Childhood and adulthood psychological ill health as predictors of midlife affective and anxiety disorders: The 1958 British Birth Cohort

Context: Affective and anxiety disorders in early adulthood are associated with internalizing and externalizing disorders in childhood. Previous studies have not examined whether the risk associated with childhood psychological ill health persists for midlife psychological health. Objectives: To examine whether childhood and adulthood psychological health are associated with midlife affective and anxiety disorders and to examine sex differences in these associations. Design: Data were gathered during a biomedical survey of the 1958 British Birth Cohort, a 45-year longitudinal study of 98% of births in 1 week in 1958. Setting: General population sample in England, Scotland, and Wales. Participants: Analyses were based on 9297 participants, 54% of the surviving sample. Main Outcome Measure: Diagnoses according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) at age 45 years for depressive episode and generalized anxiety disorder. Results: Internalizing and externalizing disorders at ages 7, 11, and 16 years were associated with a 1.5- to 2-fold increase in risk for midlife anxiety and affective disorder (P<.05), whereas psychological ill health at ages 23, 33, and 42 years was associated with a 2- to 7-fold increase in risk for midlife disorder (P<.05). Early-adulthood associations were significantly stronger for men (P<.05). Type and age at onset of childhood problems did not contribute to variations in the associations with midlife disorder. Risk for midlife disorder increased significantly with the cumulative number of adulthood reports of psychological ill health (P<.001). Conclusions: Childhood psychological health is an important independent distal factor in adulthood psychological health. Adulthood psychological health shows stronger associations with midlife disorders, indicating a poorer prognosis for adulthood than childhood psychological ill health. Men may be more susceptible than women to the effects of psychological ill health in early adulthood on midlife disorders. Targeting prevention, recognition, and treatment efforts in early adulthood, as well as in childhood and adolescence, may significantly reduce the burden of disease.