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Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife.

Authors
  • Brennan, Grace M1, 2
  • Moffitt, Terrie E1, 2, 3, 4, 5, 6, 7
  • Ambler, Antony5
  • Harrington, HonaLee2
  • Hogan, Sean8
  • Houts, Renate M2
  • Mani, Ramakrishnan9
  • Poulton, Richie8
  • Ramrakha, Sandhya8
  • Caspi, Avshalom1, 2, 3, 4, 5, 6, 7
  • 1 Duke Aging Center, Duke University School of Medicine, Durham, NC, USA.
  • 2 Department of Psychology & Neuroscience, Duke University, Durham, NC, USA.
  • 3 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
  • 4 Center for the Study of Population Health and Aging, Duke University Population Research Institute, Durham, NC, USA.
  • 5 Institute of Psychiatry, King's College London, London, UK.
  • 6 Center for Genomic and Computational Biology, Duke University, Durham, NC, USA.
  • 7 Promenta, University of Oslo, Oslo, Norway. , (Norway)
  • 8 Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand. , (New Zealand)
  • 9 School of Physiotherapy, University of Otago, Dunedin, New Zealand. , (New Zealand)
Type
Published Article
Journal
Psychological Medicine
Publisher
Cambridge University Press
Publication Date
Dec 01, 2023
Volume
53
Issue
16
Pages
7569–7580
Identifiers
DOI: 10.1017/S0033291723001320
PMID: 37161676
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains - suicidality, substance misuse, sleep problems, and pain - were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [β = 0.23, 95% CI (0.16-0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [β = 0.26, 95% CI (0.19-0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.

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