A multi-trajectory analysis of commonly co-occurring mental health issues across childhood and adolescence
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ORIGINAL CONTRIBUTION
A multi‑trajectory analysis of commonly co‑occurring mental health issues across childhood and adolescence Aja L. Murray1 · Manuel Eisner2,3 · Daniel Nagin4 · Denis Ribeaud3 Received: 3 June 2020 / Accepted: 28 October 2020 © The Author(s) 2020
Abstract Developmental trajectories of mental health issues can often be usefully summarised in a small number of clinically meaningful subtypes. Given the high levels of heterotypic and homotypic comorbidity in child and adolescent mental health symptoms, we explored whether it was possible to identify clinically meaningful developmental subtypes of multiple commonly co-occurring mental health issues. We evaluated the combined developmental trajectories of the most common and commonly co-occurring child and adolescent mental health issues: attention-deficit/hyperactivity disorder (ADHD), internalising, and externalising symptoms in a normative sample of youth with data (n = 1620) at ages 7, 8, 9, 10, 11, 12, 13 and 15 using group-based multi-trajectory modelling. Multinomial logistic regression was used to evaluate predictors of group membership. Our optimal model included six trajectory groups, labelled ‘unaffected’, ‘normative maturing’, ‘internalising’, ‘multimorbid late onset’, ‘multimorbid remitting’, and ‘multimorbid with remitting externalising’. Examining covariates of group membership suggested that males and bully victims tend to have complex mental health profiles; academic achievement and smoking during pregnancy have general associations with mental health irrespective of symptom developmental trajectories or combination; and maternal post-natal depression is primarily related to symptoms that are already in evidence by the beginning of the school years. Results suggest that developmental trajectories of commonly co-occurring mental health issues can be usefully summarised in terms of a small number of developmental subtypes. These subtypes more often than not involve multiple co-occurring mental health issues. Their association with mental health covariates depends on the combination and developmental timing of symptoms in ways that suggest they can be clinically informative. Keywords Comorbidity · Developmental trajectories · Group-based trajectory modelling · Attention-deficit/hyperactivity disorder · Internalising problems · Externalising problems
Introduction There is considerable variation across individuals in mental health symptom developmental trajectories. Often this can be usefully summarised in terms of just a small number of trajectory classes that can provide a clinically useful basis
* Aja L. Murray [email protected] 1
Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
2
Institute of Criminology, University of Cambridge, Cambridge, UK
3
Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
4
Carnegie Mellon University, Pittsburgh, PA, USA
for subtyping. Early work, for example, delineated two major developmental trajectories of
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