Psychosocial and nutritional predictors of child mental health: longitudinal study of shared and distinctive risk and protective factors in UK & India

经常殴打他人、不遵守规则以及在社会和学校环境中捣乱的幼儿，比其他儿童更有可能在成年后继续表现出行为问题，包括犯罪、关系不稳定、工作记录差、抑郁、吸毒问题。他们更有可能使自己的孩子遭受虐待。这些问题是由遗传和环境影响的复杂组合引起的，其中关键因素可能包括产前压力，早期婴儿情绪化，以及作为风险的严厉养育，以及作为保护因素的温暖养育。现在有充分的证据表明，早期生活中的个体差异和环境暴露会导致儿童后期及以后出现心理健康问题的风险。然而，以前的研究几乎都是在医疗和家庭安排标准西方化的国家进行的，而且这些国家很少有低出生体重和营养不良等额外风险。拟议研究的目的是研究儿童心理健康问题的早期风险和保护因素，以确定西方和南亚人口常见的产前和婴儿期风险以及独特的风险。采用前瞻性纵向设计，我们将招募新的IMCR（印度医学研究理事会）资助的南印度PRAMM研究（n= 650;产妇心理健康研究的前瞻性评估）的成员，目前在妊娠至8周龄期间的3个时间点进行评估，并在6个月、12个月和24个月进行详细评估。我们将在现有的英国医学研究理事会资助的队列、维拉尔儿童健康与发育研究（WCHADS）和印度队列之间使用通用测量（问卷调查、访谈、观察和发育评估），以便对合并的英国-印度数据集进行数据分析。将采用强有力的方法，以促进跨文化的测量可比性。产前和产后早期环境的各个方面，如产妇的心理健康，营养和早期分娩的模式可能与南亚环境明显相关，并与以前主要西方研究中确定的因素一起进行评估。基因-环境相互作用的证据也将在婴儿早期情绪和行为问题的预测中进行评估。这项英国-印度联合研究以及计划中的一系列培训活动将有助于印度临床研究领域的能力建设，促进在进行纵向队列研究，采样和保留，测量问题，数据管理和复杂数据集纵向分析所需的最先进统计方法方面的经验和专业知识的共享。从长远来看，研究结果将直接为亚洲和英国儿童心理健康现有早期干预措施的完善提供信息。

Young children who frequently hit other people, who disobey rules and are disruptive in social and school settings, are much more likely than other children to show continued behaviour problems into adult life, including criminality, unstable relationships, poor work record, depression, substance use problems. They are more likely to expose their own children to maltreatment. The problems arise from a complicated mix of genetic and environmental influences, in which key factors probably include, prenatal stress, early infant emotionality, and harsh parenting as risks, and warm parenting as protective factors. There is now good evidence that individual variations and environmental exposures in early life contribute to risk for mental health problems in later childhood and beyond. However, previous research has been conducted almost exclusively in countries with Westernised standards of medical care and family arrangements, and where additional risks such as low birth weight and under-nutrition are rare. The aims of the proposed research are to study early risk and protective factors for childhood mental health problems, to identify prenatal and infancy risks that are common to Western and South Asian populations and those that are distinctive. Using a prospective longitudinal design we will recruit members of the new IMCR (Indian Council of Medical Research) funded South Indian PRAMM study (n= 650; Prospective Assessment of Maternal Mental Health study), currently being assessed at 3 timepoints during pregnancy to 8 weeks of age, into a new study of infant development with detailed assessment at 6 months, 12 months and 24 months. We will use common measurement (questionnaires, interviews, observations and developmental assessments) between an existing UK Medical Research Council funded cohort, the Wirral Child Health and Development Study (WCHADS), and the Indian cohort, to enable data analyses to be conducted of merged UK - Indian datasets. Robust methods designed to facilitate cross-cultural comparability of measurement will be employed. Aspects of the prenatal and early postnatal environment such as maternal mental health, nutrition and patterns of early caregiving likely to be distinctively relevant to the South Asian setting with be assessed, and examined alongside factors identified in previously in predominantly Western research. Evidence for gene-environment interplay will also be evaluated in the prediction of early emotional and behavioural problems in infancy. This joint Uk-Indian study, together with a planned series of training events, will contribute to capacity building in the Indian clinical research domain by facilitating the sharing of experience and expertise in conducting longitudinal cohort studies, sampling and retention, measurement issues, data management and state of the art statistical methods needed in longitudinal analysis of complex data sets. The study findings in the longer term will directly inform the refinement of existing early interventions for child mental health in both Asian and UK settings.