Kids With Mental Health Problems Become Less Healthy Adults

Summary: Middle-aged people who experienced mental health problems during youth aged at a faster pace, showed greater declines in sensory, motor, and cognitive functions, and were rated as looking older than their peers.

Source: Duke University

A new pair of studies from a Duke research team’s long-term work in New Zealand make the case that mental health struggles in early life can lead to poorer physical health and advanced aging in adulthood.

But because mental health problems peak early in life and can be identified, the researchers say that more investment in prompt mental health care could be used to prevent later diseases and lower societal healthcare costs.

“The same people who experience psychiatric conditions when they are young go on to experience excess age-related physical diseases and neurodegenerative diseases when they are older adults,” explained Terrie Moffitt, the Nannerl O. Keohane professor of psychology and neuroscience at Duke, who is the senior author on both studies.

The findings in a paper appearing Feb. 17 in JAMA Psychiatry come from the long-term Dunedin Study, which has tested and monitored the health and wellbeing of a thousand New Zealanders born in 1972 and ’73 from their birth to past age 45.

In middle age, the study participants who had a history of youthful psychopathology were aging at a faster pace, had declines in sensory, motor and cognitive functions, and were rated as looking older than their peers. This pattern held even after the data were controlled for health factors such as overweight, smoking, medications and prior physical disease. Their young mental health issues included mainly anxiety, depression, and substance abuse, but also schizophrenia.

“You can identify the people at risk for physical illnesses much earlier in life,” said Jasmin Wertz, a postdoctoral researcher at Duke who led the study. “If you can improve their mental health in childhood and adolescence, it’s possible that you might intervene to improve their later physical health and aging.”

A related study by the same team that appeared in JAMA Network Open in January used a different approach and looked at 30 years of hospital records for 2.3 million New Zealanders aged 10 to 60 from 1988 to 2018. It also found a strong connection between early-life mental health diagnoses and later-life medical and neurological illnesses.

This shows a man standing alone in a busy street while people rush around him
In middle age, the study participants who had a history of youthful psychopathology were aging at a faster pace, had declines in sensory, motor and cognitive functions, and were rated as looking older than their peers. Image is in the public domain

That analysis, led by former Duke postdoctoral researcher Leah Richmond-Rakerd, showed that young individuals with mental disorders were more likely to develop subsequent physical diseases and to die earlier than people without mental disorders. People with mental illnesses experienced more hospitalizations for physical conditions, spent more time in hospitals and accumulated more healthcare costs over the subsequent 30 years.

“Our healthcare system often divides treatment between the brain and the body, but integrating the two could benefit population health,” said Richmond-Rakerd, who is now an assistant professor of psychology at the University of Michigan.

“Investing more resources in treating young people’s mental-health problems is a window of opportunity to prevent future physical diseases in older adults,” Moffitt said. “Young people with mental health problems go on to become very costly medical patients in later life.”

In a 2019 commentary for JAMA Psychiatry, Moffitt and her research partner Avshalom Caspi, the Edward M. Arnett professor of psychology and neuroscience at Duke, made the argument that mental health providers have an opportunity to forestall later health problems and other social costs by intervening in the lives of younger people. Their body of work is showing that mental disorders can be reliably predicted from childhood risk factors such as poverty, maltreatment, low IQ, poor self-control and family mental health issues. And because populations in the developed world are becoming more dominated by older people, the time to make those investments in prevention is now, they said.

Funding: These studies were supported by the U.S. National Institute on Aging, the U.S. National Institute of Child Health and Development, and the UK Medical Research Council. Additional support came from the Jacobs Foundation, the Lundbeck Foundation and the New Zealand Health Research Council (R01-AG032282, R01-AG049789, MR/P005918, P30 AG028716, P30 AG034424, 15-265, R288-2018-380, P2C HD065563). The Dunedin Multidisciplinary Health and Development Study is supported by the New Zealand Health Research Council and New Zealand Ministry of Business, Innovation, and Employment.

About this mental health and aging research news

Source: Duke University
Contact: Karl Leif Bates – Duke University
Image: The image is in the public domain

Original Research: Open access.
Association of History of Psychopathology With Accelerated Aging at Midlife” by Jasmin Wertz, Avshalom Caspi, Antony Ambler, Jonathan Broadbent, Robert J. Hancox, HonaLee Harrington, Renate M. Houts, Joan H. Leung, Richie Poulton, Suzanne C. Purdy, Sandhya Ramrakha, Line Jee Hartmann Rasmussen, Leah S. Richmond-Rakerd, Peter R. Thorne, Graham A. Wilson, Terrie E. Moffitt. JAMA Psychiatry

Open access.
Longitudinal Associations of Mental Disorders With Physical Diseases and Mortality Among 2.3 Million New Zealand Citizens” by Leah S. Richmond-Rakerd, Stephanie D’Souza, Barry J. Milne, Avshalom Caspi, Terrie E. Moffitt. JAMA Open Network


Abstract

Association of History of Psychopathology With Accelerated Aging at Midlife

Importance  

Individuals with mental disorders are at an elevated risk of developing chronic age-related physical diseases. However, it is not clear whether psychopathology is also associated with processes of accelerated aging that precede the onset of age-related disease.

Objective  To test the hypothesis that a history of psychopathology is associated with indicators of accelerated aging at midlife.

Design, Setting, and Participants  

This prospective cohort study was based on the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort of 1037 individuals born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand. Members were followed up to age 45 years (until April 2019). Data were analyzed from January 6 to December 7, 2020.

Exposures  

Mental disorders were assessed in 6 diagnostic assessments from ages 18 to 45 years and transformed through confirmatory factor analysis into continuous measures of general psychopathology (p-factor) and dimensions of internalizing, externalizing, and thought disorders (all standardized to a mean [SD] of 100 [15]).

Main Outcomes and Measures  

Signs of aging (biological pace of aging; declines in sensory, motor, and cognitive functioning; and facial age) were assessed up to age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports.

Results  

Of the original 1037 cohort participants, 997 were still alive at age 45 years, of whom 938 (94%) were assessed (474 men [50.5%]). Participants who had experienced more psychopathology exhibited a faster pace of biological aging (β, 0.27; 95% CI, 0.21-0.33; P < .01); experienced more difficulties with hearing (β, 0.18; 95% CI, 0.12-0.24; P < .01), vision (β, 0.08; 95% CI, 0.01-0.14; P < .05), balance (β, 0.20; 95% CI, 0.14-0.26; P < .01), and motor functioning (β, 0.19; 95% CI, 0.12-0.25; P < .01); experienced more cognitive difficulties (β, 0.24; 95% CI, 0.18-0.31; P < .01); and were rated as looking older (β, 0.20; 95% CI, 0.14-0.26; P < .01). Associations persisted after controlling for sex, childhood health indicators, maltreatment, and socioeconomic status and after taking into account being overweight, smoking, use of antipsychotic medication, and the presence of physical disease. Tests of diagnostic specificity revealed that associations were generalizable across externalizing, internalizing, and thought disorders.

Conclusions and Relevance  

In this cohort study, a history of psychopathology was associated with accelerated aging at midlife, years before the typical onset of age-related diseases. This link is not specific to any particular disorder family but generalizes across disorders. Prevention of psychopathology and monitoring of individuals with mental disorders for signs of accelerated aging may have the potential to reduce health inequalities and extend healthy lives.


Abstract

Longitudinal Associations of Mental Disorders With Physical Diseases and Mortality Among 2.3 Million New Zealand Citizens

Importance  

Excess risk of physical disease and mortality has been observed among individuals with psychiatric conditions, suggesting that ameliorating mental disorders might also be associated with ameliorating the later onset of physical disability and early mortality. However, the temporal association between mental disorders and physical diseases remains unclear, as many studies have relied on retrospective recall, used cross-sectional designs or prospective designs with limited follow-up periods, or given inadequate consideration to preexisting physical illnesses.

Objective  

To examine whether mental disorders are associated with subsequent physical diseases and mortality across 3 decades of observation.

Design, Setting, and Participants  

This population-based cohort study used data from the New Zealand Integrated Data Infrastructure, a collection of nationwide administrative data sources linked at the individual level, to identify mental disorders, physical diseases, and deaths recorded between July 1, 1988, and June 30, 2018, in the population of New Zealand. All individuals born in New Zealand between January 1, 1928, and December 31, 1978, who resided in the country at any time during the 30-year observation period were included in the analysis. Data were analyzed from July 2019 to November 2020.

Exposures  

Nationwide administrative records of mental disorder diagnoses made in public hospitals.

Main Outcomes and Measures  

Chronic physical disease diagnoses made in public hospitals, deaths, and health care use.

Results  

The study population comprised 2 349 897 individuals (1 191 981 men [50.7%]; age range at baseline, 10-60 years). Individuals with a mental disorder developed subsequent physical diseases at younger ages (hazard ratio [HR], 2.33; 95% CI, 2.30-2.36) and died at younger ages (HR, 3.80; 95% CI, 3.72-3.89) than those without a mental disorder. These associations remained across sex and age and after accounting for preexisting physical diseases. Associations were observed across different types of mental disorders and self-harm behavior (relative risks, 1.78-2.43; P < .001 for all comparisons). Mental disorders were associated with the onset of physical diseases and the accumulation of physical disease diagnoses (incidence rate ratio [IRR], 2.00; 95% CI, 1.98-2.03), a higher number of hospitalizations (IRR, 2.43; 95% CI, 2.39-2.48), longer hospital stays for treatment (IRR, 2.70; 95% CI, 2.62-2.79), and higher associated health care costs (b = 0.115; 95% CI, 0.112-0.118).

Conclusions and Relevance  

In this study, mental disorders were likely to begin and peak in young adulthood, and they antedated physical diseases and early mortality in the population. These findings suggest that ameliorating mental disorders may have implications for improving the length and quality of life and for reducing the health care costs associated with physical diseases.

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