The coronavirus (COVID-19) pandemic has had and will continue to have an unprecedented effect of daily living for the foreseeable future. Aside from the obvious effects of COVID-19 on physical health, this pandemic is also likely to have a profound effect on mental health. The knock on effects on mental health could be far reaching and long term especially if not understood and managed.

In addition, it is likely to exacerbate existing inequalities and the costs are likely to be felt disproportionately to the already most vulnerable ( those with a history of mental illness, job and housing insecurity , poor neighbourhoods , single parents and those in abusive relationships).

A number of rapid surveys have indicated an initial perceived rise in depression and anxiety symptoms. However, without pre-pandemic information, an accurate indication of the change is not possible. This is essential for modelling projected risk which needs to be taken into account when planning further policy regarding social distancing and lock down enforcements.

Longitudinal data is thus crucial. It is also important to identify at risk groups who could benefit from immediate help and planning for currently unknown policies for recovery stages. This project will use the unique data hosted by ALSPAC to examine how and why mental health changes as a result of the public health policies adopted during the COVID-19 pandemic.

Alcohol is the leading cause of ill-health in young adults in the UK and Europe and is the fifth leading cause across all ages in the UK population and is estimated to be the seventh leading cause globally . There are over 1 million alcohol related hospital admissions and nearly 25,000 alcohol related deaths a year in England with trends, in stark comparison to other major causes of death, not yet decreasing.

Since our previous grant (ALSPAC Alcohol at 24) there have been several important changes to our understanding of the risks of alcohol, patterns of drinking in the population, and UK response to preventing alcohol related harms.

First, levels of drinking reported by adolescents in UK and many other countries have fallen, corresponding with a fall in alcohol related hospital admissions in those under 18, but not yet resulting in any measurable decline in alcohol related harms in young adults . The motivation, reasons (and potential modifiable factors) causing the decline are not yet known but under investigation. In adults in the UK there is some evidence that changes in alcohol use has been differential with greater reductions in low level drinkers and no change in heavier drinkers with subsequently little overall impact on alcohol related harms. At the same time harmful alcohol use has been recognised as an important contributor to the “deaths of despair” that have reduced life expectancy – especially among poorer and more marginal populations - in North America.

Second, in large well powered genetic studies (and against decades of observational data) the cardio-protective effect of alcohol has been shown to be false – and instead likely to be due to non-causal factors all along (such as confounding, selection bias and reverse causation). This implies that there is no compensation of low levels of alcohol use improving morbidity and mortality and no absolutely “safe” or “non-risky” levels of drinking – and clear benefits from reducing average consumption. The UK in line with other countries issued new guidelines on safe drinking levels – which are now the same for men and women – though evidence is unclear whether there have been any changes in the UK population as a result of the new guidance. Policy changes also are underway – notably in Scotland - based on economic models that show how introducing and raising minimum price of alcohol can reduce future alcohol related morbidity and mortality. [There have been other advances in use of MR and genetic markers to identify new targets for drug discovery, compare the impact of interventions, and test for interactions between behavioural exposures – but in European populations MR of alcohol use and AUD have been limited by lack of robust markers.]

Third, it is argued that alcohol related health harms may be under-estimated in part because cohort studies under-represent heavier drinking marginal populations but also because of an under-appreciation of the interaction of alcohol with other exposures. The burden of alcohol is greater in poorer communities, alcohol combines with other exposures to increase risk of liver disease, and alcohol can act as a “snare” increasing the persistence and halting the resolution of antisocial behaviour. This has led to a renewed focus on understanding how adverse alcohol trajectories develop and interact with other exposures to increase health and social harms to strengthen the evidence base ultimately for policy-makers but also for alcohol policy models that can show the impact of alternative prevention strategies.

Data collection

Epilepsy is a neurological disorder that affects one percent of the population. Genetic factors play a role in epilepsy, but the full spectrum of the genetic architecture for this disorder is unknown. Previous work indicates that rare variation may contribute to epilepsy risk, but large sample sizes are required to increase the likelihood of identifying new risk genes or variants. The goal of this project is to investigate the genetic components of epilepsy in a large, well-characterized epilepsy cohort, in collaboration with Epi25, a consortium of over 50 epilepsy investigators. Whole exome sequencing (WES) data from epilepsy samples generated at the Broad Institute will be analyzed with ALSPAC WES data and other locally available or dbGaP-sourced controls to identify genes or variants associated with epilepsy. The inclusion of the ALSPAC data will be a valuable contribution to increase power in downstream analyses.

Parental risk factors are among the strongest early predictors of offspring mental health, cognitive and educational outcomes. This transmission of risk across generations hinders social mobility. Interventions targeting parents may thus appear promising. However, such interventions can only succeed if the relationship between parental risks and offspring outcomes are causal, which remains unclear. Here, we propose to use genetically informed design to better characterize the intergenerational pathways underlying risk transmission.

ADHD is a condition marked by symptoms of inattention and hyperactivity/impulsivity persistent over time, present and causing impairment in at least two contexts, such as in the school and at home. However, the degree to which symptoms are present across situations varies from individual to individual. At one end of the spectrum, children may show severe symptoms in several contexts (that is, pervasive ADHD) while others show severe symptoms only in one context (that is, situational ADHD). What underpins the pervasive and situational manifestations is not well understood, and the impact of pervasive and situational dysfunction on future outcome (such as mental health, occupation, and educational status) needs further investigation. Different underlying mechanisms may relate in specific ways to the degree to which ADHD is expressed pervasively or situationally in the school or home setting. In the current study, we focus specifically on the role of executive functioning (that is, goal-directed behavior), emotion processing, and aspects of the family environment, in this matter. We will examine how pervasive and situational ADHD symptoms evolve over time, mapping possible underlying mechanisms, gender differences, and long-term outcome in a large community sample. The findings will have implications for our understanding of the etiology, maintenance, treatment, and prevention of the diagnosis.

Higher body fatness is a likely cause of heart disease, but how the harms of body fat compare with the potential benefits of body muscle – another metabolically active body compartment – is unclear. This project aims to use data on body scanning and metabolism from ALSPAC parents in mid-life to determine which aspects of body muscle – whether higher volume based on body scanning or higher strength based on hand grip tests – most strongly influence a set of detailed traits related to adult heart disease susceptibility. It also aims to determine how the cardiometabolic profile of body muscle compares with the profile of body fat. Together with results from complementary studies, these results should help clarify which aspects of body composition are most important to target with limited public resources in order to prevent the onset of heart disease.

Neurodevelopmental disorders (such as autism, ADHD, learning disability, and Tic Disorders) are lifelong conditions which begin in childhood and can have significant impacts on physical and mental health, and social well-being across the lifespan.
People with neurodevelopmental disorders have reduced life expectancy than people without such conditions (neurotypicals). Cardiovascular disease (such as heart attacks and strokes) is a significant contributor to this reduced life-expectancy. It is unclear why people with neurodevelopmental disorders are at increased risk of premature cardiovascular disease. Possible explanations include higher levels of cardiovascular risk factors (such as smoking, obesity, and physical inactivity) in people with neurodevelopmental disorders; difficulties in people with neurodevelopmental disorders accessing healthcare; and potentially shared biological mechanisms which contribute to causing both neurodevelopmental disorders and cardiovascular disease (such as over or under active immune systems).

This project aims to improve understanding of the association of neurodevelopmental disorders and cardiovascular disease. We aim to compare rates of cardiovascular risk factors (blood pressure, body mass index, cholesterol, glucose, insulin, and CRP- a measure of the immune system) and very early cardiovascular disease (as measured by the stiffness of arteries) between young adults (at aged 17 and 24) with neurodevelopmental disorders and without. We predict that young adults with neurodevleopmental disorders will have higher rates of both cardiovascular risk factors and very early cardiovascular disease when compared with neurotypical young adults. If this were to the case it would support a view that people with neurodevelopmental disorders are inherantly at increased risk of cardiovascular disease independent of their access to healthcare and would support policies for screening and early intervention in this group.

This proof of concept proposal (to ESRC Research Methods Development https://esrc.ukri.org/funding/funding-opportunities/esrc-rmdg-2020/), aims to test the validity of an innovative research approach bringing narrative/life history methods to quantitative longitudinal data, to deepen their explanatory power. Drawing on Singer et al (1998), the investigators have to date developed the method to yield insights (missing from aggregate analyses) into the impact of illness on women’s employment trajectories (Holland, 2006), and counterintuitive aggregate findings that children and families receiving social work fare worse over time than similar others (Sharland et al, 2017).The validity of the approach now needs testing. If successful, it may be applied to multiple research questions and cohort/panel datasets, releasing narrative potential to discover the people behind the data and to explain complexity and change, especially in the absence of complementary qualitative longitudinal data.

Substantive focus will be on children with significant health-related difficulties as teenagers, exploring how these vulnerabilities are affected and affect their lives over time. A small sample of longstanding ALSPAC child, and unrelated parent, participants will be invited to: i) allow the research team to craft the child and family’s life history from multiple variables collected directly from and/or administratively linked to the respondent over time; ii) participate in research interviews exploring the fit between their own and ‘research-assembled’ life story accounts; iii) permit analysis of this fit to be informed by further ALSPAC data mapped to their self-reports. Care will be taken to ensure informed consent and confidentiality throughout. If the inter-story compatibility is sufficiently strong, a scaled-up bid to a further ESRC call will follow.