Mental Health Assessment and Culture Impact

Introduction to Epidemiological Methods in Life Course Research

• This lecture outlines key concepts in life course epidemiology, study designs, analytical strategies, and methods for measuring mental health in large-scale studies.

Lecture Outline

• Key concepts in life course epidemiology: This section covers fundamental ideas related to life-long effects of early exposures on health.
• Study designs: Focuses on the design of longitudinal studies, including birth cohort studies.
• Analytic strategies: Explores analytical techniques relevant to longitudinal investigations, such as random effects models and longitudinal latent class analyses.
• Measuring mental health: Discusses different methods for assessing mental health problems and disorders in large-scale studies.

Life Course Epidemiology

• Barker hypothesis: The initial framework for life course epidemiology, now expanded to mental health. It examines chronic physical health problems and mental health.
• Lifespan exposures: Examines long-term effects of exposures across the entire lifespan (gestation, childhood, adolescence, young adulthood, and further), encompassing generations.
• Systematic patterning: Examines the predictable trends and patterns of mental health onset and trajectory across the life course, influenced by age.
• Importance of transitions: Highlights the roles of biological and social transitions during the life course on risk for mental health disorders.
• Outcomes and impacts: Focuses on the broad effects of these factors on overall health, economics, and social well-being.

Key Concepts: Models for Understanding the Impact of Early Risks

• Critical period (biological programming): Describes how exposures during critical developmental stages can have lasting impacts.
• Sensitive period: Emphasizes that exposures during periods of rapid development have a greater impact but that modification is still possible.
• Accumulation of risk: Explains that adverse experiences accumulate over a person's life course.
• Chains/cascades of risk: Highlights how early risks may increase the likelihood of later events.

Life Course Causal Models of Risk

• Sensitive period model: Focuses on exposures at specific points in development and how these influence the development of chronic conditions.
• Accumulation model: Illustrates the progressive addition of risk factors over time.
• Pathway model: Depicts the interactions and relationships between exposures during different life stages and the development of chronic conditions.
• Diagram and explanation of the models: Displays the sequences of exposure and causal relationships (dotted arrows show weaker causal effects).

Pathways to symptoms of depression and anxiety (1946 British birth cohort)

• Cohort data: Details the 1946 British birth cohort study, which includes data on female participants.
• Pathways from early life to adult symptoms: The diagram shows the influence of factors like parental divorce, separation from mother, childhood deprivation, and weight at birth on the later development of depression and anxiety symptoms.

Study designs for life course epidemiology

• Cohort study: This is a fundamental study design that tracks the individuals over time to evaluate the effect of a factor on the onset of disease. This analysis encompasses an individual's entire development.
• Key design: pregnancy/birth cohort studies: Studies focused on populations born close in time are prospective, which means they follow participants forward in time and may look at a factor from pregnancy to adulthood.
• UK birth cohort studies: Describes a selection of major, long-standing birth cohort studies in Britain. Includes the 1946, 1958, and 1970 cohorts; ALSPAC, and the Millennium Cohort.

Advantages and disadvantages of birth cohort designs

• Advantages: Includes prospective follow-up, narrow age range, comparisons of different cohorts and analysis of age-related changes.
• Disadvantages: Studies can be expensive and require large samples and long follow-up periods, potentially making it difficult to maintain samples and resulting in substantial costs. 

Related alternative designs

• Reviving earlier studies: Discusses methods to re-analyze existing interrupted data of past studies.
• Records-based studies: Highlights studies using records and existing data to reconstruct birth cohorts.
• Accelerated longitudinal designs: Explains the method of recruiting several age groups and following them over time.
• Natural experiments: Examples include studies on children raised in Romanian orphanages.
• Policy-related variations: Discusses studying cohorts impacted by policy changes (e.g., school entry dates).
• Specialized cohorts: Emphasizes cohorts focused on specific mental illnesses.

Analytic Strategies

• Methods for dealing with repeated exposures/outcomes: Include random effects models and longitudinal latent class analyses.
• Models: Discusses different types of models for analysing longitudinal data with repeated measures.

Longitudinal classes of depressive/anxious symptomatology

• Symptom patterns: Illustrates how different types of symptoms have different patterns of development based on longitudinal data analysis.
• Developmental trajectories: Highlights variability in symptom trajectories across the life course.

Analytic Strategies (second iteration)

• Pathway specification:
• Confounding factors:
• Intermediate variables:
• Causal inference: Includes methods for dealing with attrition and missing data such as multiple imputation and inverse probability weighting.

Methods of assessing mental health problems/disorders

• Questionnaires: Describes questionnaires and their strengths and weaknesses in assessing mental health problems.
• Interviews: Describes interviews and their strengths and weaknesses in assessing mental health problems.
• Direct observations: Describes observation methodologies and their strengths and weaknesses in assessing mental health problems.
• Health records/Administrative data: Highlights the use of existing clinical records and administrative data.
• Wearables: Describes the advantages and disadvantages of using wearable technology to collect mental health-related data.
• Apps: Describes the use of apps in collecting data related to mental health problems.

Questionnaires (second iteration)

• Format: Typically use 3 or 5-point Likert scales to measure behaviours and symptoms.
• Strengths: Flexible for large samples, used for parents, teachers, and children and can assess very specific symptoms/traits.
• Limitations: Can be informant-specific, not detailed enough for a full assessment, reliance on informant agreement.
• Main uses: Describes the various uses (screening, diagnosis, identifying change, and for prevalence studies), including use in service planning and evaluations of interventions.

Characteristics of Questionnaire Rating Scales

• Format: Explains the common format of question scales in questionnaires.
• Reflection of Judgement:
• Shared Understanding:
• Potential biases: Describes the possible rater effects and biases to consider.

Major Questionnaires used to study Child Mental Health

• Child Behaviour Checklist (CBCL): Describes this and other major questionnaires useful in studying children and adolescents.
• Conners' Rating Scales:
• Strengths and Difficulties Questionnaire (SDQ):
• Rutter Scales:

Syndromes/Subscales

• Explains different groupings/categorization/subscales for various assessment tools (e.g., CBCL and SDQ).
• Internalizing: Describes symptoms and behaviours reflecting internal experiences of distress.
• Externalizing: Describes symptoms and behaviours reflecting outward-directed behaviours.

Interviews (second iteration)

• Strengths: Diagnostic assessment, detailed probing, and specific categories.
• Limitations: Relatively expensive, time-consuming; variability in reliability and agreement levels.

Two Broad Types of Diagnostic Interviews

• Structured Interviews: Describes the characteristics of these interviews.
• Semi-structured Interviews: Explains the characteristics of these interviews.

Some Major Diagnostic Interviews for Assessing Children and Adolescents

• DISC, CAPA/PAPA, DAWBA, and Dominic
• Table detailing specific aspects (interview style, time frame, training required, self-completion/computerized versions) for the different diagnostic interviews.

CAPA (Semi-structured Interview): Specific example

• Coding rules: Explains the coding or rating for irritability (examples). 
• Defining terms/dimensions: Definitions of important constructs, like irritability.

Comparing Interviews

• Discusses comparing interviews from different approaches (e.g., DISC, CAPA, and DAWBA).
• Angold et al 2012: Discusses an important comparison study from this publication.
• Time to administer: Compared the time taken by each interview.
• Prevalence rates: Compared rates for different diagnoses to highlight differences.

Cross-Cultural Issues

• Cultural significance and experiences: Recognizes that culture shapes experiences of mental health.
• Exposure to risk factors: Understanding how factors may differ across cultures.
• Impact on assessments: Describes how cultural biases may affect interpretations of behaviours or symptoms.
• Cross-cultural variations/biases in reports of psychopathology: Highlight that differences may exist in how mental health is expressed and recognized.
• Data Collection Issues: Highlights possible biases and limitations to avoid cross-cultural misunderstandings.

Mean CBCL Total Problems Scores (42 Societies)

• Diagram displaying scores across multiple societies.

International Comparisons

• Comparison of disorder prevalence rates across various countries/cultures, illustrating that rates can differ.
• Tables and graphs: Use of data visualisation to support the discussion of rates across different countries.

Implications

• Cross-Cultural Comparisons: Summarizes the implications of cross-cultural comparisons for understanding mental health prevalence across different regions. 
• Population-Specific Norms: Highlights potential implications. Discusses the need for population-specific norms for certain questionnaires/assessments.
• Questionnaire Measures: Highlights limitations to a valid comparison using questionnaires to assess different cultures (using questionnaire measures only may mask important cultural differences in mental health).

Direct Observation (second iteration)

• Naturalistic observation: Describes naturalistic observation and its use.
• Structured observation: Describes structured observation.
• Experimental procedures: Describes experimental procedures and their importance.

Ainsworth's Strange Situation Study (second iteration)

• Attachment related behaviors: Briefly describes the method for assessing attachment-related behaviors in infants (9-18 months) using a method of observation over a 21-minute period.
• Study on the behaviors of infants in reaction both to strangers and to caregivers (e.g., exploratory play, stranger reaction, reaction to caregiver).
• Procedure: Describes the different stages of observation and how infant interactions were assessed to evaluate attachment types.
• Coding: Describes how observed behaviours are coded for analysis.

Observational Assessment of Pre-school Disruptive Behaviour (DB-DOS Paradigm)

• Explains the methods and procedure for observations.
• Key Informants: Explains the considerations of using various informants to gather data (e.g., teachers, parents, and/or children themselves).
• Compliance: A key aspect of this method that evaluates behaviors.
• Interactive contexts: Emphasizes the interactive context.

Berkeley Puppet Interview

• Self-perception and self-report: Describes the method for assessing self-perception and self-reporting, which is relevant to both the interviewer and the participants.

Autism Diagnostic Observation Schedule (ADOS)

• Diagnosis of autistic behaviors: This is a semi-structured interview measuring behaviors and reactions to various circumstances relevant to autistic diagnoses in children.

Apps and Wearables

• Ecological momentary assessment (EMA): This method is used for collecting information on behaviors, feelings, and other experiences in the individual's natural environment.
• Passive data collection: Includes examples such as measuring heart rate using wearables.
• Data Collection Methods: Describes how data from these sources is collected.

Catalogue of Mental Health Measures

• Online catalogue: Describes an online resource listing mental health measures for longitudinal studies in the UK.
• Accessibility and utility: Explains its importance for researchers.