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“What’s a guy like you doing in a place like this?” George Patton University of Melbourne ‘Living in Interesting Times’ RANZCP Adelaide 2009

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Page 1: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“What’s a guy like you doing in a place like this?”

George Patton

University of Melbourne

‘Living in Interesting Times’RANZCP Adelaide 2009

Page 2: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“Youth are heated by nature as drunken men by wine”

Aristotle

Page 3: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“What we ought to see in the agonies of puberty is the result of the conditioning that maims

the female personality in creating the feminine.”

Germaine Greer

Page 4: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“Puberty for a girl is like floating down a broadening river into an

open sea.”

Granville Stanley Hall

Page 5: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

A paradox in adolescent health?

Pubertal changes?

“Sturm und Drang”?

Modifiable social determinants?

4 ideas – 4 studies

Page 6: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

A paradox in adolescent health?

Pubertal changes?

“Sturm und Drang”?

Modifiable social determinants?

Page 7: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Stronger, faster, fitter, smarter

but

morbidity and mortality worsen?

Page 8: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Global burden of disease study - 2004

Page 9: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

All Cause MortalityMales

0

100

200

300

400

500

600

World Highincome

AFR AMR EMR EUR SEAR WPR

/100

.000

pa

10-14

15-19

20-24

Page 10: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

All Cause MortalityFemales

0

100

200

300

400

500

600

World Highincome

AFR AMR EMR EUR SEAR WPR

/100

,000

pa

10-14

15-19

20-24

Page 11: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Male infectious disease deaths

0

20

40

60

80

100

120

10-14 15-19 20-24

/100

,000

pa Low RTI

Meningitis

HIV/AIDS

TB

Page 12: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Male injury deaths

0

20

40

60

80

100

120

10-14 15-19 20-24

/100

,000

pa

Violence

Self-inflicted

Drowning

Fires

Traffic acc

Page 13: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Global Male Disease Burden from Childhood to Young Adulthood

02000400060008000

100001200014000160001800020000

5 to 10 10 to 14 15 to 19 20 to 24

DA

LY

s/10

0,00

0 Violence

Suicide

Traffic Injury

Drug & Alcohol

Mental Disorder

Global Female Disease Burden from Childhood to Young Adulthood

02000400060008000

100001200014000160001800020000

5 to 10 10 to 14 15 to 19 20 to 24

DA

LY

s/10

0,00

0 Violence

Suicide

Traffic Injury

Drug & Alcohol

Mental Disorder

Page 14: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

The paradox is real…..

Problems in emotional control

but

they vary hugely by socio-economic-cultural context

Page 15: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

A paradox in adolescent health?

Pubertal changes?“Sturm und Drang”?Modifiable social determinants?

Page 16: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 17: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

8 9 10 11 12 13 14 15 16 17 18 years

adrenarche

Pubertal Cascade

? HPA axis

Page 18: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

8 9 10 11 12 13 14 15 16 17 18 years

adrenarche

Pubertal Cascade

gonadarche

? HPA axis

HPG axis

Page 19: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

8 9 10 11 12 13 14 15 16 17 18 years

adrenarche

Pubertal Cascade

gonadarche

Growth spurt

HPA axis

HPG axis

GH/somatomedin axis

Oxytocin system ?

Page 20: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

But that’s not all that is happening……..

Page 21: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Frontal grey matter volume

210

215

220

225

230

235

240

4 6 8 10 12 14 16 18 20 22

Page 22: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Adolescent brain development

Prefrontal cortex maturation • extends into the third decade

• impulse control• planning• emotional regulation

Page 23: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Puberty change in mental health?

Page 24: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

‘Child’ problems change

• Attention deficit hyperactivity

• Conduct disorder

• Bed-wetting

• Chronic constipation

• Gender identity disorder

• Asthma

• Eczema

• Epilepsy

Page 25: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

‘Child’ problems change

• Attention deficit hyperactivity

• Conduct disorder

• Bed-wetting

• Chronic constipation

• Gender identity disorder

• Asthma

• Eczema

• Epilepsy

Page 26: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

‘Adult’ problems emerge

• Depression - anxiety syndromes

• Deliberate self-harm

• Substance abuse

• Eating disorders

• Dysmorphophobia

• Psychotic symptoms

• Functional somatic disorders

• Pain syndromes eg migraine

Page 27: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

International Youth Development Study

www.iyds.org

Page 28: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

WASHINGTON USA VICTORIA AUSTRALIA

Age 10 11 12 13 14 15 16 10 11 12 13 14 15 16

2003 943 961 981 927 984 973

2004 936 946 975 916 970 959

2005 n/a 936 n/a 907 941 n/a

Page 29: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

I

II

III

IV

V

Early

Mid

Late

Page 30: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Mental disorders commoner from puberty

• Depression - anxiety syndromes

• Deliberate self-harm

• Substance abuse

• Eating disorders

• Dysmorphophobia

• Psychotic symptoms

• Functional somatic disorders

• Pain syndromes eg migraine

Substance abuse & pubertal stage (ages 12-15 years)

0

5

10

15

20

25

30

35

I/II III IV/V

12 yrs13 yrs14 yrs15 yrs

Page 31: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Mental disorders commoner from puberty

• Depression - anxiety syndromes

• Deliberate self-harm

• Substance abuse

• Eating disorders

• Dysmorphophobia

• Psychotic symptoms

• Functional somatic disorders

• Pain syndromes eg migraine

Deliberate self harm by early and late pubertal stage

0

2

4

6

8

10

I-III IV/V I-III IV/V

%

Males Females

Page 32: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Depressive symptoms & pubertal stage in girls

0

5

10

15

20

25

30

35

40

I/II III IV/V

Wave 1Wave 2Wave 3

Tanner stage

%

Page 33: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Depressive symptoms & pubertal stage in males

0

5

10

15

20

25

30

35

40

I/II III IV/V

Wave 1Wave 2Wave 3

Tanner stage

%

Page 34: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Depressive symptoms & pubertal stage(OR, 95% CI))

Pubertal stageEarly 1Mid 1.4 (1.0, 1.9)Late 2.5 (1.7, 3.6)

Age 1.0 (0.8, 1.2)School grade 1.0 (0.8, 1.2)

Page 35: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

So is depression all that changes?

Page 36: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 37: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 38: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 39: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 40: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Depression & Puberty: a longitudinal view

Pub Dep

M

Page 41: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

T1 T2

Transitional Models of Onset

Page 42: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Puberty

IncidentDepression

Neuro-biology

Social context

Emotional control

Page 43: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Puberty

IncidentDepression

Neuro-biology

Social context

Emotional control

Page 44: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

T1 T2

Transitional Models of Persistence

Page 45: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Puberty

IncidentDepression

Neuro-biology

Social context

Emotional control

Page 46: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Puberty

PersistingDepression

Neuro-biology

Social context

Emotional control

Page 47: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Emotional control & pubertal depression

Pub

erty

Page 48: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

‘Emotional control’ & pubertal depression

Re-emergence

Page 49: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Emotional control & pubertal depression

Re-emergence

Continuation

Page 50: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Emotional control & pubertal depression

Re-emergence

Continuation

Pubertal effect

Page 51: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Emotional control & pubertal depression

Re-emergence

Continuation

Pubertal effect

Prodrome

Page 52: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

A paradox in adolescent health?

Pubertal changes?

“Sturm und Drang”?Modifiable social determinants?

Page 53: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

20,000 years ago

2,000 years ago

200 years ago

50 years ago

Present day

10 years

20 years

30 years

Industrial revolution

Agricultural settlement

Mid 20th Century

Menarche

Psychosocial maturation

Mism

a tch of bi olo gi cal an d psy ch os oci al tra nsi tio ns *

Hunter gatherers

Social – biological disjunction

Adapted from Gluckman

Page 54: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 55: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Victorian Adolescent Health Cohort Study

1 2 3 4 5 6 7 8 914 yrs 17 yrs 21 yrs 24 yrs 28 yrs

90% 88% 87% 83% 81% 78% 81% 78% 77%

Page 56: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Teen cannabis and mental health

Teen drinking and later alcohol problems

Common eating disorders and later adjustment

Adolescent health and the next generation

Page 57: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 58: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 59: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Males

0 . 0 0

0 . 2 0

0 . 4 0

0 . 6 0

0 . 8 0 A l c o h o l u s e d i s o r d e r

0 . 0 0

0 . 1 0

0 . 2 0

0 . 3 0

0 . 4 0

0 . 5 0 H i g h - r i s k a l c o h o l u s e

0 . 0 0

0 . 1 0

0 . 2 0

0 . 3 0 A l c o h o l - r e l a te d s e x u a l b e h a v i o r

Pre

vale

nce

Nondrinker

0 2+

Waves

2001 Short Term NHMRC Guidelines

1

2001 Long Term NHMRC Guidelines

2007NHMRC Guidelines

Nondrinker

0

Waves

Nondrinker

0 2+

Waves

1 2+1

Page 60: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 61: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“I’m not a saint but I’m not a sinner,

Everything’s cool, as long as I’m

getting thinner..”

Lily Allen 2009 – The Fear

Page 62: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

1980’s: early ‘Early Intervention’

0

0.5

1

1.5

2

2.5

3

3.5

4

Anorexianervosa

BulimiaNervosa

Partialsyndrome

Binge EatingDisorder

Page 63: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

But how do partial syndromes travel in the longer term?

Page 64: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

0

10

20

30

40

50

60

70

%

Underweight Eating disorder

None Anorexic Bulimic

Eating Disorder Partial syndromes 10 yrs on

Page 65: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Eating Disorder Partial syndromes 10 yrs on

05

101520253035404550

%

Depression/anxiety Alcohol Use Disorder

None Anorexic Bulimic

Page 66: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Early intervention and thinking outside the syndrome?

Page 67: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Victorian Adolescent Health Cohort Study

1 2 3 4 5 6 7 8 914 yrs 17 yrs 21 yrs 24 yrs 28 yrs

90% 88% 87% 83% 81% 78% 81% 78% 77%

Offspring

Page 68: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Predicting Attachment Problems

0

5

10

15

20

25

Personality Disorder None

Odd Ratio 3.2 (1.2, 8.8)

Page 69: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Predicting Post-natal Depression from Teen Psychiatric Morbidity

0

5

10

15

20

25

30

Persisting Intermittent None

Odd Ratio 3.3 (1.2, 9.4)

Page 70: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Heavy teen cannabis and birth outcomes

0

5

10

15

20

25

30

35

Prem Full-term LBW Normal Wt

Odd Ratio 6.5 (1.8, 24)Odd Ratio 7.8 (1.8, 35)

Page 71: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Not just ‘Sturm und Drang’….

Page 72: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

A paradox in adolescent health?

Pubertal changes?

“Sturm und Drang”?

Modifiable social determinants?

Page 73: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“For a dozen formative

years children spend almost

half their waking hours in schools”

Page 74: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 75: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality
Page 76: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Gatehouse: a semi-structured process

Assess social

environment

School action team

Best practice at

multiple levels

Page 77: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Types of bullying

0102030405060

Tea

sing

Spr

eadi

ngru

mou

rs

Del

iber

atel

yle

ft ou

t

Phy

sica

llyth

reat

ened

or h

urt

Comparison

School X

Page 78: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

0

5

10

15

20

25

30

35

No-one to talk to ifupset

No-one to dependon

No-one knows me

Comparison

School X

Communication and social connectedness

Page 79: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

05

101520253035404550

Teachersdon't notice

me

Fewchances to

planactivities

Teachersnot fair

Too muchschoolwork

Don't helpothers

Comparison

School X

Page 80: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Gatehouse: a semi-structured process

Assess social

environment

School action team

Best practice at

multiple levels

Page 81: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Gatehouse: a semi-structured process

Assess social

environment

School action team

Best practice at

multiple levels

Page 82: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“ Clustered randomised trial meets participatory action research”

Page 83: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Baseline: year 8 students (13-14 yo)

Page 84: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

2 years: year 8 students (13-14 yo)

Page 85: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

2 years: year 8 students (13-14 yo)

Page 86: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

4 years: year 8 students (13-14 yo)

Page 87: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“Improving school ethos may reduce substance misuse and teenage pregnancy”

Editorial BMJ 2007;334;614-616

Page 88: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“a guy like you in a place like this?”

Psychiatry• Rob Selzer• Paul Moran• Anthony Mann• Mike Sawyer

Endocrinology• Russell Viner

Paediatrics• Susan Sawyer

General Practice• Lena Sanci

Biostatistics• John Carlin

Epidemiology• Carolyn Coffey• Louisa Degenhardt• Wayne Hall • Elya Moore Demography

• Colin MathersPsychology• Craig Olsson • John Toumbourou• Lyndal Bond• Sue Spence

Education• Sara Glover• Helen Butler

Sociology• Rico Catalano

Internal Medicine• Glenn Bowes• Yvonne Bonomo

Page 89: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

• Pubertal transitions in health

• Sexual & reproductive health

• Mental health

• Substance use

• Chronic conditions

• Youth friendly primary care services

2007 Lancet Series in Adolescent Health

Page 90: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

“Beyond Mortality: the future of global adolescent health”

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But what about other mental disorders?

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0

10

20

30

40

50

60

70

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< weekly Weekly + Daily

Association of high depression & anxiety at 21 years

Female daily users > 8 times symptoms rate!

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Maximal teen use & depression/anxiety at 21

Female weekly usersOR 2.3 (1.3, 4.2) Female daily users

OR 4.2 (1.6, 11)

Page 97: “What’s a guy like you doing in a place like this?”...Stronger, faster, fitter, smarter but morbidity and mortality worsen? Global burden of disease study - 2004 All Cause Mortality

Patton, Coffey, Carlin et al. (2002) Cannabis use and mental health in young people: BMJ. 325:1195-8.


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