Two kids grow up in the same home or same neighborhood. How is it that only one develops major depression? One kid grows up exposed to violence the other not. Who is more prone to anxiety? Poverty? Loss? Education? What do such circumstances and experiences mean for risk of mental illness? These are the kinds of questions that longitudinal studies attempt to answer. And that was Dr. Patricia Cohen’s life work.
This summer the mental health community lost a researcher who was among the great pioneers in psychiatric epidemiology. A longtime member of the Columbia University faculty, Dr. Patricia Cohen was remembered in a NY Times obituary, as a scientist whose compassion and curiosity left an enduring legacy. Cohen’s life work has come to be known as the Children in the Community Study and has contributed in important ways to what we know about growing up and risk for mental disorders.
Today’s Five on Friday is a salute to five seminal longitudinal studies in developmental psychopathology. Observing carefully. Listening attentively. Recording thoughtfully. Each of these studies has increased our understanding of how and why some of us develop mental disorders and other not.
1. The Children in the Community Study. Times have changed, and spanking is scorned as a means of parenting among “enlightened” communities today. While this may be part of a larger movement towards more liberal parenting styles, it was also likely informed by the Children in the Community Study that documented the relationship between parenting styles and child outcomes. Following a group of more than 800 children in upstate New York for more than 20 years, Dr. Cohen’s work showed that parenting behaviors like harsh, physical discipline were often associated with mood problems among kids later in life. Cohen’s work also described how important personality disorders in adolescence were to predicting mental illness in adulthood.
2. The Great Smoky Mountains Study. Researchers at Duke University began a longitudinal study in 1992 with over a thousand children aged 9-16 and their parents in western North Carolina, both in rural and urban areas. And then something totally unexpected happened. One-quarter of the families in the study were members of the Eastern Band of the Cherokee Nation, and a casino was built on their land. Every tribal citizen earned a share of the profits – enough to dramatically change their financial circumstances. Among the notable findings were a that improved financial circumstances were associated with a decline in behavioral and emotional problems among kids. But, of course, the story of risk for mental illness is more complicated than that. Other significant findings were that psychiatric disorders tend to start early and gender matters. For example, whereas girls and boys have similar rates of depression in childhood, by about the age of 13, girls are more likely than boys to be diagnosed with depression, and the difference endures into adulthood.
3. Three Generational Study of Major Depression. Dr. Myrna Weissman, a senior faculty member and mentor in the Department of Psychiatry at Columbia University, has been studying depression for decades. Beginning in 1975, Dr. Weissman and colleagues launched a study to examine how parental depression affects children – and even their children’s children. Following a cohort of 220 children over 40 years, Weissman and colleagues are among the first to show that children of depressed parents are more likely to have serious and impairing depression and are less likely to seek treatment. Their data also indicate that children with both a parent and a grandparent with major depression are at highest risk for major depression.
4. Avon Longitudinal Study of Parents and Children. Launched in 1990 in Great Britain, the Avon Longitudinal Study of Parents and Children (ALSPAC), made its mark by starting with pregnant mothers rather than at birth or later. ALSPAC was one of the first studies to show that mothers were at risk for depression and anxiety during pregnancy and that prenatal depression and anxiety had an impact on child outcomes like hyperactive behavior and disturbed sleep in childhood. The study also found that children whose fathers had depression were more likely to have behavior problems at ages 3 and 7, regardless of whether their mothers had depression.
5. Dunedin – big findings from down under. Inspired by Britain’s birth cohort studies, researchers in New Zealand created the Dunedin cohort study in the early 1970s. Among its numerous contributions to the field, the Dunedin cohort study documented that children as young as age 11 experience delusions and hallucinations and, while such symptoms are rare, those who report them have strongly elevated risk for diagnosis with a psychotic illness when they reach adulthood.
Who? When? Why? Why some and not others? These are the questions we ask as we try to understand the infinitely complex human experience. The longitudinal studies conducted by Dr. Pat Cohen and others require extraordinary patience, care and scientific sophistication. Each offers some answers to these questions and contributes to a greater developmental understanding of mental health. Ultimately, their work helps us develop strategies to prevent and treat mental illness. A life’s work.