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Dooley N, Kennelly B, Arseneault L, et al. Functional Outcomes Among Young People With Trajectories of Persistent Childhood Psychopathology. JAMA Netw Open. 2023;6(9):e2336520. doi:10.1001/jamanetworkopen.2023.36520

Functional outcomes among young people with trajectories of persistent childhood psychopathology

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Author: Dooley, Niamh1,2; Kennelly, Brendan3; Arseneault, Louise2;
Organizations: 1Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
2Social, Genetic and Developmental Psychology, King’s College London, London, United Kingdom
3School of Business and Economics, University of Galway, Galway, Ireland
4Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
5Population Health Sciences, University of Bristol, Bristol, United Kingdom
6Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
7School of Psychology, Trinity College Dublin, Dublin, Ireland
8Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
9School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
10Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
11Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
12NHS Lothian Child and Adolescent Mental Health Service, Edinburgh, United Kingdom
13School of Medicine, University College Dublin, Dublin, Ireland
14University of Oulu, Faculty of Medicine, Oulu, Finland
15Centre for Youth Mental Health, Orygen, Melbourne, Australia
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
Persistent link:
Language: English
Published: American Medical Association, 2023
Publish Date: 2023-10-13


Importance: Understanding which children in the general population are at greatest risk of poor functional outcomes could improve early screening and intervention strategies.

Objective: To investigate the odds of poor outcomes in emerging adulthood (ages 17 to 20 years) for children with different mental health trajectories at ages 9 to 13 years.

Design, Setting, and Participants: Growing Up in Ireland is a longitudinal, nationally representative population-based cohort study. Data collection began in August 2007 and was repeated most recently in September 2018. All results were weighted to account for sampling bias and attrition and were adjusted for socioeconomic factors. Data analysis took place from October 2022 to April 2023.

Exposure: Four latent classes captured variation in mental health in children aged 9 and 13 years, based on the parent-completed Strengths and Difficulties Questionnaire. Classes included no psychopathology, internalizing, externalizing, and high (comorbid) psychopathology. Those who remained in the same class from ages 9 to 13 years were included.

Main Outcomes and Measures: Poor functional outcomes in emerging adulthood were measured at approximate ages 17 years (range, 16 to 18 years) and 20 years (range, 19 to 21 years). Outcomes included poor mental health, poor physical health, social isolation, heavy substance use, frequent health service use, poor subjective well-being, and adverse educational/economic outcomes.

Results: Of 5141 included participants, 2618 (50.9%) were male. A total of 3726 (72.5%) were classed as having no childhood psychopathology, 1025 (19.9%) as having persistent externalizing psychopathology, 243 (4.7%) as having persistent internalizing psychopathology, and 147 (2.9%) as having persistent high psychopathology. Having any childhood psychopathology was associated with poorer functional outcomes in emerging adulthood. The internalizing group had elevated odds of most outcomes except for heavy substance use (range of odds ratios [ORs]: 1.38 [95% CI, 1.05-1.81] for frequent health service use to 3.08 [95% CI, 2.33-4.08] for poor mental health). The externalizing group had significantly elevated odds of all outcomes, albeit with relatively small effect sizes (range of ORs: 1.38 [95% CI, 1.19-1.60] for frequent health service use to 1.98 [95% CI, 1.67-2.35] for adverse educational/economic outcomes). The high psychopathology group had elevated odds of all outcomes (nonsignificantly for frequent health service use), though with wide confidence intervals (range of ORs: 1.53 [95% CI, 1.06-2.21] for poor physical health to 2.91 [95% CI, 2.05-4.12] for poor mental health). Female participants with any psychopathology had significantly higher odds of poor physical health and frequent health service use compared with male participants with any psychopathology.

Conclusions and Relevance: In this longitudinal cohort study, childhood psychopathology was associated with a widespread pattern of functional impairment in emerging adulthood. Findings point to the need for a wider range of preventive interventions in child and adolescent mental health services.

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Series: JAMA network open
ISSN: 2574-3805
ISSN-E: 2574-3805
ISSN-L: 2574-3805
Volume: 6
Issue: 9
Article number: e2336520
DOI: 10.1001/jamanetworkopen.2023.36520
Type of Publication: A1 Journal article – refereed
Field of Science: 515 Psychology
3124 Neurology and psychiatry
Funding: This research was funded by the Health Research Board of Ireland. Drs Dooley and Healy were funded by the Health Research Board in Ireland (grant ILP-PHR-2019-009). Dr Healy was also funded by the Wellcome Trust Innovations Award (grant 220438Z/20/Z). Dr Cannon was funded by the European Research Council Consolidator Award (grant 724809 iHEAR). Dr Clarke was in receipt of a Health Research Award from the Health Research Board of Ireland (grant HRA-PHR-2015–1130) and an Irish Research Council award (grant COALESCE/2019/61). Dr D. R. Cotter was funded by a Wellcome Trust Innovations Award (grant 220438Z/20/Z), a Science Foundation Ireland (grant 16/RC/3948 415), and the Health Research Board (grant CDA 2021-005). Dr Zammit was funded by a National Institute for Health and Care Research Bristol Biomedical Research Centre (grant NIHR203315). Mss Mosley and D. Cotter were funded by the Royal College of Surgeons in Ireland Research Summer School studentship. Growing Up in Ireland was funded by the Government of Ireland.
Copyright information: © 2023 Dooley N et al. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.