• By Dartington SRU
  • Posted on Wednesday 13th July, 2011

Predicting premature death?

Over the last decade, the mortality rate among people aged 55 to 64 in the United Kingdom has fallen by one-third for men a ”steady improvement” in the rate of premature deaths.But while that decline has been mirrored in Scotland, premature death remains much more common there than in England and Wales. For example, throughout the last decade, the rate of deaths among those aged 55 to 64 in Scotland has been at least a quarter higher than in England and Wales for both men and women.A recent study throws new light on why that might be, suggesting a link between childhood behavioral problems and riskier health behaviors later in lifeThe findings are contained in a 35-year follow-up of a Scottish longitudinal study comprising 7,183 individuals. Longitudinal cohort studies provide a unique opportunity to take a closer look at the actual long-term consequences associated with childhood behavioral problems. It tracks the same group of individuals over time rather than simply providing a snapshot of different people at different times. Although time consuming, longitudinal studies possess a stronger basis for analysis than provided by cross-sectional research. In particular, it removes the problem of generational differences, which can occur as a result of such work.Although previous longitudinal studies have also found behavioral problems and hyperactivity in childhood are linked with premature death in midlife, this year’s research focuses on some possible explanations.Sophie von Stumm and colleagues (2011) suggest three potential causes. First, behavioral problems in childhood can adversely affect educational and future economic outcomes. Colman and colleagues (2009) highlighted this association using follow-up data over 40 years from the National Survey of Health and Development’s 1946 birth cohort. They found behavioral problems were associated with an “increased risk of leaving school without any qualifications and suffering more financial problems throughout life”. Colman and collegaues argue that a consequence of a poorer economic situation across a lifetime is both poorer health and poorer access to healthcare. This, in turn, could be linked to premature death in midlife.Second, Jokela and colleagues (2009) found childhood behavioral problems are associated with an increased risk of injury in adulthood. These injuries have the potential to cause harm to the workings of both body and brain, which, the authors suggest, could “manifest in long-term illnesses and poor health”. Third, those with behavioral problems in childhood are more likely to engage in behavior – such as binge drinking or smoking – which damages or puts their health at risk. It is this third finding that von Stumm and her colleagues (2011) focus mainly upon. They examined the effect of childhood behavior problems on health behaviors, using a control for factors known to have an impact upon health, such as socio-economic status and cognitive ability. In their longitudinal, von Stumm and colleagues used child data collected as part of the Aberdeen Children of the 1950s Study (ACONF). At 35-year follow up, von Stumm and colleagues managed to achieve a response rate of over 50% from the original sample of 12,150 children.The original ACONF study involved collecting teacher reports of children aged between six and 12 years who were born in Scotland between 1950 and 1956. The children were assessed on aggression, worrying and concentration difficulties using the Rutter Scale B (Rutter, 1967). The scale is the predecessor to the Strengths and Difficulties Scale (Goodman, 1999). Follow-up health data was then obtained 35 years later, when participants were aged between 46 and 51 years.The research confirmed earlier findings that behavioral problems and hyperactivity were associated with more smoking, drinking and reports of general poor health. Intriguingly, childhood emotional problems reveal a different picture. The study found that children who exhibited emotional problems drank less in later life. This result is consistent with findings produced elsewhere (Jokela et al 2009). The authors therefore proposed that emotional problems could be interpreted as a “protective factor”. This study, however, does not look specifically at premature death in midlife. As a consequence, caution must be taken when deciding whether emotional problems in childhood can be so described. Furthermore, it is unclear from the study what consequences childhood emotional problems have on other aspects of development. von Stumm and colleagues’ research shows how difficult childhood behaviors can result in riskier health behaviors in adulthood. This work thus represents one of the few studies that highlights the tangible long-term consequences of problems which can be identified in childhood. References:von Stumm, S., Deary, I. J., Kivimaki, M., Jokela, M., Clark, H. & Batty, G. D. (2011). Childhood Behavior Problems and Health at Midlife: 35-year follow-up of a Scottish birth cohort. The Journal of Child Psychology and Psychiatry, 52: no. doi: 10.1111/j.1469-7610.2011.02373.xJokela, M., Ferrie, J. & Kivimaki, M. (2009). Childhood problem behaviors and death by midlife: The British National Child Development Study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 19-24. Jokela, M., Power, C., & Kivimaki, M. (2009). Childhood problem behaviors and injury risk over the life course. Journal of Child Psychology and Psychiatry, 50, 1541-1549.

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