception and antenatal CMD symptoms and offspring gestational age/PTB and size for gestational age/SGA were estimated using linear and Poisson regression.

Findings: In men, persistent preconception CMD across adolescence and young adulthood predicted offspring PTB after adjustment for ethnicity, education, BMI and adolescent substance use (adjusted RR 7·0, 95% CI 1·8,26·8), corresponding to a population attributable fraction of 31% of preterm births. In women, antenatal CMD symptoms predicted offspring PTB (adjusted RR 4·4, 95% CI 1·4,14·1). There was little evidence of associations with SGA.

Interpretation: This first report of an association between paternal preconception mental health and offspring gestational age, while requiring replication in larger samples, complements earlier work on stress in animals, and further strengthens the case for expanding preconception mental health care to both men and women.

Funding: National Health and Medical Research Council (Australia), Victorian Health Promotion Foundation, Australian Rotary Health, Colonial Foundation, Perpetual Trustees, Financial Markets Foundation for Children (Australia), Royal Children's Hospital Foundation, Murdoch Children's Research Institute, Australian Research Council.
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http://dx.doi.org/10.1016/j.eclinm.2020.100564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599306PMC
October 2020

The Mediating Effect of School Climate on Adolescent Mental Health: Findings From a Randomized Controlled Trial of a School-Wide Intervention.

J Adolesc Health 2021 07 28;69(1):90-99. Epub 2020 Oct 28.

Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Sangath, Porvorim, Goa, India; Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, Massachusetts.

Purpose: Adolescence encompasses a critical developmental phase, which fosters or hinders psychological, physical, and social health. Whole-school interventions take a universal approach in targeting the entire school environment ("school climate") to improve adolescent outcomes; however, little is known about the mediating role of school climate on these effects.

Methods: Our study (N = 5,539) was situated within the Strengthening Evidence base on scHool-based intErventions for pRomoting randomized controlled trial, which demonstrated the effectiveness of a lay counselor-delivered school intervention among secondary school students in Bihar, India. We examined the potential mediating role of school climate and its subcomponents (relationships at school, sense of belonging, commitment to academic achievement, and participation in school events) at 8 months postrandomization of the Strengthening Evidence base on scHool-based intErventions for pRomoting intervention on longer term adolescent health outcomes (depressive symptoms, experiences of bullying, and perpetration of violence) at 17 months postrandomization. The trial was registered with ClinicalTrials.gov (NCT02484014).

Results: School climate mediated the effects of the intervention on all three outcomes of interest. A nurturing school environment, characterized by supportive and engaged relationships with teachers and peers, a sense of belonging, and active participation in school climate predicted lower rates of depressive symptoms, experiences of bullying, and perpetration of violence. Noteworthy, it was the quality of these relationships, rather than the commitment to learning, which was most predictive of outcomes.

Conclusion: Educational policies should consider bolstering the school's social environment to directly impact adolescent health and well-being.
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http://dx.doi.org/10.1016/j.jadohealth.2020.09.030DOI Listing
July 2021

Preconception depression and anxiety symptoms and maternal-infant bonding: a 20-year intergenerational cohort study.

Arch Womens Ment Health 2021 06 27;24(3):513-523. Epub 2020 Oct 27.

Murdoch Children's Research Institute, Victoria, Parkville, Australia.

Early maternal-infant bonding problems are often forerunners of later emotional and behavioural difficulties. Interventions typically target the perinatal period but many risks may be established well before pregnancy. Here we examine the extent to which adolescent and young adult depression and anxiety symptoms predict perinatal maternal-infant bonding difficulties. The Victorian Intergenerational Health Cohort Study (VIHCS, est. 2006) is following offspring born to the Victorian Adolescent Health Cohort Study (VAHCS; est. 1992). VAHCS participants were assessed for depression and anxiety symptoms nine times during adolescence and young adulthood (age 14-29 years), and then contacted bi-annually (from age 29-35 years) to identify pregnancies. The Postpartum Bonding Questionnaire (PBQ) was administered to mothers at 2 and 12 months postpartum. A total of 395 women (606 infants) completed the 2-month and/or 12-month postpartum interviews. For most infants (64%), mothers had experienced depression and/or anxiety before pregnancy. Preconception depression and anxiety symptoms that persisted from adolescence into young adulthood predicted maternal-infant bonding problems at 2 months (β = 0.30, 95% CI 0.04, 0.55) and 12 months postpartum (β = 0.40, 95% CI 0.16, 0.63). Depression and anxiety symptoms occurring in young adulthood only, also predicted bonding problems at 12 months postpartum (β = 0.37, 95% CI 0.02, 0.71). Associations between preconception depression and anxiety symptoms and anxiety-related maternal-infant bonding problems at 12 months postpartum remained after adjustment for antenatal and concurrent postpartum depressive symptoms. This study puts forward a case for extending preconception health care beyond contraception and nutrition to a broader engagement in supporting the mental health of young women from adolescence.
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http://dx.doi.org/10.1007/s00737-020-01081-5DOI Listing
June 2021

Cardiovascular Health Profile at Age 25 Years in Adults Born Extremely Preterm or Extremely Low Birthweight.

Hypertension 2020 12 26;76(6):1838-1846. Epub 2020 Oct 26.

From the Neonatal Services (J.L.Y.C., A.H., L.W.D.), Royal Women's Hospital, Parkville, Victoria, Australia.

Being born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g birthweight) may predict increased cardiometabolic risk in adulthood, but other early life predictors are less well described. We aimed to (1) compare cardiovascular health profiles between 165 adults born EP/ELBW and 127 controls at age 25 years, drawn from a prospective longitudinal cohort study, recruited at birth in 1991 to 1992; and (2) in the EP/ELBW group, determine early life associations of cardiovascular health. Cardiovascular health profiles were calculated individually for measures of anthropometry, abdominal visceral fat, blood pressure, fasting plasma glucose, insulin, lipids, C-reactive protein, vascular indices, exercise tolerance and smoking status, and summed for an overall score. Cardiovascular health profiles were compared between groups; using logistic regression (individual scores) and the Mann-Whitney test (cumulative score). Compared with controls, adults born EP/ELBW had less favorable cardiovascular health profiles; individually for abdominal visceral fat (odds ratio, 0.56 [95% CI, 0.33-0.96], =0.03), blood pressure (odds ratio 0.38 [95% CI, 0.23-0.63], <0.001), exercise capacity (odds ratio 0.37 [95% CI, 0.22-0.63], <0.001), and fasting glucose (odds ratio 0.51 [95% CI, 0.31-0.84], =0.01) and overall (median [interquartile range] 10 [7-11] versus 11 [9-12], =0.007). Male sex predicted unfavorable abdominal visceral fat, blood pressure and fasting glucose, and favorable exercise capacity. Greater increases in weight scores between 2 and 8, and 8 and 18 years predicted less favorable profiles of exercise capacity and visceral fat. Longer-term follow-up is critical to determine the cardiovascular sequelae of adults born EP/ELBW.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15786DOI Listing
December 2020
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