Troubles with Trajectories: Challenges to Longitudinal Research on Mental Health William R. Avison, PhD, FCAHS Departments of Sociology, Paediatrics, and Epidemiology and Biostatistics Western University Chair, Division of Children’s Health & Therapeutics Children’s Health Research Institute Assistant Director Lawson Health Research Institute London Health Sciences Centre/St. Joseph’s Health Care

SURVEY RESEARCH IN MENTAL HEALTH RESEARCH  Multi-wave, multi-level longitudinal surveys  Multiple informants  Dimensional and categorical measures of mental health  Social, economic, family, school, and neighborhood contexts  Data linkage  Biological samples

Have technical advances in longitudinal data collection and analyses overtaken conceptual models of change?  “If all you have is a hammer, everything looks like a nail” Abraham Kaplan, 1964; Abraham Maslow, 1966: The Law of the Instrument  Scientists from all disciplines who use multivariate techniques have been guilty of: - spray and pray analyses - capitalizing on chance - kitchen sink analyses - dredge and hedge  “If you torture the data long enough, sooner or later they will confess” Ronald Coase, 1960s; Peter Rossi, 1980s

A FRAMEWORK  Jacob Cohen (1990) “Things I Have Learned (So Far).”American Psychologist 45:  less is more  simple is better  some things you learn aren’t so  Carol S. Aneshensel (2013). Theory-Based Data Analysis for the Social Sciences. Second Edition

CONCEPTUAL FRAMEWORKS  Developmental Origins of Health and Disease (DOHaD)  evidence of perinatal influences is mixed  problem of G-E correlations  alternative explanations  Donofrio et al. (2014), Child Development Perspectives  The neuroinflammation hypothesis  Miller, Chen, and Parker (2011), Psychological Bulletin  childhood maltreatment  low SES  biological embedding of childhood adversity

LBW SGA IUGR Childhood Onset of Elevated Inflammatory Response Social Structure in Adulthood Mental Health Problems in Adulthood Parental SES Adversities Stress Elevated Inflammatory Response in Adulthood Adversities Stress

WHAT IS THE GOAL? ADVERSITIES DISADVANTAGES MENTAL HEALTH PROBLEMS Neuroinflammation Processes  Identification of risk factors  Explanation of how disadvantage “gets under the skin”

LIFE COURSE PERSPECTIVES  Life course epidemiology  critical period models  accumulation of risk models  Eco-social or multi-level developmental models  Bronfenbrenner  Hertzman

WHAT CAN A SOCIOLOGICAL PERSPECTIVE CONTRIBUTE?  The stress process across the life course  the stress process paradigm (Leonard Pearlin)  what are the consequences of social structure for individuals’ mental health? STRESSORS MEDIATORS MENTAL HEALTH SOCIAL AND ECONOMIC STATUSES

STRESS AND THE LIFE COURSE  Status and role changes over the life course generate different stressors and condition differential access to mediating resources (Pearlin and Skaff 1996)  The life course perspective in the sociology of mental health  Interplay of individual lives and historical times  The timing of lives (transitions)  Linked lives  Human agency

 The long arm of childhood (Hayward and Gorman, 2004)  cumulative burden of adversity  the impact of early mental illness  Turning points or transitions in children’s lives  school entry  changing schools  moving to a different neighborhood  addition and subtraction to the household  parental job loss  poverty  child care  Linked lives  parental mental health  parenting  parents’ jobs and children’s lives

TRAJECTORIES IN MENTAL HEALTH RESEARCH  Trajectories of symptoms  Trajectories of diagnosed episodes  Trajectories of social experiences  Trajectories of psychosocial resources  Trajectory of mastery, agency

CAUTIONS ABOUT TRAJECTORIES  Limited number of data points  data points may not correspond to role transitions  Sample acquisition bias and attrition bias  who volunteers? who persistently participates?  Source of reports about children’s lives change over the life course  Sparse data for analyses of trajectories of diagnosed illness  Eaton et al. (2008) – 1071 participants in 1993 Baltimore ECA  23 year prospective study  only 92 had a first episode of MDD  50% recovered with no remission  35% had at least one recurrent episode  15% had unremitting depression  The high prevalence of flat trajectories of continuous measures and sparse trajectories of change

GROWTH CURVE ANALYSES or GROWTH MIXTURE MODELS WITH LATENT CLASSES  Wickrama et al. (2008), Family Transition Project  485 adolescents over 10 years (1989 – 2001)  depression subscale from SCL-90-R (range 13 – 65)  comparison of traditional growth curve analysis of entire sample with latent class clusters derived from growth mixture models

 Lessons we can learn  both GCA and GMM with latent clusters are wholesale data reduction techniques  latent cluster approaches may help us reduce massive heterogeneity of change over time into meaningful trajectories  we can then estimate how these trajectories are associated with  antecedent transitions  consequent social outcomes  other concomitant trajectories

T1T1 T2T2 T3T3 Early Onset 5% 10% 15% 20% 25% MDD CES-D 16% 31% 32% 21%

 More progress with conceptually or theoretically driven research on trajectories  DOHaD  the neuroinflammation hypothesis  ecological or multilevel developmental models  life course epidemiology  life course sociology  Enables the testing of alternative hypotheses which is the goal of good science

THANK YOU!