The Emerging Intersection of Physical and Mental Health During the Early Life Course. Lilly Shanahan

Transcription

1 The Emerging Intersection of Physical and Mental Health During the Early Life Course Lilly Shanahan University of North Carolina at Chapel Hill -- University of Zurich, Switzerland, starting summer

2 Outline 1. Program of Research 2. Importance of Studying the Intersection of Physical and Mental Health 3. Data Sources & Empirical Work 4. Ongoing Research

3 Overall Goals of Program of Research To understand for whom, when, and how psychopathology develops (e.g., Kramer et al) long-term outcomes for young people with psychopathology how mental and physical health are connected over the early decades How, in turn, these interconnections influence the social environment and vice versa NIMH R03MH ( ); NIMH R01MH ( ); NICHD R01HD ( ); NIDA R01DA ( )

4 Overall Program of Research Developmental Psychopathology Developmental Epidemiology

5 Overall Program of Research Psychosocial Stressors E.g., Poverty, family dysfunction Depression, Anxiety Development NIMH R03MH ( ); NIMH R01MH ( ); NICHD R01HD ( ); NIDA R01DA ( )

6 Overall Program of Research Physiological Markers Immune Function ANS reactivity Psychosocial Stressors E.g., Poverty, family dysfunction Depression, Anxiety Development NIMH R03MH ( ); NIMH R01MH ( ); NICHD R01HD ( ); NIDA R01DA ( )

7 Overall Program of Research Physiological Markers Immune Function ANS reactivity Psychosocial Stressors E.g., Poverty, family dysfunction Somatic Symptoms Disease Risk / Manifestation Depression, Anxiety Development NIMH R03MH ( ); NIMH R01MH ( ); NICHD R01HD ( ); NIDA R01DA ( )

8 Outline 1. Program of Research 2. Importance of Studying the Intersection of Physical and Mental Health 3. Data Sources & Empirical Work 4. Ongoing Research

9 Importance of the Problem Physical health problems during childhood are common. Infections. Chronic illness. Cardio-metabolic risk. Auto-immune. Other complex / chronic illness.

10 Importance of the Problem Cardiometabolic risk in children and young adults: Is becoming the norm rather than the exception. U.S. children: 33% = overweight or obese (NHANES, 2012) Majority of U.S. young adults overweight or obese pre-hypertensive or hypertensive elevated systemic inflammation e.g., Shanahan, Schorpp et al. (in press). Health Psychology.

11 Prevalence Importance of the Problem Age Being affected by mental health problems at some point during the first two decades of life is the norm, not the exception. Copeland, Shanahan et al. (2011). Journal of the American Academy of Child and Adolescent Psychiatry.

12 Importance of the Problem Physical and mental health problems often co-occur.

13 Importance of the Problem 1. Early life course is not too early to study physical and mental health. 2. Physical and mental health are intricately intertwined. 3. These interconnections are currently under-studied during the early life course. Physical Health Mental Health Development

14 Outline 1. Program of Research 2. Importance of Studying the Intersection of Physical and Mental Health 3. Data Sources & Empirical Work 4. Ongoing Research

15 Data Sources in North Carolina

16

17 Great Smoky Mountains Study: Data collection by cohort and year. Cohort Age A N=508 9 A1 10 A2 B N= B1 A3 12 B2 A4 C N= C1 B3 14 C1 B4 A5 15 C3 B5 A6 16 C4 B6 A7 19 C5 B7 A8 21 C6 B8 A9 26 C7 B9 A10 Childhood (9-16) Young Adulthood (19-26)

18 The RIGHT Track Health Study psychological and physiological data at ages 2, 4, 5, 7, 10, 15, 17. cardiovascular health and health behaviors data at ages 15, 16, 17, 18+.

19 NC in Stroke, Diabetes, and Heart Disease Belts

20 Data Sources National Longitudinal Study of Adolescent to Adult Health (Add Health), N = 20,745, Followed from ages 15 to 28 5 waves Freeman*, & Shanahan. (2016). Psychosomatic Medicine Shanahan et al. (2014). Psychoneuroendocrinology. Shanahan et al. (2014). Brain, Behavior, & Immunity.

21 Outline 1. Program of Research 2. Importance of Studying the Intersection of Physical and Mental Health 3. Data Sources & Empirical Work 4. Ongoing Research

22 Empirical Work Physical Health Mental Health Development

23 Somatic Complaints E.g., frequent and recurrent headaches, stomach aches, muscle aches. easily detected potentially less stigma in reporting

24 Why Focus on Somatic Complaints? School nurses, parents, teachers, pediatricians, family doctors: = first responders to children s physical and mental health problems

25 Research Questions 1. Are childhood somatic symptoms a predictor of later mental health problems? 2. Is there specificity in predictions? 3. Who is most at risk?

26 Great Smoky Mountains Study: Data collection by cohort and year. Cohort Age A N=508 9 A1 10 A2 B N= B1 A3 12 B2 A4 C N= C1 B3 14 C1 B4 A5 15 C3 B5 A6 16 C4 B6 A7 19 C5 B7 A8 21 C6 B8 A9 26 C7 B9 A10 Childhood (9-16) Young Adulthood (19-26)

27 Somatic Complaints frequent and recurrent headaches, abdominal pain, or muscular/joint pain. > 1 X/week in past 3 mo. Each ache lasting 1+ hrs. frequent and recurrent somatic complaints Child and Adolescent Psychiatric Assessment (CAPA) Angold et al.

28 Young Adult Disorders Depressive Disorders Anxiety Generalized anxiety disorder (GAD) Panic Disorder Agoraphobia Social Phobia Substance Abuse/Dependence Young Adult Psychiatric Assessment (YAPA) Angold et al.

29 Descriptives: Cumulative Childhood Prevalence of Somatic Complaints Headaches Stomach Aches Muscle Aches Shanahan et al. (2015). Psychological Medicine.

30 Childhood Somatic Symptoms and Young Adult Psychopathology Potential sources of spuriousness: sex, race, childhood psychiatric disorders, childhood psychosocial adversity, childhood health Adult Outcome Odds Ratio Depression 2.69* Any anxiety disorder n.s. Generalized Anxiety Disorder 2.35* Panic Disorder n.s. Agoraphobia n.s. Social Phobia n.s. Substance abuse/dependence n.s. Some specificity in predictions. Shanahan et al. (2015). Psychological Medicine.

31 Who is Most at Risk for Later Distress Disorders? % of Young Adults with Emotional Distress Disorders 0 Never During one developmental period During two developmental periods During three developmental periods Children with persistent somatic complaints.

32 Summary: Childhood Somatic Symptoms and Later Psychopathology Childhood physical health symptoms predict young adult mental health. Physical distress emotional distress. Somatic symptoms = a risk marker that could be detected by children s first responders.

33 Next Steps in Somatic Symptoms Analyses - Understanding processes. - Somatic symptoms as integrative measure of immunity, including elevated inflammation?

34 Inflammation acute inflammation Elevated chronic inflammation McEwen (1998). New England Journal of Medicine.

35 Dried blood spots: GSMS, ADD Health Immune: C-reactive protein (CRP) Epstein Barr virus antibodies

36 Dried blood spots: GSMS, ADD Health Shanahan, Copeland, Worthman, Angold, & Costello. (2013). Psychoneuroendocrinology. Shanahan, Freeman*, & Bauldry*. (2014). Psychoneuroendocrinology.

37 Young Adult CRP Levels by Years of Childhood Somatic Complaints to 2 3 or more Preliminary Findings.

38 Physiological Correlates of Somatic Complaints During Early Life Course Self-rated health: In general, how is your health. 1= poor 2= fair 3= good 4= very good 5= excellent Shanahan, Bauldry*, Freeman*, & Bondy*. (2014). Brain, Behavior, & Immunity.

39 Add Health Mean CRP by Levels of Self-Rated Health Figure. Weighted mean levels of log hs-crp across levels of self-rated health. E = Excellent, VG = Very Good, G = Good, A = Average, P = Poor Shanahan, Bauldry*, Freeman*, & Bondy*. (2014). Brain, Behavior, & Immunity.

40 Outline 1. Program of Research 2. Importance of Studying the Intersection of Physical and Mental Health 3. Data Sources & Empirical Work 4. Ongoing Research

41 Ongoing Research Health Behaviors Exercise Nutrition Sleep Dysregulation Emotional Physiological Behavioral Cognitive Cardiovascular Risk Obesity Pre-/hypertension Inflammation Early & Middle Childhood Late Adolescence

42 Interdisciplinary Team Pediatrics Psychology Exercise Physiology Nutrition

43 Interdisciplinary Technologies Health Behaviors Cardiovascular Risk

44 Ongoing Research Health Behaviors Exercise Nutrition Sleep Dysregulation Physiological Emotional Behavioral Cognitive Cardiovascular Risk Obesity Pre-/hypertension Inflammation Early & Middle Childhood Adolescence

45 Ongoing Research -- Males - Exercise - Negative Emotionality Cardiovascular Risk Childhood (Ages 4-10) Adolescence (Age 16) Preliminary Findings.

46 z scores 0.75 Noncases Subclinical only Cases Health Risky/Illegal Financial Social Copeland, Wolke, Shanahan et al. (2015). JAMA Psychiatry.

47 Summary 1. Early life course is not too early a period to study the intersection and physical and mental health. 2. Physical and mental health are intricately intertwined. 3. Possible role of physical activity, dietary intake, and inflammation in interconnections.

48 Summary Interdisciplinary research as a vehicle for understanding the intersection and physical and mental health..

49 Current Collaborations Exercise Physiology Pediatrics Nutrition Sociology Psychiatry Biostatistics

50 Acknowledgements GSMS work: collaborators: Bill Copeland, Jane Costello, Carol Worthman, Adrian Angold, Nancy Zucker, Select GSMS work funding: R03MH094605, R01DA011301, R01DA016977, R01MH063970, RO1HD29409, R01HD32336, R01DA Add Health work: collaborators: Jason Freeman, Kristen Schorpp, Shawn Bauldry, Vanessa Volpe Select Add Health work funding: R01HD RIGHT TRACK work: collaborators: Laurie Wideman, Susan Calkins, Cheryl Lovelady, Susan Keane, Marion O Brien Select Right Track work funding: R01HD061622, R01MH058144