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: dmhdru@otago.ac.nz

http://www.otago.ac.nz/dunedin study