Thesis (Ph. D.)--University of New South Wales, 2002. / Also available online.

Introduction: Maternal antenatal depression is associated with increased risk of adverse offspring outcomes, which manifest in approximately 20% of infants. However, the mechanisms by which risk is transferred from mother to infant, and the factors determining susceptibility to antenatal mood disturbance, remain poorly understood. Objectives: The primary objectives of this thesis are to investigate whether: (i) Antenatal depression is associated with alterations of the maternal and infant Hypothalamic-Pituitary-Adrenal (HPA) axis. (ii) The infant serotonin transporter genotype (5-HTTLPR) confers susceptibility to antenatal mood disturbance. Methods: This thesis is an analysis of two different cohorts. First, 103 pregnant women were recruited in Oxford, UK. Participants’ self-reported antenatal mood, and salivary cortisol was assessed in response to a stressor and diurnally. 88 participants were visited two months post-birth. Mothers reported postnatal mood and infant temperament. Infant cortisol responses to inoculation were assessed, as was infant DNA methylation. Analysis of this cohort addresses the first objective of this thesis. Next, data from the ALSPAC cohort was analysed to address the second objective. Maternal-reported antenatal mood and infant behaviour up to 7 years was available, as was 5-HTTLPR genotype data for over 4,000 infants. Results: Antenatal depression was not associated with increased maternal cortisol during pregnancy. Neither antenatal depression nor cortisol was associated with infant cortisol reactivity or temperament. Antenatal depression predicted increased NR3C1 DNA methylation in males, and decreased BDNF DNA methylation in male and female infants. Infant 5-HTTLPR genotype did not moderate associations between antenatal mood disturbance and behavioural difficulties. Conclusions: This thesis does not support the theory that antenatal depression exerts influence on infant development via increased activity of the maternal and infant HPA axis; however, changes in infant DNA methylation may be a mediating mechanism. Further, susceptibility to antenatal mood may be more complex than previously thought.

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-09-01Bitstream added on 2014-06-13T19:59:16Z : No. of bitstreams: 1 trench_ev_me_botfm.pdf: 388835 bytes, checksum: fc000ff51b6be5d7a9894374be42a215 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Os estudantes de medicina são considerados um grupo de risco para o desenvolvimento de transtornos mentais, já que os desafios enfrentados por essa população vão desde a adaptação às demandas acadêmicas e sociais até desafios próprios do curso, tais como: grande exigência na aquisição de conhecimentos teóricos, pouco tempo para lazer e auto-cuidado, contato com doença e morte e grande responsabilidade em decisões que envolvem repercussões para a vida dos pacientes. Estimar a prevalência de Transtorno Mental Comum em estudantes de medicina em momentos diferentes do curso (início e final), identificando fatores de risco relacionados à saúde mental do estudante e à exposição ao curso de medicina. Estudo observacional do tipo corte transversal repetido. A coleta de dados foi realizada em dois momentos diferentes do curso, considerando-se os mesmos sujeitos matriculados no 1º e 2º ano do curso em 2002 e no 5º e 6º ano em 2006. Utilizou-se questionário auto-aplicável, abordando características sóciodemográficas, aspectos relacionados ao curso e o Self Reporting Questionnaire. Considerou-se Transtorno Mental Comum como a variável dependente. Para a análise descritiva e a comparação das proporções das variáveis nos dois momentos, foi utilizado o modelo linear generalizado misto, adotando-se o nível de significância estatística de p ≤ 0,05, para rejeição da hipótese de nulidade. Para a análise em cada um dos momentos do levantamento, foi utilizado o Teste do Qui-quadrado. Para a análise multivariada, foi utilizada a regressão logística. Participaram do estudo 284 alunos, sendo 150 em 2002 (83%) e 134 em 2006 (74,4%). A prevalência de TMC foi 37,7% em 2002 e 40,9% em 2006, sem diferença significativa entre ambas (p=0,54). A presença de TMC associou-se significativamente... / Medical students are considered a risk group for developing mental disorders, because of the challenges faced by this population, ranging from academic and social demands and challenges inherent to the course, such as large volume of knowledge to learn, lack of leisure time and self-care, dealing with illness and death and great responsibility in taking decisions, with repercussions in patients lives. To estimate the prevalence of Common Mental Disorder (CMD) in medical students in different moments of the course (beginning and ending), identifying risk factors related to students mental health and exposure to medical school. Observational repeated cross-sectional study. Data collection was performed at two different times of the course, considering the subjects enrolled in the 1st and 2nd grade of the course in 2002 and the 5th and 6th grade in 2006. It was used a self-administered questionnaire, addressing socio-demographic and course related data, as well as the Self-Reporting Questionnaire (SRQ). Common Mental Disorder was considered the dependent variable. For descriptive analysis and comparison of the proportions of variables on both occasions, we used generalized linear mixed model, adopting the statistical significance level of p ≤ 0.05 to reject the null hypothesis. For the analysis at each moment of the survey, we used the Chisquare. For multivariate analysis, logistic regression was used. The study included 284 students, 150 in 2002 (83%) and 134 in 2006 (74.4%). The prevalence of CMD was 37.7% in 2002 and 40.9% in 2006, with no significant difference between them (p = 0.54). The presence of CMD was significantly associated with dissatisfaction with the frequency of leisure activities, to feel rejected by friends and have wanted to abandon the course in both moments of the survey. Only when... (Complete abstract click electronic access below).

Orientador: Maria Cristina Pereira Lima / Banca: Ana Teresa de Abreu Ramos-Cerqueira / Banca: Luis Fernando Ribeiro Paulin / Resumo: Os estudantes de medicina são considerados um grupo de risco para o desenvolvimento de transtornos mentais, já que os desafios enfrentados por essa população vão desde a adaptação às demandas acadêmicas e sociais até desafios próprios do curso, tais como: grande exigência na aquisição de conhecimentos teóricos, pouco tempo para lazer e auto-cuidado, contato com doença e morte e grande responsabilidade em decisões que envolvem repercussões para a vida dos pacientes. Estimar a prevalência de Transtorno Mental Comum em estudantes de medicina em momentos diferentes do curso (início e final), identificando fatores de risco relacionados à saúde mental do estudante e à exposição ao curso de medicina. Estudo observacional do tipo corte transversal repetido. A coleta de dados foi realizada em dois momentos diferentes do curso, considerando-se os mesmos sujeitos matriculados no 1º e 2º ano do curso em 2002 e no 5º e 6º ano em 2006. Utilizou-se questionário auto-aplicável, abordando características sóciodemográficas, aspectos relacionados ao curso e o Self Reporting Questionnaire. Considerou-se Transtorno Mental Comum como a variável dependente. Para a análise descritiva e a comparação das proporções das variáveis nos dois momentos, foi utilizado o modelo linear generalizado misto, adotando-se o nível de significância estatística de p ≤ 0,05, para rejeição da hipótese de nulidade. Para a análise em cada um dos momentos do levantamento, foi utilizado o Teste do Qui-quadrado. Para a análise multivariada, foi utilizada a regressão logística. Participaram do estudo 284 alunos, sendo 150 em 2002 (83%) e 134 em 2006 (74,4%). A prevalência de TMC foi 37,7% em 2002 e 40,9% em 2006, sem diferença significativa entre ambas (p=0,54). A presença de TMC associou-se significativamente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Medical students are considered a risk group for developing mental disorders, because of the challenges faced by this population, ranging from academic and social demands and challenges inherent to the course, such as large volume of knowledge to learn, lack of leisure time and self-care, dealing with illness and death and great responsibility in taking decisions, with repercussions in patients lives. To estimate the prevalence of Common Mental Disorder (CMD) in medical students in different moments of the course (beginning and ending), identifying risk factors related to students mental health and exposure to medical school. Observational repeated cross-sectional study. Data collection was performed at two different times of the course, considering the subjects enrolled in the 1st and 2nd grade of the course in 2002 and the 5th and 6th grade in 2006. It was used a self-administered questionnaire, addressing socio-demographic and course related data, as well as the Self-Reporting Questionnaire (SRQ). Common Mental Disorder was considered the dependent variable. For descriptive analysis and comparison of the proportions of variables on both occasions, we used generalized linear mixed model, adopting the statistical significance level of p ≤ 0.05 to reject the null hypothesis. For the analysis at each moment of the survey, we used the Chisquare. For multivariate analysis, logistic regression was used. The study included 284 students, 150 in 2002 (83%) and 134 in 2006 (74.4%). The prevalence of CMD was 37.7% in 2002 and 40.9% in 2006, with no significant difference between them (p = 0.54). The presence of CMD was significantly associated with dissatisfaction with the frequency of leisure activities, to feel rejected by friends and have wanted to abandon the course in both moments of the survey. Only when... (Complete abstract click electronic access below). / Mestre

by Chung-Kwong Wong. / Thesis (M.D.)--Chinese University of Hong Kong, 1990. / Includes bibliographies. / Title Page / Dedication / Table of Contents --- p.iii / Abstract --- p.ix / List of Pictures and Figure --- p.xiii / List of Tables --- p.xiv / Acknowledgements --- p.xviii / Statement of Originality --- p.xxi / Chapter PART I --- INTRODUCTION AND BACKGROUNDS TO THE STUDY / Chapter CHAPTER ONE --- INTRODUCTION AND OVERVIEW OF THE THESIS --- p.2 / Chapter CHAPTER TWO --- CHILD PSYCHIATRIC EPIDEMIOLOGY: CONCEPTUAL AND METHODOLOGICAL ISSUES --- p.7 / "Definition of ""Caseness""" --- p.7 / Classification of Specific Psychiatric Syndromes --- p.9 / Sampling --- p.12 / Sources of Information --- p.13 / Data Acquisition Through Questionnaires --- p.16 / Data Acquisition Through Interviews --- p.17 / The Multi-stage and the Multi-method Approach --- p.19 / Statistical Presentations --- p.20 / Summary --- p.20 / Chapter CHAPTER THREE --- PREVALENCE OF CHILD PSYCHIATRIC MORBIDITY： A CROSS-CULTURAL PERSPECTIVE --- p.22 / Some Earlier and More Problematic Studies --- p.22 / Some Earlier and Better Designed Studies --- p.24 / Chapter (1) --- The Buffalo Study (U.S.) --- p.24 / Chapter (2) --- The Isle of Wight and London Studies (U.K.) --- p.25 / Chapter (3) --- The Newcastle Studies (U.K.) --- p.26 / More Recent Studies --- p.28 / Chapter (1) --- The Ontario Child Health Study (Canada) --- p.28 / Chapter (2) --- The Queensland Study (Australia) --- p.29 / Chapter (3) --- The Dunedin Study (New Zealand) --- p.29 / Chapter (4) --- The North Troendelag County Study (Norway) --- p.31 / Chapter (5) --- The Puerto Rico Study (U.S.) --- p.32 / Chapter (6) --- Other Studies --- p.33 / Summary --- p.34 / Chapter CHAPTER FOUR --- THE PURSUIT OF AETIOLOGICAL FACTORS --- p.35 / The Search for Aetiological Factors - General Conceptual Issues --- p.35 / The Search for Aetiological Factors ´ؤ General Methodological Issues --- p.41 / Normal and Psychiatrically Disturbed Children 一 a Comparison of Their Families --- p.42 / The Search for Aetiological Factors - the Life Event Approach --- p.45 / Summary --- p.48 / Chapter CHAPTER FIVE --- THE PREVALENCE OF PSYCHIATRIC MORBIDITY AMONG CHINESE CHILDREN --- p.50 / Psychiatric Morbidity among Chinese Children --- p.50 / Summary --- p.54 / Chapter CHAPTER SIX --- CHILD PSYCHIATRY IN HONG KONG: HISTORICAL AND CLINICAL PERSPECTIVES --- p.55 / A Historical Perspective of Child Psychiatry in Hong Kong --- p.55 / The Child and Adolescent Psychiatric Unit at The Prince of Wales Hospital --- p.58 / Chapter (1) --- Clinical Practice --- p.60 / Chapter (2) --- Undergraduate Teaching --- p.66 / Chapter (3) --- Postgraduate Training and Training of Other Professional Disciplines --- p.67 / Chapter (4) --- Research --- p.67 / Summary --- p.68 / Chapter PART II --- THE STUDY: PSYCHIATRIC MORBIDITY AMONG CHILDREN FROM A PRIMARY SCHOOL IN A LOWER MIDDLE SOCIAL CLASS AREA IN HONG KONG / Chapter CHAPTER SEVEN --- "THE STUDY: THE RESEARCH HYPOTHESES, THE SAMPLE AND THE METHOD" --- p.70 / The Research Hypotheses --- p.70 / Description of the Sample --- p.71 / The First Stage of the Study --- p.73 / Chapter (1) --- The Design of the Multiple Criterion Screening Procedures --- p.69 / Chapter (2) --- The Individual Components of the Multi-component Scale --- p.78 / Chapter (3) --- The Cut-off Point on the Aggregate Score of the Multi-component Scale --- p.81 / Chapter (4) --- The Specific Probing Questions --- p.82 / Chapter (5) --- Missing Cases --- p.83 / The Second Stage of the Study --- p.84 / Chapter (1) --- The Second Stage Sample --- p.84 / Chapter (2) --- The Diagnostic Interview --- p.84 / The Third Stage of the Study --- p.86 / Chapter (1) --- The Third Stage Sample --- p.86 / Chapter (2) --- Interview by Medical Students --- p.86 / Aspects of Diagnosis --- p.87 / An Appraisal of the Method --- p.87 / Summary --- p.88 / Chapter CHAPTER EIGHT --- ASSESSMENT OF THE SCREENING PROCEDURES --- p.89 / "Definition of ""Caseness""" --- p.89 / An Overall Evaluation of the Screening Procedures --- p.90 / An Evaluation of the Individual Components of the Screening Procedures --- p.95 / Constructing Simplified Screening Procedures --- p.104 / Discussion --- p.108 / Chapter (1) --- An Overall Appraisal of the Performance of the Screening Procedures --- p.108 / Chapter (2) --- A Cross-Cultural Comparison of the Screening Procedures --- p.109 / Chapter (3) --- Simplified Alternatives of the Screening Procedures --- p.112 / Chapter (4) --- Alternative Research Approaches to Designing Child Psychiatric Screening Procedures for Hongkong --- p.113 / Summary --- p.114 / Chapter CHAPTER NINE --- THE PREVALENCE OF PSYCHIATRIC MORBIDITY --- p.116 / Aspects of Diagnosis --- p.117 / Chapter (1) --- Classification of Specific Psychiatric Syndromes --- p.117 / Chapter (2) --- The Level of Adaptive Functioning --- p.121 / Chapter (3) --- The Duration of Morbidity --- p.122 / Calculation of Prevalence Rates and Confidence Limits --- p.123 / Prevalence Rates of Specific Psychiatric Syndromes --- p.125 / Discussion --- p.131 / Chapter (1) --- An Appraisal of the Method --- p.131 / Chapter (2) --- The Cross´ؤCultural Similarities --- p.135 / Chapter (3) --- The Controversial Case of the Hyperkinetic Syndromes --- p.137 / Chapter (4) --- The Cross-Cultural Differences --- p.139 / Chapter (5) --- The Subclinical Cases: Implications for Preventive Psychiatry --- p.140 / Chapter (6) --- Representativeness of the Sample and the Generalizability of the Results --- p.141 / Summary --- p.142 / Chapter CHAPTER TEN --- ASSOCIATED ABNORMAL PSYCHOSOCIAL SITUATIONS --- p.144 / Definitions of the Psychosocial Aetiological Factors --- p.145 / Statistical Approaches --- p.148 / The Psychosocial Aetiological Factors in the Sample --- p.150 / Discussion --- p.162 / Chapter (1) --- An Appraisal of the Method --- p.162 / Chapter (2) --- Abnormal Psychosocial Situations in Emotional Disorder and the Two Conduct Disorders in Boys --- p.166 / Chapter (3) --- Abnormal Psychosocial Situations in Conduct Disorders and the Hyperkinetic Syndromes in Boys --- p.168 / Chapter (4) --- Current Abnormal Psychosocial Situations and Emotional Disorder in Girlsi The Gender Factor --- p.171 / Chapter (5) --- Abnormal Psychosocial Situations and Subclinical Cases --- p.172 / Chapter (6) --- The Chinese Approach to Parenting and Socialization - the Influence of Culture --- p.173 / Summary --- p.175 / Chapter CHAPTER ELEVEN --- IMPLICATIONS FOR THE DEVELOPMENT OF CHILD PSYCHIATRY IN HONG KONG --- p.177 / Treatment of Psychiatrically Disturbed Children --- p.177 / Prevention --- p.178 / Undergraduate Medical Education --- p.180 / Research --- p.180 / Child and Adolescent Psychiatry as an Independent Subspecialty in Hong Kong --- p.181 / Summary --- p.182 / Chapter CHAPTER TWELVE --- CONCLUSION --- p.184 / Methodology --- p.184 / Salient Aspects of the Results --- p.186 / Implications for the Future --- p.187 / References --- p.189 / Chapter Appendix --- Selected Publications by the Author --- p.215