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

经常打人、不遵守规则、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出现持续的行为问题，包括犯罪、不稳定的关系、不良的工作记录、抑郁、药物使用问题。他们更有可能让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，其中的关键因素可能包括产前压力、婴儿早期情绪、作为风险的严厉父母和作为保护因素的温暖父母。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增加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保健和家庭安排标准西方化的国家进行的，在这些国家，低出生体重和营养不良等额外风险很少。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普遍存在的产前和婴儿期风险以及那些独特的风险。采用前瞻性纵向设计，我们将招募新IMCR（印度医学研究委员会）资助的南印度PRAMM研究的成员（n= 650；孕产妇心理健康前瞻性评估研究），目前正在妊娠至8周龄的3个时间点进行评估，并在6个月、12个月和24个月时进行详细评估。我们将在现有的英国医学研究委员会资助的队列、威勒尔儿童健康与发展研究（WCHADS）和印度队列之间使用通用测量方法（问卷调查、访谈、观察和发展评估），以便对合并的英国-印度数据集进行数据分析。将采用旨在促进跨文化测量可比性的稳健方法。产前和产后早期环境的各个方面，如产妇心理健康、营养和早期照料模式，可能与南亚环境特别相关，将与以前以西方为主的研究确定的因素一起进行评估和审查。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，连同计划的一系列培训活动，将促进在纵向队列研究、抽样和保留、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分享，从而促进印度临床研究领域的能力建设。从长远来看，研究结果将直接为亚洲和英国儿童心理健康的现有早期干预措施的改进提供信息。

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.