BACKGROUND:Experiencing material hardship is a significant risk factor for developing depression and anxiety in adolescents. This study investigates the potential mediator roles of maternal mental health and bullying victimisation in the association between material hardship and adolescent depression and anxiety symptoms. METHOD:The study included 4563 adolescents from the Growing Up in New Zealand (GUiNZ) longitudinal study. Depression and anxiety symptoms were measured at the 12-year Data Collection Waves (DCWs). Material hardship was measured at nine-month and 4.5-year DCWs. The potential mediators, maternal mental health and bullying victimisation, were assessed at the eight-year-DCW. For each outcome, we analysed the mediating effects of each mediator separately and jointly, accounting for potential cross-path effects. Structural mediation models were adjusted for relevant covariates. RESULTS:The covariate-adjusted multiple mediation model showed that the direct effect of maternal hardship was significant for depression (β 0.75, p < 0.001) but not anxiety symptoms. The total indirect effect was significant for both depression (β 0.19, p < 0.001) and anxiety symptoms (β 0.30, 95% p < 0.001). A significant cross-path effect was observed from maternal mental health to bullying victimisation, whereas the reverse path was not significant. DISCUSSION:Our findings revealed distinct mediation pathways through which material hardship influences adolescent depression and anxiety symptoms. The effect of material hardship on depression symptoms was both direct and indirectly mediated by maternal mental health and bullying victimisation. In contrast, the effect on anxiety symptoms was fully mediated by these factors, suggesting no direct association.

The impact of the COVID-19 pandemic and associated lockdown measures on child and family functioning requires ongoing investigation to understand its far-reaching effects. This study investigated the experiences of 10-year-old children ( n  = 2421) from the Growing Up in New Zealand longitudinal cohort during some of the strictest pandemic-related lockdown measures of 2020, with the aim of examining the effects of these measures on several aspects of children's lives and wellbeing. Children reported on their lockdown experiences in relation to household ‘bubbles’, school, family, social connectedness and activities. The findings indicate that although the lockdown restrictions disrupted regular routines and activities, children and their families largely demonstrated great adaptability and had largely positive experiences together, despite the worldwide crisis. For example, 79% of children in the study indicated that they were having a good time with their family during the lockdown period and almost 85% indicated that they felt moderately or strongly socially connected with others during this time. This study also highlights challenges experienced by some children during lockdown. Post-pandemic strategies aimed at mitigating difficulties and improving children's experiences should aim to reflect the diversity of these experiences. The findings of this study are relevant to other countries that implemented lockdown restrictions during the COVID-19 pandemic, shedding light on the day-to-day experiences of children and families during this unprecedented time.

Regular school attendance is critical for young people, supporting academic achievement, social development, and the cultivation of lifelong habits. Existing research for analysing attendance patterns often relies on structured survey data targeted at their parents and teachers, which overlooks students' perspectives and experiences. To address this gap, our team developed and deployed the Our Journey platform, which enables young people to share their experiences through multimodal responses such as texts and images, offering unique insights into the factors influencing school attendance. The data is linked to official attendance records from the Ministry of Education, allowing the modelling of attendance outcomes based on students' input. To effectively analyse the data, we propose Thematic Bottleneck Models (TBMs) to enhance the understanding of subjective experiences behind data and the interpretability of attendance modelling. TBMs introduce qualitative concepts as intermediate labels, mapping multimodal data to qualitative insights from thematic analysis before the outcomes. The attendance modelling with TBMs outperforms existing multimodal methods in predicting attendance percentage and persistent absenteeism. Analysis of themes within TBMs reveals motivational and contextual factors associated with regular attendance and persistent absenteeism. The findings are used to inform education policy and guide strategies to support student engagement in New Zealand.

School attendance is an important factor in educational success and plays a key role in shaping students' academic and social development. Longitudinal surveys provide valuable insights into factors affecting attendance patterns, yet analysing such data presents unique challenges. First, the variation in survey questions across data collection waves complicates the application of standard temporal modelling techniques that assume consistent features over time. Second, conventional methods often one-hot encode survey responses, stripping away contextual meaning within questions and responses. Lastly, open-ended responses are typically omitted, leading to a loss of valuable qualitative insights. To address these challenges, we propose Survey-as-Text Modelling (STM), which represents multi-wave survey questionnaires as coherent textual sequences. By maintaining the textual format, STM allows similar questions across different years to be compared directly rather than existing as independent features. STM also retains the meaning within question-response pairs, preventing loss of information from one-hot encoding and enabling the incorporation of open-ended responses. We apply STM to survey data from Growing Up in New Zealand and link it to official attendance records from the New Zealand Ministry of Education. We leverage large language models (LLMs) to predict future school attendance from text-based surveys, outperforming existing temporal methods. Beyond predictive accuracy, we propose gradient-guided counterfactual analysis to identify key survey questions influencing the model's decision-making. Our findings highlight the potential of LLMs for survey analysis and provide data-driven insights that can inform policy and intervention strategies.

The impact of the COVID‐19 pandemic and associated lockdown measures on child and family functioning requires ongoing investigation to understand its far‐reaching effects. This study investigated the experiences of 10‐year‐old children ( n = 2421) from the Growing Up in New Zealand longitudinal cohort during some of the strictest pandemic‐related lockdown measures of 2020, with the aim of examining the effects of these measures on several aspects of children's lives and wellbeing. Children reported on their lockdown experiences in relation to household ‘bubbles’, school, family, social connectedness and activities. The findings indicate that although the lockdown restrictions disrupted regular routines and activities, children and their families largely demonstrated great adaptability and had largely positive experiences together, despite the worldwide crisis. For example, 79% of children in the study indicated that they were having a good time with their family during the lockdown period and almost 85% indicated that they felt moderately or strongly socially connected with others during this time. This study also highlights challenges experienced by some children during lockdown. Post‐pandemic strategies aimed at mitigating difficulties and improving children's experiences should aim to reflect the diversity of these experiences. The findings of this study are relevant to other countries that implemented lockdown restrictions during the COVID‐19 pandemic, shedding light on the day‐to‐day experiences of children and families during this unprecedented time.

BACKGROUND:Depression and anxiety often co-occur, resulting in a more severe prognosis than either condition alone. Identifying the impact of risk factors on this comorbidity is essential for guiding early interventions. METHOD:Data from 4563 young participants in the Growing Up in New Zealand (GUiNZ) longitudinal study were analysed to identify risk factors associated with comorbid depression and anxiety. Scores for depression and anxiety symptoms were converted into binary variables using the cut-off of 10 and 60, respectively, and then combined to create the comorbidity outcome. A Cumulative Risk (CR) score was used to measure the impact of multiple risk factors from prenatal to childhood on the likelihood of this comorbidity. CR scores were further grouped into three levels of risk, and their association with comorbidity was examined using univariable and multivariable logistic regression analyses. RESULTS:The prevalence of comorbidity at age 12 years was 8.9% (406/4563). Among young people, 14.2% (647/ 4563) had no risk factors, 64.7% (2953/4563) had one to three (low CR score level), and 21.1% (963/4563) had four or more risk factors (high CR score level). In the adjusted analyses, young people in the low and high CR levels had 2.6 times and 4.6 times higher odds, respectively, of experiencing comorbidity compared to those with no risk factors. DISCUSSION:The risk of comorbid depression and anxiety symptoms increases with the number of risk factors experienced from prenatal to childhood. Multi-faceted interventions targeting several risk factors are recommended to improve youth mental health.

Autism is a relatively common neurodevelopmental difference with considerable phenotypic heterogeneity impacting cognitive, sensory, and social processing, and often co-occurs with other conditions. Therefore, there is not a one-size-fits-all clinical support pathway for autistic individuals following diagnosis. DNA sequencing technology has enabled the discovery of genes causative of, or associated with, autism. Unsurprisingly, genetic heterogeneity goes hand-in-hand with the phenotypic heterogeneity for this condition; with causative genetic variation ranging from single base pair changes to complex chromosomal rearrangements in more than 100 different genes. This study captures a snapshot (201 individuals) of the autistic population (both clinically referred and self-referred) in Aotearoa New Zealand and documents a decade's research effort to refine diagnosis using a flexible and customised genome-wide sequencing approach. The diagnostic yield in this phenotypically disparate cohort was 12.9%, with an additional 15.9% of individuals harbouring 'likely causal' variants, providing the groundwork to tailor clinical, social, and educational care. Importantly, this study reveals the diagnostic utility of customised genetic screening for autism across a phenotypically diverse autistic population.

Introduction Asthma is a heterogeneous condition that is characterized by reversible airway obstruction. Childhood-onset asthma (COA) and adult-onset asthma (AOA) are two prominent asthma subtypes, each with unique etiological factors and prognosis, which suggests the existence of both shared and distinct risk factors.Methods Here, we employed a two-sample Mendelian randomization analysis to elucidate the causal association between genes within lung and whole-blood-specific gene regulatory networks (GRNs) and the development of unspecified asthma, COA, and AOA using the Wald ratio method. Lung and whole blood-specific GRNs, encompassing spatial eQTLs (instrumental variables) and their target genes (exposures), were utilized as exposure data. Genome-wide association studies for unspecified asthma, COA, and AOA were used as outcome data in this investigation.Results We identified 101 genes that were causally linked to unspecified asthma, 39 genes causally associated with COA, and ten genes causally associated with AOA. Among the identified genes, 29 were shared across some, or all of the asthma subtypes. Of the identified causal genes, ORMDL3 had the strongest causal association with both unspecified asthma (OR: 1.49; 95% CI:1.42-1.57; p=7.30x10-51) and COA (OR: 3.37; 95% CI: 3.02-3.76; p=1.95x10-102), whereas PEBP1P3 had the strongest causal association with AOA (OR: 1.28; 95% CI: 1.16-1.41; p=0.007).Discussion This study identified shared and unique genetic factors causally associated with different asthma subtypes. In so doing, our study emphasizes the need to move beyond perceiving asthma as a singular condition to enable the development of therapeutic interventions that target sub-type specific causal genes.

BACKGROUND:Adolescent depression has increased markedly over the last decade and often persists into adulthood with a range of adverse outcomes. Identifying the perinatal risk factors contributing to adolescent depression is crucial to advise early interventions. METHODS:The study included 4563 young people from the Growing Up in New Zealand (GUiNZ) longitudinal study who completed a questionnaire on depression symptoms at age 12 years (Centre for Epidemiological Studies Depression Scale for Children (CESD-10). Cumulative Risk (CR) scores were created by combining the perinatal risk factors significantly associated with depression symptoms. Then, these CR scores were grouped into three levels and their association with depression symptoms was investigated in univariable and multivariable analyses. RESULTS:We found a statistically significant association between the CR scores (from one to six perinatal risk factors) and depression score at age 12, compared to the no-risk factor group, suggesting a dose-response relationship. In the adjusted analysis, young people exposed to the lower CR score (1-3 risk factors) had a 0.85 unit increase in depression score (p- < .001), and those exposed to the higher CR (4 ≥ risk factors) had a 1.70 unit increase (p < .001) compared to no perinatal risk factors. LIMITATIONS:Our model was focused on the perinatal CR score without including the effects of childhood risk factors. CONCLUSIONS:The perinatal CR score is a valuable approach to identifying the subgroup of young people who are most at risk for depression symptoms. As such, early interventions that simultaneously address multiple perinatal risk factors for depression are recommended.

Psychosocial challenges impact patients’ ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs’ understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.

Background: Early life environments can have long-lasting impacts on future health and wellbeing. Maternal health during pregnancy, including experiencing stress or mood disorders, has been associated with psychopathology in later life. Anxiety disorders are one of the most prevalent mental health conditions, affecting approximately 7 % of children and adolescents globally, with a lifetime prevalence of 15-20 %. Identifying prenatal risk factors can support future and current public health interventions and maternity care. Methods: Data were obtained from the Growing Up in New Zealand longitudinal study of child development. Prenatally, mothers provided sociodemographic information as well as data on their mental health, potential teratogens, and lifestyle factors such as supplement intake and exercise levels. At 8-years old, 4922 children selfcompleted the PROMIS-SF anxiety measure. Bivariate analyses and backward stepwise regression were used to determine the best multivariable model. Results: Significant prenatal predictors of anxiety symptoms at 8-years old included elevated maternal depression symptoms, body mass index in the overweight/obese range, exercise patterns, and paracetamol, antiinflammatory and alcohol intake. Limitations: Sample attrition from baseline to 8-year may have affected statistical power. To further untangle the effect of timing and duration of the exposures reported in this study, larger sample sizes would be required. Conclusions: Prenatal mental health and wellbeing was significantly associated with child anxiety symptoms at 8years of age. This study highlights the importance of supporting expectant mothers' health and wellbeing during pregnancy to ensure children have the best opportunity to have good mental health.

The biological mechanisms that explain how adverse early life events influence adult disease risk are poorly understood. One proposed mechanism is via the induction of accelerated biological aging, for which telomere length is considered a biomarker. We aimed to determine if maternal depression pre- and post-partum was associated with telomere length in children at 4 years of age (n=4299). Mothers completed structured questionnaires assessing depression during pregnancy (Edinburgh Depression Scale), at 9 months (Edinburgh Depression Scale), and at 54 months postpartum (Patient Health Questionnaire 9). Regression methods were used to investigate the relationship between telomere length (DNA from saliva) and maternal depression score recorded at each stage. Significant covariates included in the final model were: maternal age at pregnancy; child sex; child ethnicity; gestational age group, and rurality group. Child telomere length was found to be longer if their mother had a higher depression score at both postpartum time points tested (9 months of age; coefficient 0.003, SE=0.001, P=0.01, 54 months of age; coefficient 0.003, SE=0.002, P=0.02). Although these findings seem paradoxical, increased telomere length may be an adaptive response to early life stressors. We propose several testable hypotheses for these results and to determine if the positive association between depression and telomere length is a developmental adaptation or an indirect consequence of environmental factors.

Racism is a determinant of individual and offspring health. Accelerated telomere shortening, an indicator of cellular aging, is a potential mechanism through which parental experience of racism could affect offspring. Here we longitudinally evaluated the relationship between maternal lifetime experience of an ethnically-motivated verbal or physical attack, as reported in pregnancy, with offspring telomere length in 4.5-year-old children. We also explored the potential association between positive feelings about one’s culture and offspring telomere length. Data come from a nationally representative, multi-ethnic birth cohort in Aotearoa New Zealand (NZ) (Māori N = 417, Pacific N = 364, Asian N = 381). In models adjusting for covariates, including socioeconomic status and health status, Māori mothers who experienced an ethnically-motivated physical attack had children with significantly shorter telomere length than children of Māori mothers who did not report an attack (B = − 0.20, p = 0.01). Conversely, Māori mothers who had positive feelings about their culture had offspring with significantly longer telomeres (B = 0.25, p = 0.02). Our results suggest that ethnicity-based health inequities are shaped by racism, with impacts for clinical care and policy. Future research should also evaluate the potential protective effects of positive cultural identity.

Since 2015 Médecins Sans Frontières (MSF) has been supporting the Ministry of Health (MoH) in Tonkolili district, Sierra Leone, with an integrated health care approach at the community, primary health centre (PHC), and hospital level. This programme is planned to be handed over to MoH. To prepare for this handover, a qualitative study exploring elements of a successful handover was undertaken in 2019. Focus group discussions (FGD) with the community members (n-48) and in-depth interviews (IDI) with MSF staff, community leaders, and MoH staff in Sierra Leone (n-15) were conducted. Data were audio-recorded, transcribed verbatim from English, Creole, and Themne, coded, and thematically analysed. Participants expressed that an optimal project handover and exit strategy should be a continuous, long-term, the staggered process included from the inception of the programme design. It requires clear communication and relationship building by all relevant stakeholders and demands efficient resources and management capacity. Associated policy implications are applicable across humanitarian settings on the handover of programmes where the government is functional and willing to accept responsibilities.

BACKGROUND:Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression. METHODS:Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure. RESULTS:When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated. LIMITATIONS:The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems. CONCLUSIONS:Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.

Abstract Asthma is a heterogeneous phenotype that is often associated with other phenotypes. Identifying the genetic mediators that modulate the interaction between asthma and asthma-associated conditions will help inform our understanding of asthma heterogeneity. Here, we used Mendelian randomisation to identify asthma causal genes and their modifier spatial eQTLs within lung and whole blood-specific gene regulatory networks (GRNs), which integrate information on spatial genome organisation with tissue-specific expression quantitative trait loci (eQTL) data. Subsequently, we located the asthma-causal genes in the tissue-specific GRNs to define a putative asthma GRN and identified curated protein interaction partners occurring up to 4 edges (levels) away from the asthma GRN (level 0). We then queried the GWAS Catalog with the spatial eQTLs regulating level 0-4 genes to identify the GWAS traits enriched at each level (hypergeometric test; FDR≤0.05). This identified 113 traits significantly enriched in the regulatory space proximal to asthma, 106 of which had known associations with asthma (e.g., systemic lupus erythematosus and age-related macular degeneration) and seven traits whose association with asthma is yet to be confirmed. Importantly, our analysis identifies the genes and SNPs that modulate the interaction between asthma and asthma-associated traits by identifying the direct and indirect protein interacting partners of asthma causal genes. Finally, we highlight the druggable genes identified in our analysis, thereby providing new drug-repurposing opportunities for asthma.

BACKGROUND:Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention.METHODS:The current study included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information. Depressive symptoms were measured at age 8 using the Centre for Epidemiological Studies Depression Scale for Children (CESD-10) short form questionnaire. Hierarchical linear regression was used to determine the relationship between prenatal factors and depressive symptoms at age 8.RESULTS:When controlling for sociodemographic characteristics, our hierarchical linear regression revealed that the most significant maternal prenatal predictors of high depressive symptoms at age 8 were maternal perceived stress, smoking during pregnancy, body mass index (BMI) in the overweight/obese range, and paracetamol intake.LIMITATIONS:One limitation with the current study was a reduction in the sample due to attrition. This may have affected our statistical power, reflected in our modest effect sizes. The sample remained both socioeconomically and ethnically diverse, however our results should be interpreted with respect to the sample and not the whole New Zealand population.CONCLUSIONS:A combination of maternal mental health and lifestyle factors contribute to depressive symptoms for children, possibly through foetal programming. Our results emphasise the importance of mental and physical health support for expectant mothers.

BACKGROUND:The time that children spend in physical activity, sedentary behaviour, and sleep each day (i.e., 24-h time-use behaviours), is related to physical and mental health outcomes. Currently, there is no comprehensive evidence on New Zealand school-aged children's 24-h time-use behaviours, adherence to the New Zealand 24-h Movement Guidelines, and how these vary among different sociodemographic groups.METHODS:This study utilises data from the 8-year wave of the Growing Up in New Zealand longitudinal study. Using two Axivity AX3 accelerometers, children's 24-h time-use behaviours were described from two perspectives: activity intensity and activity type. Compositional data analysis techniques were used to explore the differences in 24-h time-use compositions across various sociodemographic groups.RESULTS:Children spent on average, 31.1%, 22.3%, 6.8%, and 39.8% of their time in sedentary, light physical activity, moderate-to-vigorous physical activity, and sleep, respectively. However, the daily distribution of time in different activity types was 33.2% sitting, 10.8% standing, 7.3% walking, 0.4% running, and 48.2% lying. Both the activity intensity and activity type compositions varied across groups of child ethnicity, gender, and household income or deprivation. The proportion of children meeting each of the guidelines was 90% for physical activity, 62.5% for sleep, 16% for screen time, and 10.6% for the combined guidelines. Both gender and residence location (i.e., urban vs. rural) were associated with meeting the physical activity guideline, whereas child ethnicity, mother's education and residence location were associated with meeting the screen time guideline. Child ethnicity and mother's education were also significantly associated with the adherence to the combined 24-h Movement Guidelines.CONCLUSIONS:This study provided comprehensive evidence on how New Zealand children engage in 24-h time-use behaviours, adherence to the New Zealand 24-h Movement Guidelines, and how these behaviours differ across key sociodemographic groups. These findings should be considered in designing future interventions for promoting healthy time-use patterns in New Zealand children.