Family Health History Study

The Family Health History Study began in 2003 and was officially completed in January 2006, more than 1900 interviews later and with over 90% of Dunedin Multidisciplinary Health and Development Study (DMHDS) members’ parents (and some aunts and uncles) being interviewed. The purpose of this study was to find out about the health of the family members of the young people in the DMHDS. The Research Leader of this Study was Professor Terrie Moffitt .

Overview

 What participation in the Study involved

A research interviewer visited the participants in their home. The interview lasted for about two hours and covered a variety of topics about the participants and their family members. These topics are listed below.

Interview topics:

The participants were asked a range of questions about their health and the health of their family members, and covered six main topics:

1.  Questions about life in general, including:

• Name, date of birth, marital status and living arrangements, e.g. whether the participant rented or owned their home, and how many people lived with them.
• Education level and jobs held.
• Retirement or plans for retirement.
• Household finances, and superannuation plans.
• Any religious or spiritual beliefs.

2.  Questions about physical health, including:

• a range of possible health problems that may have been experienced, such as heart attacks, angina, strokes, high cholesterol, diabetes, asthma, allergies, arthritis, high blood pressure, cancers, dental problems and headaches.
• Height, weight, exercise participation and smoking.
• Alcohol consumption over the lifecourse and use of illegal drugs.
• Women’s menopause, fertility treatment and hormone replacement therapy.

3.  Questions about the physical health of family members, including the participant’s parents, children, and husband/wife.

4.  Questions about emotional health during the participant’s life, and any emotional difficulties that may have been experienced, such as depression.

5.  Questions about the participant’s family members’ emotional health.

6.  Questions about the participant’s views on life and the people important to them, including:

• attitudes to life generally
• family members and friends who provide support
• relationship with partner or spouse
• experience of being a grandparent, or whether the participant is looking forward to becoming a grandparent.

Some results

Nearly three-quarters had grand-children, with the number of grandchildren ranging from 1 to over 20!

Of the 10% who have already retired, nearly two-thirds find retirement to be “Very Satisfying’.

In terms of general health, 5% had had at least one heart attack, and one-third had been told by their Doctor that they have (or have had) High Cholesterol and High Blood Pressure. Interestingly, while over 50% had smoked at some time in their lives, only 20% smoke now.

On the exercise front, nearly half reported doing absolutely no “intense physical exercise” during the week, but 20% were doing 4 or more sessions per week, with 10% doing up to 3 sessions.

Whereas a little over 40% of had been depressed at some point in their lives, close to 90% felt optimistic about their future and more than half felt things were “better than you expected them to be”.

Publications:

Milne, B. J., Caspi, A., Crump, R., Poulton, R., Rutter, M., Sears, M. R., and Moffitt, T. E. The validity of the Family History Screen for assessing family history of mental disorders. American Journal Of Medical Genetics B: Neuropsychiatric Genetics, 2009, 150B(1): 41-49.

Abstract: There is a need to collect psychiatric family history information quickly and economically (e.g., for genome-wide studies and primary care practice). We sought to evaluate the validity of family history reports using a brief screening instrument, the Family History Screen (FHS). We assessed the validity of parents' reports of seven psychiatric disorders in their adult children probands from the Dunedin Study (n = 959, 52% male), using the proband's diagnosis as the criterion outcome. We also investigated whether there were informant characteristics that enhanced accuracy of reporting or were associated with reporting biases. Using reports from multiple informants, we obtained sensitivities ranging from 31.7% (alcohol dependence) to 60.0% (conduct disorder) and specificities ranging from 76.0% (major depressive episode) to 97.1% (suicide attempt). There was little evidence that any informant characteristics enhanced accuracy of reporting. However, three reporting biases were found: the probability of reporting disorder in the proband was greater for informants with versus without a disorder, for female versus male informants, and for younger versus older informants. We conclude that the FHS is as valid as other family history instruments (e.g., the FH-RDC, FISC), and its brief administration time makes it a cost-effective method for collecting family history data. To avoid biasing results, researchers who aim to compare groups in terms of their family history should ensure that the informants reporting on these groups do not differ in terms of age, sex or personal history of disorder. (DMHDS PUBLICATION ID NO. RO570)

Milne, B. J., Caspi, A., Harrington, H. L., Poulton, R., Rutter, M., and Moffitt, T. E. Predictive value of family history on severity of illness: the case for depression, anxiety, alcohol dependence, and drug dependence. Archives of General Psychiatry, 2009 , 66(7): 738-47.

Abstract: CONTEXT: If family history is associated with clinical features that are thought to index seriousness of disorder, this could inform clinicians predicting patients' prognosis and researchers selecting cases for genetic studies. Although tests of associations between family history and clinical features are numerous for depression, such tests are relatively lacking for other disorders. OBJECTIVE: To test the hypothesis that family history is associated with 4 clinical indexes of disorder (recurrence, impairment, service use, and age at onset) in relation to 4 psychiatric disorders (major depressive episode, anxiety disorder, alcohol dependence, and drug dependence). DESIGN: Prospective longitudinal cohort study. SETTING: New Zealand. PARTICIPANTS: A total of 981 members of the 1972 to 1973 Dunedin Study birth cohort (96% retention). MAIN OUTCOME MEASURES: For each disorder, family history scores were calculated as the proportion of affected family members from data on 3 generations of the participants' families. Data collected prospectively at the study's repeated assessments (ages 11-32 years) were used to assess recurrence, impairment, and age at onset; data collected by means of a life history calendar at age 32 years were used to assess service use. RESULTS: Family history was associated with the presence of all 4 disorder types. In addition, family history was associated with a more recurrent course for all 4 disorders (but not significantly for women with depression), worse impairment, and greater service use. Family history was not associated with younger age at onset for any disorder. CONCLUSIONS: Associations between family history of a disorder and clinical features of that disorder in probands showed consistent direction of effects across depression, anxiety disorder, alcohol dependence, and drug dependence. For these disorder types, family history is useful for determining patients' clinical prognosis and for selecting cases for genetic studies. (DMHDS PUBLICATION ID NO. RO585)

Milne, B. J., Moffitt, T. E., Crump, R., Poulton, R., Rutter, M., Sears, M. R., Taylor, A., and Caspi, A. How should we construct psychiatric family history scores? A comparison of alternative approaches from the Dunedin Family Health History Study. Psychological Medicine, 2008, 38(12): 1793-802.

Abstract: BACKGROUND: There is increased interest in assessing the family history of psychiatric disorders for both genetic research and public health screening. It is unclear how best to combine family history reports into an overall score. We compare the predictive validity of different family history scores. Method: Probands from the Dunedin Study (n=981, 51% male) had their family history assessed for nine different conditions. We computed four family history scores for each disorder: (1) a simple dichotomous categorization of whether or not probands had any disordered first-degree relatives; (2) the observed number of disordered first-degree relatives; (3) the proportion of first-degree relatives who are disordered; and (4) Reed's score, which expressed the observed number of disordered first-degree relatives in terms of the number expected given the age and sex of each relative. We compared the strength of association between each family history score and probands' disorder outcome. RESULTS: Each score produced significant family history associations for all disorders. The scores that took account of the number of disordered relatives within families (i.e. the observed, proportion, and Reed's scores) produced significantly stronger associations than the dichotomous score for conduct disorder, alcohol dependence and smoking. Taking account of family size (i.e. using the proportion or Reed's score) produced stronger family history associations depending on the prevalence of the disorder among family members. CONCLUSIONS: Dichotomous family history scores can be improved upon by considering the number of disordered relatives in a family and the population prevalence of the disorder. (DMHDS PUBLICATION ID NO. RO569)

Odgers, C. L., Milne, B. J., Caspi, A., Crump, R., Poulton, R., and Moffitt, T. E. Predicting prognosis for the conduct-problem boy: Can family history help? Journal of the American Academy of Child and Adolescent Psychiatry, 2007, 46(10): 1240-1249.

Abstract: OBJECTIVE: Many children with conduct disorder develop life-course persistent antisocial behavior; however, other children exhibit childhood-limited or adolescence-limited conduct disorder symptoms and escape poor adult outcomes. Prospective prediction of long-term prognosis in pediatric and adolescent clinical settings is difficult. Improved prognosis prediction would support wise allocation of limited treatment resources. The purpose of this article is to evaluate whether family history of psychiatric disorder can statically predict long-term prognosis among conduct-problem children. METHOD: Participants were male members of the Dunedin Study, a birth cohort of 1,037 children (52% male). Conduct-problem subtypes were defined using prospective assessments between ages 7 and 26 years. Family history interviews assessed mental disorders for three generations: the participants' grandparents, parents, and siblings. RESULTS: Family history of externalizing disorders distinguished life-course persistent antisocial males from other conduct-problem children and added significant incremental validity beyond family and child risk factors. A simple three-item family history screen of maternal-reported alcohol abuse was associated with life-course persistent prognosis in our research setting and should be evaluated in clinical practice. CONCLUSIONS: Family history of externalizing disorders distinguished between life-course persistent versus childhood-limited and adolescent-onset conduct problems. Brief family history questions may assist clinicians in pediatric settings to refine the diagnosis of conduct disorder and identify children who most need treatment in pediatric settings to refine the diagnosis of CD and identify children who need treatment most. (DMHDS PUBLICATION ID NO. RO540)