Persistent Childhood and Adolescent Anxiety and Risk for Psychosis: A Longitudinal Birth Cohort Study

Morales‐Muñoz, Isabel; Marwaha, Steven; Palmer, Edward; Mallikarjun, Pavan; Upthegrove, Rachel

doi:10.1016/j.biopsych.2021.12.003

Cited by 14 publications

(7 citation statements)

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“…First, other potential contributing factors, such as depression, cognition, obstetric complications, viral infections, smoking or body mass index, which could have some effect on the results were left unexplored. For this study, we decided to control only for socio‐demographic factors and early life family adversities and not to over‐control for variables, consistent with our previous research using this cohort (Morales‐Muñoz et al., 2020 ; Morales‐Muñoz, Palmer, Marwaha, Mallikarjun, & Upthegrove, 2022 ); however, further relevant confounders should be also explored in future studies. Second, probable ADHD at 10 years was coded by collecting information from parents, and thus parental perceptions and/or assumptions could bias this assessment.…”

Section: Discussionmentioning

confidence: 99%

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study

Morales‐Muñoz

Upthegrove

Lawrence

et al. 2023

Child Psychology Psychiatry

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Background: Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations. Methods: Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. Results: Less regular sleep routines (OR = 0.51, 95% CI = 0.28-0.93, p = .029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56-0.89, p = .004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06-1.52, p = .009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, À0.002; p = .005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p = .003). Conclusions: Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.

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Section: Discussionmentioning

confidence: 99%

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study

Morales‐Muñoz

Upthegrove

Lawrence

et al. 2023

Child Psychology Psychiatry

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“…This difference might suggest that only clinically relevant anxiety symptoms might be associated with the occurrence of PLEs. Of note, causality cannot be established in our study; however, a longitudinal study of children and adolescents demonstrated that persistent high levels of anxiety predict the development of PLEs and psychotic disorders at the age of 24 years [44]. Similarly, cross-sectional studies, based on clinical samples, revealed the association between anxiety disorders and PLEs [45, 46].…”

Section: Discussionmentioning

confidence: 66%

Dimensions of psychopathology associated with psychotic-like experiences: Findings from the network analysis in a nonclinical sample

Rejek,

Misiak

2023

Eur. Psychiatr.

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Background Psychotic-like experiences (PLEs) are associated with a variety of psychopathological symptoms. However, it remains unknown which dimensions of psychopathology are most closely related to the occurrence of PLEs. In this study, we aimed to analyze the association of PLEs with various domains of psychopathology. Methods A total of 1100 nonclinical adults (aged 18–35 years, 51.4% females) with a negative history of psychiatric treatment were surveyed. Assessment of psychopathology was performed using self-reports. Symptoms associated with PLEs were explored as continuous variables and based on clinically relevant thresholds using two separate network analyses. Results In both network analyses, PLEs were directly connected to obsessive-compulsive disorder (OCD) symptoms, manic symptoms, depressive symptoms, and attention-deficit/hyperactivity disorder (ADHD) symptoms. Anxiety symptoms were associated with PLEs only in the network based on threshold scores. Importantly, edge weight for the connection of PLEs and OCD symptoms was significantly higher compared to edge weights of all other direct connections of PLEs with psychopathology in both networks. Edge weight for the connection between PLEs and manic symptoms was significantly higher compared to edge weights for direct connections of PLEs with depressive and ADHD symptoms in the network based on continuous scores of psychopathological symptoms. Edge weights of direct connections of PLEs with depressive, anxiety, and ADHD symptoms did not differ significantly in both networks. Conclusions Our findings indicate that PLEs are associated with multiple domains of psychopathology. However, these phenomena are most strongly associated with OCD symptoms regardless of their severity threshold.

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“…The findings of our current study are congruent with a recent study of ours using ALSPAC data where we found that IL-6 level, but not CRP level (both at 9 years), partially mediated the associations between sleep problems in childhood and ADHD diagnosis at 10 years. Another recent study from our group also using ALSPAC data found that CRP level at 9 and 15 years, but not IL-6 level at 9 years, partially mediated the associations between persistent anxiety across childhood and psychosis at 24 years. Based on this limited evidence, we could hypothesize that different physiological actions associate with each of these inflammatory markers ; thus, IL-6 level may be more sensitive to sleep problems, although anxiety may have a greater association with CRP levels, in the pathway to psychosis.…”

Section: Discussionmentioning

confidence: 99%

Role of Inflammation in Short Sleep Duration Across Childhood and Psychosis in Young Adulthood

Morales-Muñoz,

Marwaha,

Upthegrove

et al. 2024

JAMA Psychiatry

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ImportanceShort sleep duration over a prolonged period in childhood could have a detrimental impact on long-term mental health, including the development of psychosis. Further, potential underlying mechanisms of these associations remain unknown.ObjectiveTo examine the association between persistent shorter nighttime sleep duration throughout childhood with psychotic experiences (PEs) and/or psychotic disorder (PD) at age 24 years and whether inflammatory markers (C-reactive protein [CRP] and interleukin 6 [IL-6]) potentially mediate any association.Design, Setting, and ParticipantsThis cohort study used data from the Avon Longitudinal Study of Parents and Children. Data analysis was conducted from January 30 to August 1, 2023.ExposuresNighttime sleep duration was collected at 6, 18, and 30 months and at 3.5, 4 to 5, 5 to 6, and 6 to 7 years.Main Outcomes and MeasuresPEs and PD were assessed at age 24 years from the Psychosislike Symptoms Interview. CRP level at ages 9 and 15 years and IL-6 level at 9 years were used as mediators. Latent class growth analyses (LCGAs) were applied to detect trajectories of nighttime sleep duration, and logistic regressions were applied for the longitudinal associations between trajectories of nighttime sleep duration and psychotic outcomes at 24 years. Path analyses were applied to test CRP and IL-6 as potential mediators.ResultsData were available on 12 394 children (6254 female [50.5%]) for the LCGA and on 3962 young adults (2429 female [61.3%]) for the logistic regression and path analyses. The LCGA identified a group of individuals with persistent shorter nighttime sleep duration across childhood. These individuals were more likely to develop PD (odds ratio [OR], 2.50; 95% CI, 1.51-4.15; P &lt; .001) and PEs (OR, 3.64; 95% CI, 2.23-5.95; P &lt; .001) at age 24 years. Increased levels of IL-6 at 9 years, but not CRP at 9 or 15 years, partially mediated the associations between persistent shorter sleep duration and PD (bias-corrected estimate = 0.003; 95% CI, 0.002-0.005; P = .007) and PEs (bias-corrected estimate = 0.002; 95% CI, 0-0.003; P = .03) in young adulthood.Conclusions and RelevanceFindings of this cohort study highlight the necessity of addressing short sleep duration in children, as persistence of this sleep problem was associated with subsequent psychosis. This study also provides preliminary evidence for future targeted interventions in children addressing both sleep and inflammatory responses.

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Persistent Childhood and Adolescent Anxiety and Risk for Psychosis: A Longitudinal Birth Cohort Study

Cited by 14 publications

References 58 publications

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: findings from a UK birth cohort study

Dimensions of psychopathology associated with psychotic-like experiences: Findings from the network analysis in a nonclinical sample

Role of Inflammation in Short Sleep Duration Across Childhood and Psychosis in Young Adulthood

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