Paediatrics (RCH) - Research Publications
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ItemNo Preview AvailableMaternal mental health and infant emotional reactivity: a 20-year two-cohort study of preconception and perinatal exposures(CAMBRIDGE UNIV PRESS, 2020-04-01)BACKGROUND: Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied. METHODS: We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum. RESULTS: Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4-3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure. CONCLUSIONS: Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.
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ItemThe Victorian Intergenerational Health Cohort Study (VIHCS): Study design of a preconception cohort from parent adolescence to offspring childhood(WILEY, 2020-01-01)BACKGROUND: There is increasing evidence that parental determinants of offspring early life development begin well before pregnancy. OBJECTIVES: We established the Victorian Intergenerational Health Cohort Study (VIHCS) to examine the contributions of parental mental health, substance use, and socio-economic characteristics before pregnancy to child emotional, physical, social, and cognitive development. POPULATION: Men and women were recruited from the Victorian Adolescent Health Cohort (VAHCS), an existing cohort study beginning in 1992 that assessed a representative sample of 1943 secondary school students in Victoria, Australia, repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). METHODS: Victorian Adolescent Health Cohort participants with children born between 2006 and 2013 were recruited to VIHCS and invited to participate during trimester three, at 2 months postpartum, and 1 year postpartum. Parental mental health, substance use and socio-economic characteristics were assessed repeatedly throughout; infant characteristics were assessed postnatally and in infancy. Data will be supplemented by linkage to routine datasets. A further follow-up is underway as children reach 8 years of age. PRELIMINARY RESULTS: Of the 1307 infants born to VAHCS participants between 2006 and 2013, 1030 were recruited to VIHCS. At VIHCS study entry, 18% of recruited parents had preconception common mental disorder in adolescence and young adulthood, 18% smoked daily in adolescence and young adulthood, and 6% had not completed high school. Half of VIHCS infants were female (48%), 4% were from multiple births, and 7% were preterm (<37 weeks' gestation). CONCLUSIONS: Victorian Intergenerational Health Cohort Study is a prospective cohort of 1030 children with up to nine waves of preconception parental data and three waves of perinatal parental and infant data. These will allow examination of continuities of parental health and health risks from the decades before pregnancy to offspring childhood, and the contributions of exposures before pregnancy to offspring outcomes in childhood.
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ItemGeneral anaesthesia or conscious sedation for painful procedures in childhood cancer: the family's perspective(BRITISH MED JOURNAL PUBL GROUP, 2003-03-01)BACKGROUND: Until recently, midazolam sedation was routinely used in our institution for bone marrow aspirates and lumbar punctures in children with cancer. It has been perceived by many doctors and nurses as being well tolerated by children and their families. AIM: To compare the efficacy of inhalational general anaesthesia and midazolam sedation for these procedures. METHODS: A total of 96 children with neoplastic disorders, who received either inhalational general anaesthesia with sevoflurane, nitrous oxide, and oxygen (GA) or sedation with oral or nasal midazolam (SED) as part of their routine preparation for procedures were studied. The experiences of these children were examined during their current procedure and during their first ever procedure. Main outcome measures were the degree of physical restraint used on the child, and the levels of distress and pain experienced by the child during the current procedure and during the first procedure. The family's preference for future procedures was also determined. RESULTS: During 102 procedures under GA, restraint was needed on four occasions (4%) when the anaesthetic mask was first applied, minimal pain was reported, and children were reported as distressed about 25% of the time. During 80 SED procedures, restraint was required in 94%, firm restraint was required in 66%, the child could not be restrained in 14%, median pain score was 6 (scale 0 (no pain) to 6 (maximum pain)), and 90% of the parents reported distress in their child. Ninety per cent of families wanted GA for future procedures. Many families reported dissatisfaction with the sedation regime and raised concerns about the restraint used on their child. CONCLUSIONS: This general anaesthetic regime minimised the need for restraint and was associated with low levels of pain and distress. The sedation regime, by contrast, was much less effective. There was a significant disparity between the perceptions of health professionals and those of families with respect to how children coped with painful procedures.
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ItemPredicting Female Depression Across Puberty: A Two-Nation Longitudinal Study(ELSEVIER SCIENCE INC, 2008-12-01)OBJECTIVE: To prospectively examine the relation between pubertal stage and the onset and course of depressive symptoms. METHOD: The design was a three-wave longitudinal study of health and social development using statewide community samples in Washington, United States, and Victoria, Australia. Approximately 5,769 students initially ages 10 to 15 years were assessed for depressive symptoms with the Short Mood and Feelings Questionnaire. Pubertal status was assessed using a self-report version of the Pubertal Development Scale. RESULTS: Advancing pubertal stage carried higher risks for depressive symptoms in female subjects in all of the three study waves. The pubertal rise in female depressive symptoms was due to both higher risk for incident cases and an even greater effect on risks for persistence of depressive symptoms. Report of poor emotional control 12 months earlier carried a twofold higher risk for incident depressive symptoms and largely explained the pubertal rise in female incident cases. High family conflict and severity of bullying also predicted persistence of depressive symptoms. Preexisting depressive symptoms were not associated with later increases in the rate of pubertal transition. CONCLUSIONS: Advancing pubertal stage carries risks for both the onset and persistence of depressive symptoms in females. Social adversity around puberty predicts the persistence of symptoms but does not account for a pubertal rise in female depression. A report of poor emotional control may be a useful marker of girls at risk for depressive symptoms and as a target for preventive intervention.
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ItemThe natural history of self-harm from adolescence to young adulthood: a population-based cohort study(ELSEVIER SCIENCE INC, 2012-01-21)BACKGROUND: Knowledge about the natural history of self-harm is scarce, especially during the transition from adolescence to young adulthood, a period characterised by a sharp rise in self-inflicted deaths. From a repeated measures cohort of a representative sample, we describe the course of self-harm from middle adolescence to young adulthood. METHODS: A stratified, random sample of 1943 adolescents was recruited from 44 schools across the state of Victoria, Australia, between August, 1992, and January, 2008. We obtained data pertaining to self-harm from questionnaires and telephone interviews at seven waves of follow-up, commencing at mean age 15·9 years (SD 0·49) and ending at mean age 29·0 years (SD 0·59). Summary adolescent measures (waves three to six) were obtained for cannabis use, cigarette smoking, high-risk alcohol use, depression and anxiety, antisocial behaviour and parental separation or divorce. FINDINGS: 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1·6, 95% CI 1·2-2·2). We recorded a substantial reduction in the frequency of self-harm during late adolescence. 122 of 1652 (7%) participants who reported self-harm during adolescence reported no further self-harm in young adulthood, with a stronger continuity in girls (13/888) than boys (1/764). During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (HR 3·7, 95% CI 2·4-5·9), antisocial behaviour (1·9, 1·1-3·4), high-risk alcohol use (2·1, 1·2-3·7), cannabis use (2·4, 1·4-4·4), and cigarette smoking (1·8, 1·0-3·1). Adolescent symptoms of depression and anxiety were clearly associated with incident self-harm in young adulthood (5·9, 2·2-16). INTERPRETATION: Most self-harming behaviour in adolescents resolves spontaneously. The early detection and treatment of common mental disorders during adolescence might constitute an important and hitherto unrecognised component of suicide prevention in young adults. FUNDING: National Health and Medical Research Council, Australia, and operational infrastructure support programme, Government of Victoria, Australia.
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ItemThe prevalence of childhood sexual abuse and adolescent unwanted sexual contact among boys and girls living in Victoria, Australia(PERGAMON-ELSEVIER SCIENCE LTD, 2010-05-01)OBJECTIVES: Childhood sexual abuse (CSA) is associated with both short- and long-term adverse mental and physical health consequences, yet there remains considerable controversy about the prevalence of CSA in the general population. There is also little prospective data on unwanted sexual contact (USC) collected during adolescence. METHODS: Data from a 10-year cohort study of a nationally representative sample of students aged 14-15 years in Victoria, Australia from 1992 to 2003 was used. CSA prior to age 16 was assessed retrospectively at age 24 years using a 6-item validated questionnaire. USC was assessed prospectively via questionnaire at 3 time points during adolescence. Multiple imputation was used to handle missing data. RESULTS: One thousand nine hundred forty-three of 2032 eligible adolescents participated in at least one wave of the study. One thousand seven hundred forty-five (812 males and 933 females) provided sufficient information to allow for multiple imputation and inclusion in the main analysis. The prevalence of any CSA was substantially higher among girls [17%, 95% confidence interval (CI): 14-20%] than boys (7%, 95% CI: 3-10%), as was the prevalence of USC reported during adolescence (14%, 95% CI 11-16%, versus 6%, 95% CI: 4-8% respectively). CONCLUSIONS: These findings highlight the high prevalence of childhood sexual abuse and unwanted sexual contact among girls as well as boys. PRACTICE IMPLICATIONS: In order to accurately inform early recognition, intervention and education programs for individuals with a history of CSA the frequency of sexual abuse must first be precisely quantified. Developing more standardized approaches will be important in order to improve our understanding of the extent of this problem.