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1.  Reaction time and onset of psychological distress: the UK Health and Lifestyle Survey 
Background
Cross-sectional studies have shown that depression is often accompanied by less efficient cognitive function, as indicated by slower speed of information processing. The direction of effect is unclear. We investigated prospectively whether slower processing speed, as indexed by longer simple or choice reaction time, is associated with an increased risk of psychological distress.
Methods
Participants were 3088 men and women aged 18 and over who had taken part in the UK Health and Lifestyle Survey. Simple and choice reaction time was measured in the baseline survey. Symptoms of psychological distress were assessed at baseline and at the 7-year follow-up survey with the 30-item General Health Questionnaire (GHQ).
Results
In unadjusted models, a SD slower simple or choice reaction time at baseline was associated with ORs for psychological distress (≥5 on GHQ) at follow-up of 1.14 (1.06 to 1.23; p<0.001) or 1.13 (1.04 to 1.22; p=0.002), respectively. Further adjustment for age, sex, social class, educational attainment, health behaviours, number of chronic physical illnesses present, neuroticism and GHQ score at baseline had only slight attenuating effects on these associations. In fully adjusted models, a SD slower simple or choice reaction time at baseline was associated with ORs for psychological distress of 1.11 (1.02 to 1.21; p=0.017) or 1.11 (1.00 to 1.24; p=0.048), respectively.
Conclusions
Slower processing speed may be a risk factor for the development of psychological distress. Future studies should explore the extent to which slower processing speed explains previously demonstrated associations between lower intelligence and poorer mental health.
doi:10.1136/jech-2015-206479
PMCID: PMC4975803  PMID: 26847135
COGNITION; Cohort studies; DEPRESSION; MENTAL HEALTH
2.  Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936 
Background
Information on childhood determinants of frailty or allostatic load in later life is sparse. We investigated whether lower intelligence and greater socioeconomic disadvantage in childhood increased the risk of frailty and higher allostatic load, and explored the mediating roles of adult socioeconomic position, educational attainment and health behaviours.
Methods
Participants were 876 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11. At age 70, frailty was assessed using the Fried criteria. Measurements were made of fibrinogen, triglyceride, total and high-density lipoprotein cholesterol, albumin, glycated haemoglobin, C reactive protein, body mass index and blood pressure, from which an allostatic load score was calculated.
Results
In sex-adjusted analyses, lower intelligence and lower social class in childhood were associated with an increased risk of frailty: relative risks (95% CIs) were 1.57 (1.21 to 2.03) for a SD decrease in intelligence and 1.48 (1.12 to 1.96) for a category decrease in social class. In the fully adjusted model, both associations ceased to be significant: relative risks were 1.13 (0.83 to 1.54) and 1.19 (0.86 to 1.61), respectively. Educational attainment had a significant mediating effect. Lower childhood intelligence in childhood, but not social class, was associated with higher allostatic load. The sex-adjusted coefficient for allostatic load for a SD decrease in intelligence was 0.10 (0.07 to 0.14). In the fully adjusted model, this association was attenuated but remained significant (0.05 (0.01 to 0.09)).
Conclusions
Further research will need to investigate the mechanisms whereby lower childhood intelligence is linked to higher allostatic load in later life.
doi:10.1136/jech-2015-205789
PMCID: PMC4820036  PMID: 26700299
COGNITION; ELDERLY; SOCIAL CLASS; Cohort studies
3.  Well-Being and Chronic Disease Incidence: The English Longitudinal Study of Ageing 
Psychosomatic Medicine  2016;78(3):335-344.
Supplemental digital content is available in the text.
ABSTRACT
Background
Previous research suggests that greater well-being may protect against onset of chronic disease. However, it is unclear whether this association is similar across different types of disease.
Method
We used Cox proportional hazards regression to examine the prospective relationship between well-being (measured using the CASP-19 quality of life questionnaire) and incidence of arthritis, cancer, stroke, diabetes, myocardial infarction, and chronic lung disease over 8 years. The sample consisted of 8182 participants 50 years or older from the English Longitudinal Study of Ageing.
Results
After adjustments for established risk factors, a standard deviation increase in CASP-19 score was associated with a decrease in arthritis risk (hazard ratio [HR] = 0.89, 95% confidence interval [CI] = 0.83–0.96) and, in those younger than 65 years, a decrease in diabetes risk (HR = 0.82, 95% CI = 0.70–0.95) and chronic lung disease risk (HR = 0.80, 95% CI = 0.66–0.97). Higher CASP-19 scores were associated with reduced risk for stroke and myocardial infarction; however, these associations were no longer significant after adjustments for established risk factors. No association was observed for cancer incidence. An age interaction was observed for diabetes, myocardial infarction, and chronic lung disease, with a stronger association between CASP-19 score and disease incidence at younger ages.
Conclusions
The extent of association between well-being and incident disease risk is not consistent across different chronic diseases. Future studies should examine the cause of this variation.
doi:10.1097/PSY.0000000000000279
PMCID: PMC4819773  PMID: 26569542
CASP-19; chronic disease; well-being; aging; BMI = body mass index; CVD = cardiovascular disease; ELSA = English Longitudinal Study of Ageing; SD = standard deviation
4.  Ageing and brain white matter structure in 3,513 UK Biobank participants 
Nature Communications  2016;7:13629.
Quantifying the microstructural properties of the human brain's connections is necessary for understanding normal ageing and disease. Here we examine brain white matter magnetic resonance imaging (MRI) data in 3,513 generally healthy people aged 44.64–77.12 years from the UK Biobank. Using conventional water diffusion measures and newer, rarely studied indices from neurite orientation dispersion and density imaging, we document large age associations with white matter microstructure. Mean diffusivity is the most age-sensitive measure, with negative age associations strongest in the thalamic radiation and association fibres. White matter microstructure across brain tracts becomes increasingly correlated in older age. This may reflect an age-related aggregation of systemic detrimental effects. We report several other novel results, including age associations with hemisphere and sex, and comparative volumetric MRI analyses. Results from this unusually large, single-scanner sample provide one of the most extensive characterizations of age associations with major white matter tracts in the human brain.
Part of understanding ageing involves knowing how the brain's connecting pathways change in healthy aging. Here, authors provide a detailed characterisation of data from 3513 UK Biobank participants, and show that the microstructure of these pathways becomes more similar with age.
doi:10.1038/ncomms13629
PMCID: PMC5172385  PMID: 27976682
5.  Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936 
Background
Information on childhood determinants of frailty or allostatic load in later life is sparse. We investigated whether lower intelligence and greater socioeconomic disadvantage in childhood increased the risk of frailty and higher allostatic load and explored the mediating roles of adult socioeconomic position, educational attainment and health behaviours.
Methods
Participants were 876 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11. At age 70, frailty was assessed using the Fried criteria. Measurements were made of fibrinogen, triglyceride, total and high-density lipoprotein cholesterol, albumin, glycated haemoglobin, C-reactive protein, BMI, and blood pressure from which an allostatic load score was calculated.
Results
In sex-adjusted analyses, lower intelligence and lower social class in childhood were associated with an increased risk of frailty: relative risks (95% confidence intervals) were 1.57 (1.21, 2.03) for a standard deviation decrease in intelligence and 1.48 (1.12, 1.96) for a category decrease in social class. In the fully-adjusted model, both associations ceased to be significant: relative risks were 1.13 (0.83, 1.54) and 1.19 (0.86, 1.61) respectively. Educational attainment had a significant mediating effect. Lower childhood intelligence in childhood, but not social class, was associated with higher allostatic load. The sex-adjusted coefficient for allostatic load for a standard deviation decrease in intelligence was 0.10 (0.07, 0.14). In the fully-adjusted model, this association was attenuated but remained significant (0.05 (0.01, 0.09)).
Conclusion
Further research will need to investigate the mechanisms whereby lower childhood intelligence is linked to higher allostatic load in later life.
doi:10.1136/jech-2015-205789
PMCID: PMC4820036  PMID: 26700299
frailty; intelligence; socioeconomic position; childhood; allostatic load
6.  Wellbeing and Arthritis Incidence: the Survey of Health, Ageing and Retirement in Europe 
Annals of Behavioral Medicine  2016;50:419-426.
Background
A number of studies provide evidence for an association between psychosocial factors and risk of incident arthritis. Current evidence is largely limited to the examination of negative factors such as perceived stress, but positive factors such as subjective wellbeing may also play a role.
Purpose
The purpose of the current study was to investigate whether people with higher subjective wellbeing have a lower risk of developing arthritis.
Methods
We used Cox proportional hazards regression to examine the prospective relationship between wellbeing (measured using the CASP-12) and incidence of arthritis over a 9-year period. The sample consisted of 13,594 participants aged ≥50 years from the Survey of Health, Ageing and Retirement in Europe.
Results
There was a significant association between greater wellbeing and reduced incident arthritis that was stronger at younger ages. In sex-adjusted analyses, for a standard deviation increase in CASP-12 score, the hazard ratios (95 % confidence intervals) for incident arthritis in people aged <65 and ≥65 years were 0.73 (0.69–0.77) and 0.80 (0.77–0.85), respectively. After further adjustment for other established risk factors, these associations were attenuated but remained significant in both age groups: the fully adjusted hazard ratios were 0.82 (0.77–0.87) and 0.88 (0.82–0.95), respectively.
Conclusions
These results provide evidence for an association between greater wellbeing and reduced risk of incident arthritis and, more generally, support the theory that psychosocial factors are implicated in the aetiology of this disease. Future research needs to delineate the mechanisms underlying the association between wellbeing and arthritis risk.
Electronic supplementary material
The online version of this article (doi:10.1007/s12160-015-9764-6) contains supplementary material, which is available to authorized users.
doi:10.1007/s12160-015-9764-6
PMCID: PMC4869763  PMID: 26769022
Wellbeing; Arthritis; CASP-12; Ageing; Longitudinal study
7.  Molecular Genetic Contributions to Social Deprivation and Household Income in UK Biobank 
Current Biology  2016;26(22):3083-3089.
Summary
Individuals with lower socio-economic status (SES) are at increased risk of physical and mental illnesses and tend to die at an earlier age [1, 2, 3]. Explanations for the association between SES and health typically focus on factors that are environmental in origin [4]. However, common SNPs have been found collectively to explain around 18% of the phenotypic variance of an area-based social deprivation measure of SES [5]. Molecular genetic studies have also shown that common physical and psychiatric diseases are partly heritable [6]. It is possible that phenotypic associations between SES and health arise partly due to a shared genetic etiology. We conducted a genome-wide association study (GWAS) on social deprivation and on household income using 112,151 participants of UK Biobank. We find that common SNPs explain 21% of the variation in social deprivation and 11% of household income. Two independent loci attained genome-wide significance for household income, with the most significant SNP in each of these loci being rs187848990 on chromosome 2 and rs8100891 on chromosome 19. Genes in the regions of these SNPs have been associated with intellectual disabilities, schizophrenia, and synaptic plasticity. Extensive genetic correlations were found between both measures of SES and illnesses, anthropometric variables, psychiatric disorders, and cognitive ability. These findings suggest that some SNPs associated with SES are involved in the brain and central nervous system. The genetic associations with SES obviously do not reflect direct causal effects and are probably mediated via other partly heritable variables, including cognitive ability, personality, and health.
Highlights
•Common SNPs explain 21% of social deprivation and 11% of household income•Two loci attained genome-wide significance for household income•Genes in these loci have been linked to synaptic plasticity•Genetic correlations were found between both measures of SES and many other traits
Individuals with lower socio-economic status (SES) are at increased risk of physical and mental illnesses. Hill et al. find extensive genetic correlations between SES and health, psychiatric, and cognitive traits. This suggests that the link between SES and health is driven, in part, by a shared genetic association.
doi:10.1016/j.cub.2016.09.035
PMCID: PMC5130721  PMID: 27818178
GWAS; genetics; genetic correlation; UK Biobank; socioeconomic status; SES; income; social deprivation
8.  Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing 
Age and Ageing  2016;45(6):789-794.
Background
falls are a major cause of disability and death in older people. Women are more likely to fall than men, but little is known about whether risk factors for falls differ between the sexes. We used data from the English Longitudinal Study of Ageing to investigate the prevalence of falls by sex and to examine cross-sectionally sex-specific associations between a range of potential risk factors and likelihood of falling.
Methods
participants were 4,301 men and women aged 60 and over who had taken part in the 2012–13 survey of the English Longitudinal Study of Ageing. They provided information about sociodemographic, lifestyle and behavioural and medical factors, had their physical and cognitive function assessed and responded to a question about whether they had fallen down in the last two years.
Results
in multivariable logistic regression models, severe pain and diagnosis of at least one chronic disease were independently associated with falls in both sexes. Sex-specific risk factors were incontinence (odds ratio (OR), 1.48; 95% CI, 1.19, 1.85) and frailty (OR 1.69, 95% CI 1.06, 2.69) in women, and older age (OR 1.02, 95% CI 1.04, 1.07), high levels of depressive symptoms (OR 1.33, 95% CI 1.05, 1.68), and being unable to perform a standing balance test (OR 3.32, 95% CI 2.09, 5.29) in men.
Conclusion
although we found some homogeneity between the sexes in the risk factors that were associated with falls, the existence of several sex-specific risk factors suggests that gender should be taken into account in designing fall-prevention strategies.
doi:10.1093/ageing/afw129
PMCID: PMC5105823  PMID: 27496938
older people; falls; prevalence; risk factors
9.  Reaction Time in Adolescence, Cumulative Allostatic Load, and Symptoms of Anxiety and Depression in Adulthood: The West of Scotland Twenty-07 Study 
Psychosomatic Medicine  2015;77(5):493-505.
Supplemental digital content is available in the text.
ABSTRACT
Objective
To examine the relation between reaction time in adolescence and subsequent symptoms of anxiety and depression and investigate the mediating role of sociodemographic measures, health behaviors, and allostatic load.
Methods
Participants were 705 members of the West of Scotland Twenty-07 Study. Choice reaction time was measured at age 16. At age 36 years, anxiety and depression were assessed with the 12-item General Health Questionnaire (GHQ) and the Hospital Anxiety and Depression Scale (HADS), and measurements were made of blood pressure, pulse rate, waist-to-hip ratio, and total and high-density lipoprotein cholesterol, C-reactive protein, albumin, and glycosolated hemoglobin from which allostatic load was calculated.
Results
In unadjusted models, longer choice reaction time at age 16 years was positively associated with symptoms of anxiety and depression at age 36 years: for a standard deviation increment in choice reaction time, regression coefficients (95% confidence intervals) for logged GHQ score, and square-root–transformed HADS anxiety and depression scores were 0.048 (0.016–0.080), 0.064 (0.009–0.118), and 0.097 (0.032–0.163) respectively. Adjustment for sex, parental social class, GHQ score at age 16 years, health behaviors at age 36 years and allostatic load had little attenuating effect on the association between reaction time and GHQ score, but weakened those between reaction time and the HADS subscales. Part of the effect of reaction time on depression was mediated through allostatic load; this mediating role was of borderline significance after adjustment.
Conclusions
Adolescents with slower processing speed may be at increased risk for anxiety and depression. Cumulative allostatic load may partially mediate the relation between processing speed and depression.
doi:10.1097/PSY.0000000000000189
PMCID: PMC4459883  PMID: 25984823
reaction time; anxiety; depression; allostatic load; GHQ = General Health Questionnaire; HADS = Hospital Anxiety and Depression Scale; HbA1c = glycosolated hemoglobin; HDL = high-density lipoprotein; SD = standard deviation
10.  Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English Longitudinal Study of Ageing 
Background
The English NHS Bowel Cancer Screening Programme has offered biennial faecal occult blood testing to people aged 60–69 years since 2006, and to those aged 60–74 years since 2010. Analysis of the first 2.6 million screening invitations found that 54% of eligible people took up the invitation. The reasons for this low uptake are unclear. We investigated whether participation in screening varies according to cognitive ability and personality.
Methods
Participants were members of The English Longitudinal Study of Ageing. In 2010–2011, respondents were asked about participation in bowel cancer screening, and cognitive ability and the ‘Big Five’ personality traits were assessed. Logistic regression was used to examine the cross-sectional relationships between cognitive ability and personality and screening participation in 2681 people aged 60–75 years who were eligible to have been invited to take part in the UK national screening programme for bowel cancer.
Results
In age-adjusted and sex-adjusted analyses, better cognition and higher conscientiousness were associated with increased participation in cancer screening. ORs (95% CIs) per SD increase were 1.10 (1.03 to 1.18) for cognitive ability and 1.10 (1.01 to 1.19) for conscientiousness. After further adjustment for household wealth and health literacy—shown previously to be associated with participation—these associations were attenuated (ORs were 1.07 (1.00 to 1.15) and 1.07 (0.97 to 1.18), respectively).
Conclusions
We found some indication that better cognitive function and greater conscientiousness may be linked with a slightly increased likelihood of participation in bowel cancer screening. These relationships need investigation in other cohorts of older people.
doi:10.1136/jech-2014-204888
PMCID: PMC4453587  PMID: 25648994
COGNITION; PSYCHOLOGY; SCREENING; SOCIAL CLASS; SOCIO-ECONOMIC
11.  Intelligence in youth and mental health at age 50 
Intelligence  2016;58:69-79.
Background
Few cognitive epidemiology studies on mental health have focused on the links between pre-morbid intelligence and self-reports of common mental disorders, such as depression, sleep difficulties, and mental health status. The current study examines these associations in 50-year-old adults.
Methods
The study uses data from the 5793 participants in the National Longitudinal Survey of Youth 1979 cohort (NLSY-79) who responded to questions on mental health at age 50 and had IQ measured with the Armed Forces Qualification Test (AFQT) when they were aged between 15 and 23 years in 1980. Mental health outcomes were: life-time diagnosis of depression; the mental component score of the 12-item short-form Health Survey (SF-12); the 7-item Center for Epidemiological Studies Depression Scale (CES-D); and a summary measure of sleep difficulty.
Results & conclusion
Higher intelligence in youth is associated with a reduced risk of self-reported mental health problems at age 50, with age-at-first-interview and sex adjusted Bs as follows: CES-depression (B = − 0.16, C.I. − 0.19 to − 0.12, p < 0.001), sleep difficulties (B = − 0.11, C.I. − 0.13 to − 0.08, p < 0.001), and SF-12 mental health status (OR = 0.78, C.I. 0.72 to 0.85, p < 0.001; r = − 0.03 p = 0.075). Conversely, intelligence in youth is linked with an increased risk of receiving a diagnosis of depression by the age of 50 (OR 1.11, C.I. 1.01 to 1.22, p = 0.024; r = 0.03, p = 0.109). No sex differences were observed in the associations. Adjusting for adult SES accounted for most of the association between IQ and the mental health outcomes, except for having reported a diagnosis of depression, in which case adjusting for adult SES led to an increase in the size of the positive association (OR = 1.32, C.I. 1.16 to 1.51, p < 0.001).
Highlights
•Links between IQ in youth and four mental health outcomes at age 50 were examined.•Higher IQ was associated with a greater risk of a depression diagnosis (OR 1.11).•Adjusting for adult SES amplified the diagnosis of depression coefficient (OR 1.32)•Higher IQ was associated with a lower risk of the other three mental health outcomes.
doi:10.1016/j.intell.2016.06.005
PMCID: PMC5014225  PMID: 27642201
Cognitive epidemiology; Intelligence; Sleep difficulties; Mental health; Depression; SES; Age 50; AFQT; NLSY-79
12.  The neighbourhood environment and use of neighbourhood resources in older adults with and without lower limb osteoarthritis: results from the Hertfordshire Cohort Study 
Clinical Rheumatology  2016;35(11):2797-2805.
This study aimed to examine the associations of perceptions of neighbourhood cohesion and neighbourhood problems and objectively measured neighbourhood deprivation with the use of neighbourhood resources by older adults with and without lower limb osteoarthritis (LLOA), and to assess whether these relationships are stronger in older persons with LLOA than in those without the condition. Data from the Hertfordshire Cohort Study were used. American College of Rheumatology classification criteria were used to diagnose clinical LLOA (knee and/or hip osteoarthritis). Use of neighbourhood resources was assessed using the Home and Community Environment instrument. Participants were asked about their perceptions of neighbourhood cohesion and neighbourhood problems. Objective neighbourhood deprivation was assessed using the Index of Multiple Deprivation score based on 2010 census data. Of the 401 participants (71–80 years), 74 (18.5 %) had LLOA. The neighbourhood measures were not significantly associated with use of resources in the full sample. A trend for a negative association between use of public transport and perceived neighbourhood problems was observed in participants with LLOA (OR = 0.77, 99 % CI = 0.53–1.12), whereas a trend for a positive association between perceived neighbourhood problems and use of public transport was found in participants without LLOA (OR = 1.18, 99 % CI = 1.00–1.39). The perception of more neighbourhood problems seems only to hinder older adults with LLOA to make use of public transport. Older adults with LLOA may be less able to deal with neighbourhood problems and more challenging environments than those without the condition.
doi:10.1007/s10067-016-3388-5
PMCID: PMC5063902  PMID: 27567628
Neighbourhood environment; Older population; Osteoarthritis
13.  Association between maternal nutritional status in pregnancy and offspring cognitive function during childhood and adolescence; a systematic review 
Background
The mother is the only source of nutrition for fetal growth including brain development. Maternal nutritional status (anthropometry, macro- and micro-nutrients) before and/or during pregnancy is therefore a potential predictor of offspring cognitive function. The relationship of maternal nutrition to offspring cognitive function is unclear. This review aims to assess existing evidence linking maternal nutritional status with offspring cognitive function.
Methods
Exposures considered were maternal BMI, height and weight, micronutrient status (vitamins D, B12, folate and iron) and macronutrient intakes (carbohydrate, protein and fat). The outcome was any measure of cognitive function in children aged <18 years. We considered observational studies and trials with allocation groups that differed by single nutrients. We searched Medline/PubMed and the Cochrane Library databases and reference lists of retrieved literature. Two reviewers independently extracted data from relevant articles. We used methods recommended by the Centre for Reviews and Dissemination, University of York and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Results
Of 16,143 articles identified, 38 met inclusion criteria. Most studies were observational, and from high-income settings. There were few randomized controlled trials. There was consistent evidence linking maternal obesity with lower cognitive function in children; low maternal BMI has been inadequately studied. Among three studies of maternal vitamin D status, two showed lower cognitive function in children of deficient mothers. One trial of folic acid supplementation showed no effects on the children’s cognitive function and evidence from 13 observational studies was mixed. Among seven studies of maternal vitamin B12 status, most showed no association, though two studies in highly deficient populations suggested a possible effect. Four out of six observational studies and two trials (including one in an Iron deficient population) found no association of maternal iron status with offspring cognitive function. One trial of maternal carbohydrate/protein supplementation showed no effects on offspring cognitive function.
Conclusions
Current evidence that maternal nutritional status during pregnancy as defined by BMI, single micronutrient studies, or macronutrient intakes influences offspring cognitive function is inconclusive. There is a need for more trials especially in populations with high rates of maternal undernutrition.
Systematic review registration
Registered in PROSPERO CRD42013005702.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-016-1011-z) contains supplementary material, which is available to authorized users.
doi:10.1186/s12884-016-1011-z
PMCID: PMC4982007  PMID: 27520466
Maternal adiposity; Maternal micronutrients; Pregnancy; Children; Cognition
14.  Reaction time in adolescence, cumulative allostatic load and symptoms of anxiety and depression in adulthood: The West of Scotland Twenty-07 Study 
Psychosomatic medicine  2015;77(5):493-505.
Objective
To examine the relation between reaction time in adolescence and subsequent symptoms of anxiety and depression and investigate the mediating role of sociodemographic measures, health behaviors, and allostatic load.
Methods
Participants were 705 members of the West of Scotland Twenty-07 Study (54% female). Choice reaction time was measured at age 16 years. At age 36 years, anxiety and depression were assessed with the 12-item General Health Questionnaire and the Hospital Anxiety and Depression Scale, and measurements were made of blood pressure, pulse rate, waist-to-hip ratio, total and HDL cholesterol, C-reactive protein, albumin and HbA1c from which allostatic load was calculated.
Results
In unadjusted models, longer choice reaction time at age 16 was positively associated with symptoms of anxiety and depression at age 36: for a SD increment in choice reaction time, regression coefficients (95% confidence intervals) for logged GHQ score, and square-root transformed HADS anxiety and depression scores were 0.048 (0.016, 0.080), 0.064 (0.009, 0.118) and 0.097 (0.032, 0.163) respectively. Adjustment for sex, parental social class, GHQ score at age 16, health behaviors at age 36 and allostatic loach had little attenuating effect on the association between reaction time and GHQ score, but weakened those between reaction time and the HADS subscales. Part of the effect of reaction time on depression was mediated through allostatic load; this mediating role was of borderline significance after adjustment.
Conclusion
Adolescents with slower processing speed may be at increased later risk of anxiety and depression. Cumulative allostatic load may partially mediate the relation between processing speed and depression.
doi:10.1097/PSY.0000000000000189
PMCID: PMC4459883  PMID: 25984823
reaction time; anxiety; depression; allostatic load
15.  Cognitive Ability in Early Adulthood and Risk of 5 Specific Psychiatric Disorders in Middle Age 
Archives of general psychiatry  2008;65(12):1410-1418.
Context
Lower cognitive ability is a risk factor for some forms of psychopathology, but much of the evidence for risk is based on individuals who required specialist care. It is unclear whether lower ability influences the risk of particular patterns of comorbidity.
Objective
To examine the relation between premorbid cognitive ability in early adulthood and the risk of major depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), alcohol and other drug abuse or dependence, and comorbid forms of these conditions in midlife.
Design
Prospective cohort study in which cognitive ability was measured on enlistment into military service at a mean age of 20.4 years and psychiatric disorder was assessed by structured diagnostic interview at a mean age of 38.3 years.
Setting
The United States.
Participants
A total of 3258 male veterans, participants in the Vietnam Experience Study.
Main Outcome Measures
Major depression, GAD, PTSD, and alcohol or other drug abuse or dependence since enlistment and currently, diagnosed according to the DSM-III.
Results
Lower cognitive ability was associated with an increased risk of depression, GAD, alcohol abuse or dependence, and PTSD and with some patterns of comorbidity. For a 1-SD decrease in cognitive ability, unadjusted odds ratios (95% confidence interval) for having these disorders currently were 1.32 (1.12–1.56) for depression, 1.43 (1.27–1.64) for GAD, 1.20 (1.08–1.35) for alcohol abuse or dependence, 1.39 (1.18–1.67) for PTSD, 2.50 (1.41–4.55) for PTSD plus GAD, 2.17 (1.47–3.22) for PTSD plus GAD plus depression, and 2.77 (1.12–6.66) for all 4 disorders. Most associations remained statistically significant after adjustment for confounders.
Conclusions
Lower cognitive ability is a risk factor for several specific psychiatric disorders, including some forms of comorbidity. Understanding the mechanisms whereby ability is linked to individual patterns of psychopathology may inform intervention.
doi:10.1001/archpsyc.65.12.1410
PMCID: PMC3634571  PMID: 19047528
16.  Parent–child relationships and offspring’s positive mental wellbeing from adolescence to early older age 
We examined parent-child relationship quality and positive mental well-being using Medical Research Council National Survey of Health and Development data. Well-being was measured at ages 13–15 (teacher-rated happiness), 36 (life satisfaction), 43 (satisfaction with home and family life) and 60–64 years (Diener Satisfaction With Life scale and Warwick Edinburgh Mental Well-being scale). The Parental Bonding Instrument captured perceived care and control from the father and mother to age 16, recalled by study members at age 43. Greater well-being was seen for offspring with higher combined parental care and lower combined parental psychological control (p < 0.05 at all ages). Controlling for maternal care and paternal and maternal behavioural and psychological control, childhood social class, parental separation, mother’s neuroticism and study member’s personality, higher well-being was consistently related to paternal care. This suggests that both mother–child and father–child relationships may have short and long-term consequences for positive mental well-being.
doi:10.1080/17439760.2015.1081971
PMCID: PMC4784487  PMID: 27019664
well-being; longitudinal; birth cohort study; life satisfaction
17.  Mental ability across childhood in relation to risk factors for premature mortality in adult life: the 1970 British Cohort Study 
Objective
To examine the relation of scores on tests of mental ability across childhood with established risk factors for premature mortality at the age of 30 years.
Methods
A prospective cohort study based on members of the British Cohort Study born in Great Britain in 1970 who had complete data on IQ scores at five (N  =  8203) or 10 (N  =  8171) years of age and risk factors at age 30 years.
Results
In sex‐adjusted analyses, higher IQ score at age 10 years was associated with a reduced prevalence of current smoking (ORper 1 SD advantage in IQ 0.84; 95% CI 0.80, 0.88), overweight (0.88; 0.84, 0.92), obesity (0.84; 0.79, 0.92), and hypertension (0.90; 0.83, 0.98), and an increased likelihood of having given up smoking by the age of 30 years (1.25; 1.18, 1.24). These gradients were attenuated after adjustment for markers of socioeconomic circumstances across the life course, particularly education. There was no apparent relationship between IQ and diabetes. Essentially the same pattern of association was evident when the predictive value of IQ scores at five years of age was examined.
Conclusions
The mental ability–risk factor gradients reported in the present study may offer some insights into the apparent link between low pre‐adult mental ability and premature mortality.
doi:10.1136/jech.2006.054494
PMCID: PMC2465619  PMID: 17933959
mental ability; risk factors; mortality
18.  Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing 
Age and Ageing  2014;44(1):162-165.
Objective: to examine the prevalence of frailty and disability in people aged 60 and over and the proportion of those with disabilities who receive help or use assistive devices.
Methods: participants were 5,450 people aged 60 and over from the English Longitudinal Study of Ageing. Frailty was defined according to the Fried criteria. Participants were asked about difficulties with mobility or other everyday activities. Those with difficulties were asked whether they received help or used assistive devices.
Results: the overall weighted prevalence of frailty was 14%. Prevalence rose with increasing age, from 6.5% in those aged 60–69 years to 65% in those aged 90 or over. Frailty occurred more frequently in women than in men (16 versus 12%). Mobility difficulties were very common: 93% of frail individuals had such difficulties versus 58% of the non-frail individuals. Among frail individuals, difficulties in performing activities or instrumental activities of daily living were reported by 57 or 64%, respectively, versus 13 or 15%, respectively, among the non-frail individuals. Among those with difficulties with mobility or other daily activities, 71% of frail individuals and 31% of non-frail individuals said that they received help. Of those with difficulties, 63% of frail individuals and 20% of non-frail individuals used a walking stick, but the use of other assistive devices was uncommon.
Conclusions: frailty becomes increasingly common in older age groups and is associated with a sizeable burden as regards difficulties with mobility and other everyday activities.
doi:10.1093/ageing/afu148
PMCID: PMC4311180  PMID: 25313241
frailty; disability; assistive devices; older people
19.  Intelligence in youth and health at age 50 
Intelligence  2015;53:23-32.
Background
The link between intelligence in youth and all-cause mortality in later-life is well established. To better understand this relationship, the current study examines the links between pre-morbid intelligence and a number of specific health outcomes at age 50 using the NLSY-1979 cohort.
Methods
Participants were the 5793 participants in the NLSY-79 who responded to questions about health outcomes at age 50. Sixteen health outcomes were examined: two were summary measures (physical health and functional limitation), 9 were diagnosed illness conditions, 4 were self-reported conditions, and one was a measure of general health status. Linear and logistic regressions were used, as appropriate, to examine the relationship between intelligence in youth and the health outcomes. Age, sex and both childhood and adult SES, and its sub-components – income, education, & occupational prestige – are all adjusted for separately.
Results & conclusion
Higher pre-morbid intelligence is linked with better physical health at age 50, and a lower risk for a number of chronic health conditions. For example, a 1 SD higher score in IQ was significantly associated with increased odds of having good, very good, or excellent health, with an odds ratio of 1.70 (C.I. 1.55–1.86). Thirteen of the illness outcomes were significantly and negatively associated with IQ in youth; the odds ratios ranged from 0.85 for diabetes/high blood sugar to 0.65 for stroke, per one standard deviation higher score in IQ. Adjustment for childhood SES led to little attenuation but adult SES partially mediated the relationship for a number of conditions. Mediation by adult SES was not consistently explained by any one of its components—income, education, and occupation status. The current findings contribute to our understanding of lower intelligence as a risk factor for poor health and how this may contribute to health inequalities.
Highlights
•We examined links between intelligence in youth and health at age 50 in NLSY-1979.•Higher intelligence in youth is linked with better physical health at age 50.•Higher intelligence in youth is linked with lower risk for chronic illnesses.•Adult but not childhood SES partially mediated the intelligence–health relationship.
doi:10.1016/j.intell.2015.08.001
PMCID: PMC4659286  PMID: 26766880
Cognitive epidemiology; Intelligence; IQ; Health; Chronic disease; SES; Age 50; AFQT; NLSY-79
20.  Health and Employment after Fifty (HEAF): a new prospective cohort study 
BMC Public Health  2015;15:1071.
Background
Demographic trends in developed countries have prompted governmental policies aimed at extending working lives. However, working beyond the traditional retirement age may not be feasible for those with major health problems of ageing, and depending on occupational and personal circumstances, might be either good or bad for health. To address these uncertainties, we have initiated a new longitudinal study.
Methods/design
We recruited some 8000 adults aged 50–64 years from 24 British general practices contributing to the Clinical Practice Research Datalink (CPRD). Participants have completed questionnaires about their work and home circumstances at baseline, and will do so regularly over follow-up, initially for a 5-year period. With their permission, we will access their primary care health records via the CPRD. The inter-relation of changes in employment (with reasons) and changes in health (e.g., major new illnesses, new treatments, mortality) will be examined.
Discussion
CPRD linkage allows cost-effective frequent capture of detailed objective health data with which to examine the impact of health on work at older ages and of work on health. Findings will inform government policy and also the design of work for older people and the measures needed to support employment in later life, especially for those with health limitations.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-015-2396-8) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-015-2396-8
PMCID: PMC4615332  PMID: 26482655
Ageing population; Older worker; Retirement; CPRD
22.  The Dynamic Relationship Between Cognitive Function and Positive Well-Being in Older People: A Prospective Study Using the English Longitudinal Study of Aging 
Psychology and Aging  2014;29(2):306-318.
There is evidence that having a stronger sense of positive well-being may be a potential resource for healthier aging as represented by slower physical decline, reduced risk of frailty and longer survival. However, it is unclear whether positive well-being is protective of another crucial component of healthy aging, cognitive function, or whether it has a bidirectional relationship with cognitive function. We use multilevel models with within-person centering to estimate the within- and between-person association between cognitive function and positive well-being in 4 waves of data from the English Longitudinal Study of Ageing (ELSA), (N = 10985, aged 50–90 years at wave 1). Our findings show that, although most variation in cognitive function was explained by age, and most variation in well-being was explained by depression, small but significant associations between cognition and well-being remained after variation in age and depression were controlled. In models where cognition was the outcome, the association was mainly because of variation in mean levels of well-being between persons. In models where well-being was the outcome, the association was mainly because of within-person fluctuation in cognitive test performance. Exercise and depression were the most important moderating influences on the association between cognition and positive well-being. Depression had greater effect upon this association for those with higher well-being, but exercise protected cognitive performance against the adverse effects of lower well-being.
doi:10.1037/a0036551
PMCID: PMC4196750  PMID: 24955999
positive well-being; cognitive function; multilevel model; within-person change
23.  Childhood Environment and Mental Wellbeing at Age 60-64 Years: Prospective Evidence from the MRC National Survey of Health and Development 
PLoS ONE  2015;10(6):e0126683.
Background
Mental wellbeing, conceptualised as positive affect, life satisfaction and realisation of needs that contribute to psychological growth, captures more than the absence of mental ill health. Several nations now aim to monitor and improve mental wellbeing. Whilst many studies document associations between adverse childhood experiences and mental disorders in adulthood, possible links between childhood experiences and adult mental wellbeing have so far received less attention.
Methods
Using data from 1976 men and women in the MRC National Survey for Health and Development, we investigated prospective associations between childhood socioeconomic and psychosocial environments and the Warwick Edinburgh Mental Wellbeing Scale, designed to capture both hedonic and eudaimonic facets of wellbeing, at age 60-64.
Results
Whilst there was no evidence that childhood socioeconomic circumstances were related to later wellbeing independently of other childhood experiences, elements of childrearing and parenting, parental health and adjustment, and childhood illness were related. More advantaged socioeconomic position was associated with greater wellbeing but this did not explain the links between these childhood exposures and adult wellbeing, suggesting alternative explanatory pathways should be considered.
Conclusions
Childhood illness and family psychosocial environment are associated with mental wellbeing in early older age, with effects sizes that are larger or comparable to socioeconomic circumstances in adulthood. Initiatives to improve the nation’s mental wellbeing that include programmes targeted to supporting families and children may additionally have benefits that continue into older age.
doi:10.1371/journal.pone.0126683
PMCID: PMC4451971  PMID: 26030929
24.  Is the Relationship between Common Mental Disorder and Adiposity Bidirectional? Prospective Analyses of a UK General Population-Based Study 
PLoS ONE  2015;10(5):e0119970.
The direction of the association between mental health and adiposity is poorly understood. Our objective was to empirically examine this link in a UK study. This is a prospective cohort study of 3 388 people (men) aged ≥ 18 years at study induction who participated in both the UK Health and Lifestyle Survey at baseline (HALS-1, 1984/1985) and the re-survey (HALS-2, 1991/1992). At both survey examinations, body mass index, waist circumference and self-reported common mental disorder (the 30-item General Health Questionnaire, GHQ) were measured. Logistic regression models were used to compute odds ratios (OR) and accompanying 95% confidence intervals (CI) for the associations between (1) baseline common mental disorder (QHQ score > 4) and subsequent general and abdominal obesity and (2) baseline general and abdominal obesity and re-survey common mental disorders. After controlling for a range of covariates, participants with common mental disorder at baseline experienced greater odds of subsequently becoming overweight (women, OR: 1.30, 1.03 – 1.64; men, 1.05, 0.81 – 1.38) and obese (women, 1.26, 0.82 – 1.94; men, OR: 2.10, 1.23 – 3.55) than those who were free of common mental disorder. Similarly, having baseline common mental health disorder was also related to a greater risk of developing moderate (1.57, 1.21 – 2.04) and severe (1.48, 1.09 – 2.01) abdominal obesity (women only). Baseline general or abdominal obesity was not associated with the risk of future common mental disorder. These findings of the present study suggest that the direction of association between common mental disorders and adiposity is from common mental disorder to increased future risk of adiposity as opposed to the converse.
doi:10.1371/journal.pone.0119970
PMCID: PMC4436271  PMID: 25993130
25.  Interarm Differences in Systolic Blood Pressure and Mortality Among US Army Veterans: Aetiological Associations and Risk Prediction in the Vietnam Experience Study 
Background
Differences between the arms in systolic blood pressure [SBP] of ≥10 mm Hg have been associated with an increased risk of mortality in patients with hypertensive and chronic renal disease. For the first time, we examined these relationships in a non-clinical population.
Design
Cohort study.
Methods
Participants were 4419 men [mean age, 38.37] from the Vietnam Experience Study. Bilateral SBP and diastolic BP [DBP], serum lipids, fasting glucose, erythrocyte sedimentation rate [ESR], metabolic syndrome, and ankle brachial index were assessed in 1986.
Results
Ten percent of men had an interarm difference of ≥10 and 2.4% of ≥15 mmHg. A 15-year follow-up period gave rise to 246 deaths [64 from cardiovascular disease [(CVD)]. Interarm differences of ≥10 mm Hg were associated with an elevated risk of all-cause [hazard ratio (HR) = 1.49, 95% confidence interval (CI), 1.04 – 2.14] and CVD mortality [HR = 1.93, 95% CI, 1.01 – 3.69]. After adjusting for SBP, DBP, lipids, fasting glucose and ESR, associations between interarm differences of ≥10 mm Hg and all-cause (HR=1.35, 95% CI = 0.94 – 1.95) and CVD mortality (HR = 1.62, 95% CI, 0.84 - 3.14) were significantly attenuated.
Conclusions
In this non-clinical cohort study, interarm differences in SBP were not associated with mortality after accounting for traditional CVD risk factors. Interarm differences might not be valuable as an additional risk factor for mortality in populations with a low risk of CVD.
doi:10.1177/2047487313496193
PMCID: PMC3805466  PMID: 23818287
Epidemiology; Risk Factors; Hypertension

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