Josiah King’s research while affiliated with University of Edinburgh and other places

Background The number of reported maternal mental health (MH) difficulties during the COVID-19 pandemic was higher than during the pre-pandemic period. Findings on the link between the COVID-19 pandemic and children’s developmental outcomes suggest lower scores on the Ages and Stages Questionnaire (ASQ-3) among children born during the COVID-19 pandemic compared to pre-pandemic cohorts. The present study explored the interaction between maternal MH and being born during the COVID-19 pandemic on children’s developmental outcomes. Furthermore, it examined the combined effect of maternal MH and birth during the pandemic on children’s developmental outcomes. Study design This study used a linked administrative dataset from Scotland. Children born between 1st March 2020 and 30th June 2021, inclusive ( n = 32,683), and a comparative historical cohort that included those born between 1st April 2017 and 31st October 2018 in Scotland ( n = 50,257) were included. Regression models were used to adjust for covariates, with outcomes such as ASQ-3 scores and developmental concerns and predictors such as maternal MH and birth during the COVID-19 pandemic. Results A history of MH hospital admission was associated with increased odds of developmental concerns: OR = 1.038, 95% CI [1.012, 1.064], p = 0.004** and reduced ASQ-3 scores (effect size = 0.130, 95% CI [-0.204, -0.056], p < 0.001***). There were mixed findings on the association between being born during the COVID-19 pandemic (developmental concerns: OR = 1.024, 95% CI [1.019, 1.029], p < 0.001***) and ASQ-3 scores (ES = 0.012, 95% CI [-0.002, 0.025], p = 0.08) but no interaction between a history of MH hospital admission and birth during the COVID-19 pandemic. However, there was an interaction effect on mental health assessed by psychiatric outpatient attendance records association and birth during the COVID-19 pandemic on the ASQ-3 scores SD; -0.07 (ES =-0.066, 95% CI [-0.106, -0.027], p < 0.001***). Conclusions Our findings suggest that being born during the COVID-19 pandemic and maternal MH influenced child development with relatively small effects, with mixed findings on their combined presence. Our study only examined developmental outcomes up to age 13–15 months. Future studies should explore the potential long-term effects of being born during the pandemic and MH.

Background Socioeconomic deprivation has been linked to negative child developmental outcomes including brain development, psychological well-being, educational attainment, and social-emotional well-being. Maternal mental health has also been linked to mothers’ parenting practices and their children’s developmental outcomes. However, limited evidence exists regarding the role of maternal mental health (prenatal and postnatal) in the association between socioeconomic deprivation and children’s developmental outcomes. Methods We examined the potential role of maternal mental health in the association between socioeconomic deprivation (SED) and child development outcomes. We used a large linked administrative health dataset covering children born between 2011 and 2015 in Greater Glasgow and Clyde, Scotland. Of the 76,483 participants, 55,856 mothers with matched children’s developmental outcome data were included. A mediation analysis model, adjusted for confounders and covariates, was used. Results Maternal mental health assessed by a history of hospital admissions mediated, but to a small extent, the relationship between SED and children’s developmental outcomes. The average direct effect (ADE), of SED in the first model with a history of hospital admissions, was ADE: ES = − 0.0875 (95% CI = − 0.097, − 0.08; p < 0.001) and ACME: ES = − 0.0002 (95% CI = − 0.001, − 0.0001; p = 0.01). The proportion mediated by the history of mental health admission was 0.3%. Conclusion The association between SED and children’s developmental outcomes appears to be partially mediated by maternal mental health, although the proportional-mediated effect was very small.

To illuminate individual differences in the development of attention-deficit hyperactivity disorder (ADHD) symptoms in the general population, psychometric measures are needed that can capture general population-level symptom variation reliably, validly, and comparably from childhood through to the transition to adulthood. The ADHD subscale of the Social Behavior Questionnaire (SBQ-ADHD) provides a candidate for a measure that can meet this need. We thus evaluate the psychometric properties of the SBQ-ADHD as administered in adulthood (ages 20 and 24) to a large normative sample, as well as the cross-informant (parent-teacher-self-reports) and developmental (ages 7–24) measurement invariance of a core SBQ-ADHD item set. Results support score internal consistency reliability, gender measurement invariance, and criterion validity. Scores from the core item set showed some evidence of non-invariance, providing insights into how ADHD symptoms may manifest and/or be perceived differently by different informants/in different contexts and at different ages. Our findings overall support the use of the SBQ-ADHD items for developmental studies of ADHD symptoms from childhood to adulthood.

Background Given the challenges and resources involved in mental health intervention development and evaluation, it is valuable to obtain early evidence on which intervention targets represent the most promising investments. Observational datasets provide a rich resource for exploring these types of questions; however, the lack of randomisation to treatments in these data means they are vulnerable to confounding issues. Counterfactual analysis refers to a family of techniques within the potential outcomes framework that can help address confounding. In doing so, they can help differentiate potential intervention targets that may reflect genuine active ingredients in mental health from those that are only associated with mental health outcomes due to their common dependence on ‘third variables’. However, counterfactual analysis is rarely used for this purpose and where it is used in health research it is often implemented in a suboptimal fashion. One key reason may be a lack of accessible tutorials and software that embeds best practices. Methods To help promote the principled use of counterfactual analysis we developed DigiCAT. DigiCAT is an open digital tool built in R and Shiny that implements a range of counterfactual analysis methods. It is accompanied by accessible tutorials. The tool has been designed to handle real data, with capabilities for missing data, non-binary treatment effects, and complex survey designs. Results The current article describes the development of DigiCAT, drawing on user and lived experience expert input and provides an overview of its features and examples of its uses. Conclusions Counterfactual analysis could help prioritise intervention targets by establishing which ones remain associated with mental health outcomes after accounting for potential confounding. Accessible digital tools supported by clear guidance may help promote the uptake and principled use of these techniques.

Background Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self‐reported survey data, or data on hospital‐recorded infections only, resulting in gaps in data collection. Methods This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011–2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital‐diagnosed prenatal infections and receipt of infection‐related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6‐8 week or 27‐30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross‐motor‐skills, hearing‐communication, vision‐social‐awareness, personal‐social, emotional‐behavioural‐attention and speech‐language‐communication) and (b) the trimester(s) in which infections occurred. Results After confounder/covariate adjustment, hospital‐diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19–1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07–1.67) and 3 (OR: 1.33; 95% CI: 1.21–1.47), that is the trimesters in which foetal brain myelination occurs. Infection‐related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98–1.08), but were associated with slightly increased odds of concerns specifically related to personal‐social (OR: 1.12; 95% CI: 1.03–1.22) and emotional‐behavioural‐attention (OR: 1.15; 95% CI: 1.08–1.22) development. Conclusions Prenatal infections, particularly those which are hospital‐diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.

Parental stress occurs when parenting demands exceed the resources available to cope with parenting. Previous research has identified household wealth, educational level, marital status, age, and number of dependent children as predictors of parental stress. However, limited evidence exists from sub-Saharan Africa. This study investigated the sociodemographic predictors of parenting stress among mothers in Kenya and Zambia. This cross-sectional study utilised baseline secondary data from parenting intervention programs implemented in Kisumu County (rural Kenya), Nairobi County (Urban Kenya), and Chisamba District (rural Zambia). Out of 913 caregivers recruited for the parenting program, 844 with complete data were included in the analysis. The mean age was 1.0 (SD = 0.7) years. Parental stress was measured using the Parental Stress Score (PSS) tool and demographic questionnaires were used to collect demographic information. Mean PSS were compared across study sites, and a multiple linear regression model was used to examine associations between sociodemographic predictors (household income, educational level, marital status, maternal age, child age, and number of children aged < 5 years) and PSS, adjusting for clustering and other predictors. From the results, the mean PSS in rural Kenya was 37.6 [SD = 11.8], in urban Kenya was 48.4 [SD = 4.2], and in rural Zambia was 43.0 [SD = 9.1]. In addition, the significant association between PSS and mothers’ income and educational level was only observed in Kenyan study sites (income: Kenya rural β = -0.40, p < 0.001**; Kenya urban, β = − 0.33, p = .02*; Zambia rural, β = − 0.01, p = 0.7) education: Kenya rural, β = − 0.25, p = .005**; Kenya urban, β = − 0.14, p = 0.07; Zambia rural, β = 0.04, p = 0.3). However, marital status, mother’s age, child’s age, and the number of children below five years were not associated with PSS. The results revealed that mothers’ income and education level were negatively associated with PSS, indicating that higher socioeconomic status can buffer the effects of parental stress. Trial registration Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID Number: PACTR20180774832663 Date: 26/July/2018; (ID number: PACTR201905787868050 Date: 06/May/2019.

Background Prenatal infections are associated with childhood developmental outcomes such as reduced cognitive abilities, emotional problems and other developmental vulnerabilities. However, there is currently a lack of research examining whether this arises due to potential intermediary variables like low birth weight or preterm birth, or due to some other mechanisms of maternal immune activation arising from prenatal infections. Methods Administrative data from the National Health Service health board of Greater Glasgow & Clyde, Scotland, were used, linking birth records to hospital records and universal child health review records for 55 534 children born from 2011 to 2015, and their mothers. Causal mediation analysis was conducted to examine the extent to which low birth weight and preterm birth mediate the relationship between hospital-diagnosed prenatal infections and having developmental concern(s) identified by a health visitor during 6–8 weeks or 27–30 months child health reviews. Results Model estimates suggest that 5.18% (95% CI 3.77% to 7.65%) of the positive association observed between hospital-diagnosed prenatal infections and developmental concern(s) was mediated by low birth weight, while 7.37% (95% CI 5.36 to 10.88%) was mediated by preterm birth. Conclusion Low birth weight and preterm birth appear to mediate the relationship between prenatal infections and childhood development, but only to a small extent. Maternal immune activation mechanisms unrelated to low birth weight and preterm birth remain the most likely explanation for associations observed between prenatal infections and child developmental outcomes, although other factors (for example, genetic factors) may also be involved.

Background: Prenatal infections are associated with childhood developmental outcomes such as reduced cognitive abilities, emotional problems and other developmental vulnerabilities. However, there is currently a lack of research examining whether this arises due to potential intermediary variables like low birthweight or preterm birth, or due to some other mechanisms of maternal immune activation arising from prenatal infections. Methods: Administrative data from the National Health Service (NHS) health board of Greater Glasgow & Clyde, Scotland, was used, linking birth records to hospital records and universal child health review records for 55,534 children born from 2011-2015, and their mothers. Causal mediation analysis was conducted to examine the extent to which low birthweight and preterm birth mediate the relationship between hospital-diagnosed prenatal infections and having developmental concern(s) identified by a health visitor during 6-8 week or 27-30 month child health reviews. Results: Model estimates suggest that 5.18% [95% CI: 3.77-7.65%] of the positive association observed between hospital diagnosed prenatal infections and developmental concern(s) was mediated by low birthweight, whilst 7.37% [95% CI: 5.36-10.88%] was mediated by preterm birth. Conclusion: Low birthweight and preterm birth appear to mediate the relationship between prenatal infections and childhood development, but only to a small extent. Maternal immune activation mechanisms unrelated to low birthweight and preterm birth remain the most likely explanation for associations observed between prenatal infections and child developmental outcomes, although other factors (e.g. genetic factors) may also be involved.

Background Parental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes. Methods The findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children’s mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children’s developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers’ parenting stress, child stimulation practices, and child developmental outcomes. Results The findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers’ stimulation practices and children’s developmental outcomes were not universally supported. Conclusion The findings show that improved caregiver stimulation practices are likely to improve children’s developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs. Trial registration Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID number: PACTR20180774832663 Date: 26/July/2018.