department of psychology university of otago dunedin, new zealand professor richie poulton, frsnz...
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Department of Psychology
University of Otago
Dunedin, New Zealand
Professor Richie Poulton, FRSNZDirector, Dunedin Multidisciplinary Health
and Development Research Unit; Co-Director, National Centre for Lifecourse
Research
Men and mental health: What has longitudinal research taught us?
Retention in the Dunedin Study
Age Year Number Percent*
Birth 1972-73 3 1975-76 1037
100% 5 1977-78 991
96% 7 1979-80 954
92% 9 1981-82 955
92% 11 1983-84 925
90% 13 1985-86 850
82% 15 1987-88 976
95% 18 1990-91 993
97% 21 1993-94 992
97% 26 1998-99 980
96% 32 2004-05 972
96% 38 2010-12 961
95%
* Percentage seen of those who were eligible (i.e. alive) at each age
Location of Study Members seen at age 38
Current research activities include studies of:
SES inequalities - selection v causation
Pathways to employment
Personality continuities across the life-course
Antisocial behaviour and criminality
Long-term consequences of childhood adversity
Maori health/cultural identity
Cognition and neuropsychology
Family health history study
Mental health (including substance abuse)
Intimate relationships and domestic violence
Oral health
Sexual & reproductive health
Cardiovascular risk factors
Retinal imaging and endothelial function
Respiratory health
Next generation studies (age 3 and age 15 years)
Current research activities (contd)
Blood based studies
– Chlamydia trachomatis
– Herpes immunity
– Cardiovascular disease risk factors
– Inflammatory biomarkers
Genetic studies
– Mental health phenotypes
– Asthma/allergy
– Cardiovascular risk factors
– Periodontal disease
Methodological studies
– Comparison of Dunedin sample with national data
– Attrition analyses
Conventional wisdom
Kim-Cohen, Caspi, Moffitt, Harrington, Milne and Poulton. Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 2003, 60: 709-719.
Kim-Cohen, Caspi, Moffitt, Harrington, Milne and Poulton. Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 2003, 60: 709-719.
Antisocial behaviour
We have identified: early-onset individuals whose behaviour
persists throughout their lives (i.e. lifecourse persistent);
as well as another larger group comprising about one-fifth of the population, who begin to engage in antisocial behaviour in adolescence.
The Dunedin study has arguably one of the most detailed research programmes on antisocial behaviour in the world.
The implications for intervention
Early onset life-course persistent group: you need to intervene with both child and their family as early as possible
Adolescent-onset group: the worst thing you can do is use a group intervention approach, given that their behaviour is partly driven by peer influence – individual interventions are required
NB: Prison is a group intervention which tends to expand rather than diminish the antisocial repertoire.
Bad behaviour = bad healthAntisocial behaviour that emerges early in life and persists over time is not only associated with
– poor mental health;– bad relationships; and – criminal behaviour in adulthood
but also increased risk for a range of physical health problems:
– Heart disease and stroke (x 3)– Symptoms of chronic bronchitis (x 3)– Gum disease (x 4)– Herpes (x 2)– Smoking (x 10)– Injuries (x 4)– High rates of hospitalisation (x3)
Odgers, Caspi, Broadbent, Dickson, Hancox, Harrington, Poulton, Sears, Thomson, Moffitt. Archives of General Psychiatry, 2007, 64: 476-484
Take away messages
Serious conduct problems have a long reach
Their impact is pervasive
Previous ‘cost’ calculations are likely to be underestimates
Should be a top public health priority
‘Earlier the better’ for intervention efforts
Aging, men and mental health
Life expectancy increasing but want extra ‘life’ in those extra years!
Aging begins early – an accumulation of wear and tear in multiple organ systems
A lifecourse perspective asks: are there modifiable interventon targets that might slow or even reverse disease-causing processes when people are still young?
Psychiatric diagnoses as novel targets?
Compared to the general population, those with diagnoses have higher mortality rates, but die of same causes (e.g., CVD, cancer)
Internalising disorders (depression, GAD, PTSD) are sufficiently common to be a public health intervention target
Timing is right: internalising disorders onset in first ½ of lifecourse, age-related diseases in the 2nd half of the lifecourse
Internalising disorders are treatable
Shalev, Moffitt, Braithwaite, Danese, Fleming, Goldman-Mellor, Harrington, Houts, Israel, Poulton, Robertson, Sugden, Williams and Caspi. Molecular Psychiatry, 2014, 19(11): 1163-1170.
Analysis – 2 parts
Number of assessments at which individuals met criteria for an internalsing disorder (depression, GAD and PTSD), from age 11 to 38 and telomere length at age 38 years
Focus not on telomere length at age 38, but on the amount of telomere erosion between age 26 and age 38 and internalising disorders experienced between the same ages
Telomere length. Association between internalizing disorder from age 11 to 38 years, and leukocyte telomere length (LTL) at 38 years for men (a) and women (b).
Molecular Psychiatry (2014) 19, 1163-1170;doi:10.1038/mp.2013.183
Pearson correlations and multivariate linear regression analyses of internalizing disorder from 11–38 years, predicting LTL at 38 years, controlling for alternative explanatory variables
Molecular Psychiatry (2014) 19, 1163-1170;doi:10.1038/mp.2013.183
Telomere erosion. Association between generalized anxiety disorder (GAD), depression and post-traumatic stress disorder (PTSD) between ages 26–38 years, and leukocyte telomere length (LTL) at age 38 years (after controlling for baseline LTL at age 26 years) for men (a) and women (b).
Molecular Psychiatry (2014) 19, 1163-1170;doi:10.1038/mp.2013.183
Some strengths of the study
Improvement over single point-in-time assessment of internalising disorder
Able to also examine erosion (change) in relation to disorder
Could rule out multiple alternative explanations for the association
Examined multiple internalising disorders (i.e not just depression)
Possible mechanisms
Some studies show that physiological and/or biochemical processes involved in internalising disorder affect men more than women
Dysregulation of the HPA axis, elvated proinflammatory cytokines and elevated oxidative stress markers
Protective role of estrogens against mitochondrial damage from oxidation processes (i.e., the women were still in reproductive years)
Take home messages
Male Mental Health “Is there such a thing?”
(still) High prevalence (internalising disorders) AND/OR high impact (externalising)
Men may be physiologically more vulnerable to aging effects of mental health problems?
Policy implications are to intervene much earlier than current practice
Multiple benefits are likely to accrue – a healthier future indeed!
Acknowledgements This on-going research would not have been
possible without the co-operation and commitment of the Study members, their families and friends over a long period of time.
Core funding for the Dunedin Multidisciplinary Health and Development Research Unit comes from the Health Research Council of New Zealand.
For copies of research articles referred to in this presentation or other information on the Study, contact Michelle McCann:
+64 3 479-8507 email: [email protected]
http://www.otago.ac.nz/dunedin study