Author: oliviamaynard

One new drug a week: club drugs and novel psychoactive substances

Posted on by oliviamaynard

By Meg Fluhart, @MegEliz_

This blog originally appeared on the Mental Elf blog on 24th October 2014

A recent report from the Faculty of Addictions at the Royal College of Psychiatrists has highlighted the changing face of drug abuse in the UK.

While drug abuse was previously dominated by crack, heroin, and ecstasy, an increasing number of people are being admitted to treatment for harm related to club drugs and novel psychoactive substances.

Club drugs are:

Psychoactive substances that are recreationally used in nightclubs, bars, festivals, music events, circuit and house parties.

Novel Psychoactive Substances (NPS) are synthesised to mimic traditional drugs and are marketed “not for human consumption” to avoid detection. They are sold under the guise of bath salts or other chemicals (Royal College of Psychiatrists, 2014).

The

Current problems

Serious harm

  • There is increasing evidence of risks and long-term effects of these drugs. For example:
    • GHB has a very small degree of dosing between euphoria and one resulting in coma or death (Club Drug Clinic, 2013)
    • Long term methamphetamine use may result in psychotic states
    • Ketamine can cause kidney and bladder problems
    • Mephedrone use can result in heart problems

New users, more drugs

  • Each year 1 million adults are estimated to use club drugs per year in the UK (National Treatment Agency for Substance Misuse, 2012), and this population of users has not just switched from crack and heroin but has emerged from a diverse population of students, ‘clubbers’ and LGBT communities
  • Additionally, the number of available drugs is growing, with a new NPS per week becoming available in Europe via the internet outlets (European Monitoring Centre for Drugs and Drug Addiction, 2012)

Unprepared services

  • Club drug and NPS users tend to not perceive current drug services as for them and are therefore more likely to receive treatment in alternative care facilities such as sexual or mental health clinics (National Treatment Agency for Substance Misuse, 2012)
  • Staff in these non-specialists centres have reported feeling unconfident in club drug and NPS assessment, intervention, and referrals
  • Furthermore, even specialist services have historically focused on crack and heroin related harm reduction and need further guidance and training to provide support to individuals with these emerging drug problems

The

Possible solutions

Widen the front door

  • Services need to encourage individuals to engage and seek treatment for club drugs and NPS-related problems, by understanding the population and drug specific problems they may come encounter with (e.g. gay men using mephedrone for sexual enhancement)

Support the front line

  • Information and clinical networks can be established in order to share information, develop knowledge, and keep on top of the rapidly emerging new drugs

‘Connect’ the front line

  • As club drug/NPS users are more apt to wind up in non-specialist treatment, it would be beneficial to integrate all different health centres into a clinical network. This would allow specialised centres to support non-specialist centres, as well as gather information across all different bases

Watch all horizons for harm

  • As many club drugs and novel psychoactive substances are new, little is known about the possible short and long term effects. Therefore healthcare centres from a range of clinical areas should be monitoring and recording club drug/NPS incidences (e.g. emergency/acute care, primary care, sexual health, and mental health services)

Promote research into club drugs and novel psychoactive substances

  • With the increase of new drugs on the market, funders should consider prioritising resources towards club drugs and novel psychoactive substances
  • Due the diverse population of users and context of club drugs, we cannot assume the same interventions that are established with crack and heroin will work with these drugs. Therefore, future research proposals should consider club drug/NPS treatment interventions

Empower users through education

  • A main priority should be to provide the public with high quality and comprehensive information on the risks of club drugs and novel psychoactive substances in order to prevent initiation
  • In addition, information on harm reduction must be provided, including advice on safe injection, warnings on increased sexual health risks when using, and material on support and recovery

The report calls for non-specialist staff

Summary

This faculty report has brought to attention the rising problem of club drugs and novel psychoactive substances in the UK, which are popular amongst students, clubbers, and the LGBT community.

The large number of users (estimated at 1 million people per year) has subsequently resulted in new drugs becoming rapidly available via online markets (National Treatment Agency for Substance Misuse, 2012; European Monitoring Centre for Drugs and Drug Addiction, 2012).

The report authors highlight several key points:

  1. Users of club drugs and novel psychoactive substances are likely to seek alternative treatment to traditional drug specialist centres. Therefore, it is important to train and educate staff in these non-specialist centres so they can confidently provide support and referrals to users
  2. All healthcare centres should work together to monitor and share information on club drug/NPS cases in order to monitor the possible side effects of these rapidly emerging new drugs
  3. Funding bodies should consider shifting the attention from traditional drug use (crack/heroin) to club drugs to determine whether different treatment interventions are needed

Should research funding be directed away from 'traditional' street drugs to these new club drugs and novel psychoactive substances?

Links

One new drug a week: Why novel psychoactive substances and club drugs need a different response from UK treatment providers (PDF). Royal College of Psychiatrists, 2 Sep 2014.

Club Drugs: Emerging Trends and Risks (PDF). National Treatment Agency for Substance Misuse, 2012.

Annual Report 2012 on the State of the Drugs Problem in Europe. European Monitoring Centre for Drugs and Drug Addiction, 2012.

GHB/GBL. Club Drug Clinic, 2013.

– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/one-new-drug-a-week-club-drugs-and-novel-psychoactive-substances/#sthash.LrMnqRPK.dpuf

Smoking cessation in the emergency setting

Posted on by oliviamaynard

By Olivia Maynard @OliviaMaynard17

This blog originally appeared on the Mental Elf site on 20th October 2014

shutterstock_198435872

The prevalence of smoking among patients in emergency departments (ED) is reported to be higher than in the general population, so encouraging smoking cessation in these settings has been recommended. However, 57% of ED staff believe that smoking cessation treatments are inappropriate for the ED setting, citing time constraints, lack of patient interest and treatment ineffectiveness as the main causes of these beliefs (Tong et al., 2010).

A systematic review published in the American Journal of Emergency Medicine (Pelletier et al., 2014), has recently analysed the most up to date research on the effectiveness, feasibility and appropriateness of smoking cessation interventions in ED settings.

The primary outcome measure was:

  • Self-reported and/or biomarker-assessed smoking cessation.

Secondary outcomes were:

  • All-cause mortality;
  • Cost per quit;
  • Patient satisfaction;
  • Practitioner time spent and non-practitioner time spent (these last two were considered together).

Methods

The authors included all original studies of smoking cessation interventions performed in either adult or paediatric ED settings that assessed at least one of the outcome measures outlined above.

One investigator conducted the literature search (on the Medline and CINAHL databases), identifying 17 articles which were then examined for sources of bias (such as lack of randomisation, non-blinding of participants or study personnel and incomplete outcome data reporting). Four studies were excluded due to a high or unclear risk of bias, leaving 13 studies to undergo full systematic review.

Although a meta-analysis of these studies was planned, their heterogeneity precluded this and therefore only a systematic review was conducted. All studies were also rated on a three point scale for quality, using 19 quality criteria questions.

This review looked at a range of

This review looked at a range of interventions for helping people to quit smoking in the emergency setting.

Results

Of the 13 studies, 11 were conducted in the USA, one in Germany and one in Turkey. Six studies used a single time-point follow-up for assessing smoking cessation, three had two follow-ups, three studies had three follow-ups and one had four follow-ups.

The smoking cessation interventions varied between studies and fell into six broad categories:

  1. Administration of self-help materials;
  2. Faxed referrals to other programmes;
  3. Brief advice;
  4. Counselling;
  5. Nicotine replacement therapy (NRT);
  6. Motivational interviewing-based interventions.

Eleven studies included at least two of these interventions and there was no consistent control group across the studies.

The main findings of the systematic review were as follows:

  • The overall quality of the studies was relatively poor:
    • Quality ratings ranged from 31 to 81% (where 100% refers to a study scoring top marks on all 19 quality criteria)
    • The average quality rating was 57% (SD = 15.1%).
    • Studies generally scored poorly on the documentation of participant retention and follow-up, justification of sample size and appropriate follow-up.
    • Data on all-cause mortality and cost per quit were absent or inadequate in the majority of studies and therefore these two secondary outcome measures were dropped from further consideration.
  • The majority of studies found no difference between intervention and control groups in terms of cessation rates (the primary outcome measure):
    • Twelve studies reported cessation rates and 10 of these reported no beneficial effect of the intervention.
    • Two studies reported a beneficial effect of smoking cessation intervention (Bock et al, 2008; Bernstein et al, 2013), however, this was only observed at three months in the first study and only one and three months, but not six months in the second study.
    • The authors of the systematic review note that these two studies used motivational interviewing-based techniques, and suggest that these techniques may be particularly effective. However, it is important to note that four other studies also used motivational interviewing, but did not find any beneficial effect.
    • Although the majority of these studies did not observe a beneficial effect of smoking cessation interventions, the authors note that many did find that overall smoking cessation rates (in both intervention and control arms) was higher than that reported among the general population in the USA (according to the 2010 National Health Interview Survey [NHIS]). This is a crude comparison however, as the 13 studies included in this review were conducted between 2000 and 2014, and were conducted in Turkey and Germany as well as the USA, whereas the NHIS survey was conducted in 2010 only in the USA.
  • Patient satisfaction was high, but was not often reported:
    • In the two studies reporting patient satisfaction, this was found to be 90% or above.
    • Both of these studies used motivational interviewing-based interventions and both considered paediatric patients or their parents, rather than adult patients receiving treatment for themselves.
  • Intervention time varied, but was not often reported:
    • A faxed referral was reported to take an average of 3 minutes, brief advice 5 minutes and motivational interviewing-based interventions 37 minutes.

MOst studies found no difference between intervention and control groups in terms of cessation rates.

Most studies found no difference between intervention and control groups in terms of cessation rates.

Conclusions and implications for practice

The authors of this systematic review conclude that:

ED-based cessation interventions may be effective, but the available data are somewhat limited and heterogeneous.

Only two of the 13 studies included in the review found any benefit of smoking cessation intervention in the ED settings, with both using motivational interviewing. This led the authors of this review to further conclude that:

Motivational interviewing may prove to be a promising strategy where feasible.

However, it is important to note that four of the six studies which used motivational interviewing did not find any beneficial effect of this intervention.

The authors recommend that:

ED providers ask about smoking status, provide brief motivational interviewing or brief advice to quit as time allows, and provide a pamphlet with information about the benefits of smoking cessation and information about the benefits of smoking cessation and information for verified smoking cessation programs to all patients.

The evidence supporting emergency based interventions for smoking cessation is limited and heterogeneous. Further research is required to determine whether smoking cessation interventions are more effective in encouraging cessation than simply visiting the ED alone, and if so, which interventions are most effective.

The evidence-base is not yet of sufficient quality for us to draw any conclusions about the best course of action for smoking cessation in emergency departments.

The evidence-base is not yet of sufficient quality for us to draw any conclusions about the best course of action for smoking cessation in emergency departments.

Limitations

  • The reviewers only searched two databases (Medline and CINAHL) so are likely to have missed studies published in journals not indexed on those databases.
  • The general quality of the studies included in the systematic review was weak to moderate, even after studies with high risk of bias were excluded. Future research should use rigorous designs with large sample sizes.
  • No studies investigated time-effectiveness, all-cause mortality, or cost per quit as outcomes and these factors should be considered in future research.
  • Only four studies pre-registered study information, meaning that the degree to which the remaining studies fully reported all study outcomes cannot be guaranteed.
  • Smoking cessation was assessed by the majority of studies using self-report, rather than through biometrically confirmed abstinence, potentially artificially increasing cessation success.
  • The lack of a standardised control group meant that study findings could not be pooled into a meta-analysis.
  • None of the studies included in this systematic review were conducted in the UK, with the focus on EDs in the USA.

The reviewers could have done more to find studies to include in their review.

The reviewers could have done more to find studies to include in their review.

Links

Pelletier JH, Strout TD, Baumann MR. A systematic review of smoking cessation interventions in the emergency setting. Am J Emerg Med. 2014 Jul;32(7):713-24. doi: 10.1016/j.ajem.2014.03.042. Epub 2014 Apr 2. [PubMed abstract]

Bernstein SL Bijur P, Cooperman N et al. Efficacy of an ED-cased multi-component intervention for smokers with substance use disorders. Journal of Substance Abuse Treatment, 2013; 44(1): 139-42.

Bock BC, Becker BM, Niaura RS et al. Smoking cessation among patients in an emergency chest pain observation unit; outcomes of the Chest Pain Smoking Study (CPSS). Nicotine and Tobacco Research, 2008; 10(10):1523-31. [PubMed abstract]

Quitting Smoking Among Adults – United States, 2001-2010. Centers for Disease Control and Prevention; 2011 [11/11/2011]

– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/smoking-cessation-in-the-emergency-setting/#sthash.SCNL87pV.dpuf

Alcohol minimum unit pricing: time to take action?

Posted on by oliviamaynard

By Olivia Maynard @OliviaMaynard17

This blog originally appeared on the Mental Elf site on 3rd October 2014

The UK government’s minimum pricing policy for alcohol has been hotly debated over the last couple of years and this week a new study describing the potential benefit of minimum unit pricing over the governments’ current ban on below cost selling has started sparks flying once more.

In the paper, published on Wednesday in the British Medical Journal (BMJ), Brennan and colleagues (2014) use sophisticated modelling to compare the expected effects of the two policies on the following outcomes:

  • Alcohol consumption
  • Health harms, including deaths, illness, admissions to hospital, quality of life and costs to the NHS
  • Drinkers’ expenditure
  • Tax and duty revenues

However, before we get our teeth stuck into the study itself, what’s the difference between the two policies?

Minimum unit pricing is about setting a floor price (e.g. 45p) for a single unit of alcohol.

Minimum unit pricing is about setting a floor price (e.g. 45p) for a single unit of alcohol.

Minimum unit pricing (MUP)

  • A ‘unit’ of alcohol (roughly half a pint of low strength beer, a measure of spirits or half a regular sized glass of wine) would have to be sold at a set price, such as 45p
  • This policy was initially supported in 2012 by the UK government, but was later rejected
  • The Scottish government passed legislation to introduce MUP at 50p per unit in June 2012, but as yet this has not been introduced due to a legal challenge from the Scotch Whiskey Association which has now gone all the way to the European Court of Justice. The outcome of this legal challenge is not expected until late 2015
  • Canada, Russia and Uzbekistan have all introduced MUP

A ban on below cost selling (BBCS)

  • Alcoholic drinks must not be sold for less than the tax payable on the product
  • Under this policy, the price of alcohol does not necessarily increase with the strength of the alcohol and for drinks like high strength cider, a unit of alcohol can be sold for as little as 6p under this policy
  • The UK government favoured this policy over MUP in 2013 and introduced it in May 2014

The authors answer the following question in their study:

What would the differential potential impact of a BBCS versus a MUP policy of 40p, 45p or 50p if the policies were to be implemented in 2014-2015?

Despite once publicly supporting a minimum unit pricing of 40p. David Cameron's government has decided instead to put in place a ban on the sale of “below cost” drinks.

Despite once publicly supporting a minimum unit pricing of 40p. David Cameron’s government has decided instead to put in place a ban on the sale of “below cost” drinks.

Methods

As I said, the authors used some pretty sophisticated modelling techniques (using the Sheffield Alcohol Policy Model [version 2.5]) to answer their research question, but in brief, in order to work out the likely effects of these two alcohol policies, the following information was entered into the model:

  • Baseline data on:
    • Alcohol consumption for different population subgroups in England (split by sex, age, mean consumption level and income)
    • Prices paid for 10 different beverage types and quantity of each purchased, for the different subgroups
  • An estimate of the effect that price increases for these 10 beverages would have on consumption levels for the subgroups (given that different subgroups spend and drink different amounts of the 10 beverages)
  • The effects of this estimated change in consumption on death and disease rates at one and 10 years post implementation

Results

Given that harmful drinkers are a policy priority group, (consuming on average 58 units for females and 80 for males per week and spending £1,800 and £3,400 per year respectively), the authors focus in particular on the effects of the two policies on this group. Also, whilst MUP at 40p, 45p and 50p were all assessed, I will focus on MUP at 45p, as this is the level initially proposed by the UK government.

Proportion of the market affected by the policies

  • Under a BBCS, only 0.7% of all units of alcohol sold in the UK would see a price increase, whilst MUP would affect 23.2% of all units sold
  • MUP would disproportionately affect harmful drinkers, increasing the price of 30.5% of the units they purchase, as compared with only 12.5% of units purchased by moderate drinkers

Alcohol consumption

  • A BBCS was estimated to reduce the number of units consumed by harmful drinkers by only 3 units per year
  • By contrast, MUP was estimated to reduce this by 137 units; a 45-fold reduction as compared with a BBCS

Health harms, including deaths, admissions to hospital, quality of life and costs to the NHS

  • The estimated effects on the general population of the two policies after 10 years of implementation are shown below:
BBCS MUP
Annual reduction in number of deaths 14 624
Annual reduction in hospital admissions 500 23,700
Annual reduction in alcohol-related illness 300 12,500
Total number of quality adjusted life years gained 500 24,200
Total saving in healthcare costs £9.5 million £417.2 million
  • Based on these estimates, MUP will reduce deaths attributable to alcohol by 40 times more than BBCS
  • The majority of this harm reduction is likely to be among harmful drinkers, with 89% of the reduction in deaths after 10 years among this group

The study findings suggest that harmful drinkers would be helped most by minimum unit pricing

The study findings suggest that harmful drinkers would be helped most by minimum unit pricing.

Drinkers’ expenditure

  • Due to the high price elasticity of alcohol (higher prices mean people lower their consumption to a level which ensures they continue to spend the same amount) neither policy is expected to greatly affect spending

Tax and duty revenues

  • A BBCS is estimated to increase revenues in shops and supermarkets by 0.3% (£5.4m)
  • By contrast, MUP is estimated to result in a 5.6% (£201.1m) increase in revenues, although the effects on actual profits is unknown
  • The effects of the two policies on government tax revenue is small, as although VAT will rise (because this is charged as a percentage of product price and products will be sold at higher prices), alcohol duty revenue will fall (as this is related to the volume of alcohol sold)

Discussion

Professor Alan Brennan, professor of Health Economics and Decision Modelling at the University of Sheffield, who led the study said:

Despite some study limitations we found that a minimum unit price of 45p would be expected to have 40-50 times larger reductions in consumption and health harms.

The limitations Professor Brennan alludes to include the fact that certain assumptions about alcohol price elasticity and actual alcohol consumption and expenditure had to be made in order to run the model. However, the authors state that the sensitivity analyses they have conducted show that the relative scale of the impact of a BBCS versus MUP is robust to these assumptions and uncertainties and, if anything, the scale of the difference is likely to be conservative.

In the editorial accompanying the paper (Stockwell, 2014), Tim Stockwell, the director of the Centre for Addictions Research at the University of British Columbia, Canada, notes that one way to test whether the model is conservative is to compare the model’s predicted effects with actual reported effects in a country where MUP has been introduced. Indeed, when the model is applied to two Canadian provinces with MUP policies, the model underestimates the number of deaths by 2.3 times and the number of hospital admissions by almost 5 times.

It seems therefore that the model is robust enough to assess the effects of the two policies and if anything, underestimates the true likely effect of MUP. These data suggest that MUP would be a far more effective method of reducing consumption and preventing alcohol related harm than the BBCS implemented earlier this year in the UK.

Minimum unit pricing in Canada has been associated with significant reductions in alcohol related harm

Minimum unit pricing in Canada has been associated with significant reductions in alcohol related harm.

Implications for policy

  • The UK government introduced a BBCS in May 2014
  • The Scottish legal case will likely pave the way for alcohol pricing policies in other EU jurisdictions interested in introducing MUP, including the Republic of Ireland, Estonia and regional governments in the UK
  • Given the potential effectiveness of MUP as compared with a BBCS, the outcome of this legal case is likely to have important implications for public health across Europe

Response from government, industry and others

Perhaps unsurprisingly, this study has not found favour among the alcohol industry, with Miles Beale, Chief Executive of the Wine and Spirits Association arguing that the government should not be “punishing responsible drinkers through higher prices”, a statement which seems at odds with the study’s results which shows that MUP would specifically target harmful drinkers. Indeed, this is what makes MUP different from more indiscriminate policies, such as general price or tax increases, which would indeed punish moderate drinkers.

By contrast, Sir Ian Gilmore, chairman of the Alcohol Health Alliance, warmly received the results of the study and urged Westminster politicians to back the Scottish plans for MUP and “help push it through the European Court of Justice for the good of the public’s health.”

However, the response from the Department of Health was lukewarm, with a spokeswoman reiterating the fact that the government is “taking action to tackle cheap and harmful alcohol such as banning the lowest priced drinks” and noting that the government is “working with industry to promote responsible drinking.”

This close relationship between UK government and the alcohol industry is well documented and alcohol industry lobbying has been cited as the main reason for the government U-turn on MUP in 2013 (Gornall, 2014). Unlike tobacco control policies in the UK, which are protected from the tobacco industry and other commercial interests through a World Health Organisation framework (WHO FCTC, 2005), this is not the case for alcohol policies. John Holmes, a Public Health Research Fellow at the Sheffield Alcohol Research Group, and one of the authors of this study, has previously acknowledged that the alcohol industry should have some say in alcohol policies, but that he is also concerned that the industry is “not particularly interested in . . . engaging in any kind of debate about whether their arguments are accurate. It’s all about creating doubt about what we’re saying.”

Whether the alcohol industry will continue to cast doubt on this research and whether the government will choose to listen to the researchers or the industry, remains to be seen.

In late 2015, the European Court of Justice will decide if the Scottish parliament’s 2012 legislation can be passed, which will have a massive impact on public health in Europe.

In late 2015, the European Court of Justice will decide if the Scottish parliament’s 2012 legislation can be passed, which will have a massive impact on public health in Europe.

Links

Brennan A, Meng Y, Holmes J, Hill-McManus D, Meier PS. (2014). Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study. BMJ, 349(g5452).

Gornall J. (2014). Under the influence: 1. False dawn for minimum unit pricing. BMJ 2014;348:f7435.

Stockwell D. (2014). Editorial: Minimum unit pricing for alcohol. BMJ, 349(g5617).

WHO FCTC. (2005). WHO Framework Convention on Tobacco Control (PDF). World Health Organisation.

Radu Bercan/Shutterstock.com, Peter Fuchs/Shutterstock.com.

– See more at: http://www.thementalelf.net/mental-health-conditions/substance-misuse/alcohol-minimum-unit-pricing-time-to-take-action/#sthash.hAkkpG2g.dpuf

Exercise for the prevention and treatment of antenatal depression

Posted on by oliviamaynard

By Meg Fluharty

This blog originally appeared on the Mental Elf blog on 19th September 2014

shutterstock_59173807

Depression occurring during pregnancy, known as antenatal depression, is very common; affecting 10-13% of women (Gavin et al, 2005), which can result in premature labour, low birth weight, and a compromised mother-child relationship (Li et al, 2009; Mancuso et al 2004).

The current treatments include antidepressants and psychotherapy (Field et al, 2009; Rethorst et al 2009). However, antidepressant use may result in adverse effects during pregnancy and psychotherapy often has lengthy waiting lists (Einerson et al 2010, Parker et al; 2008).

Exercise is also recommended as a treatment option for mental and physical health during pregnancy, by NICE (NICE, 2006), the Royal College of Obstetricians and Gynaecologists (RCOG, 2006) and the American College of Obstetricians and Gynaecologists (Artal & O’Tool, 2006).

This study is the first systematic review and meta-analysis of randomised controlled trials (RCTs) investigating the effectiveness of exercise as a treatment option in antenatal depression (Daley et al, 2014).

Exercise balls are a popular training aid and also a soft place to grab a few minutes sneaky shut-eye.

“Balls to exercise” Insert exclamation mark or question mark as you see fit.

Methods

The authors conducted a literature search of multiple electronic databases, and studies were selected for inclusion if they were RCTs which compared exercise with usual care, a control group or another comparator. Studies were also included which recruited non-depressed, at risk, and depressed participants as the review focused on both prevention and treatment of antenatal depression. Studies were excluded if the intervention was less than 6 weeks (Daley et al, 2014).

The primary outcome was change in depression score between baseline and final antenatal follow-up. The means and standard deviations of the different depression scores were extracted, or calculated if necessary. The standardised mean different (SMD) was calculated in order to summarise the effects across the trials. For the meta-analysis, a random effects model was used, with subgroup analyses in depressed vs. non-depressed patients and aerobic vs. non-aerobic exercise conditions (Daley et al, 2014).

Results

Included studies

Six out of a total of 919 papers were chosen for inclusion in the review and analysis. Studies were primarily excluded if they were not RCTs, did not measure depression, or compared exercise interventions.

All six studies investigated exercise as an intervention versus a control:

  • 2 studies used standard prenatal care
  • 2 used a waiting list
  • 1 used social support
  • 1 used parent education sessions as the control groups

The interventions ranged from 8-12 weeks and were categorised as either aerobic exercise or non aerobic.

In total, there were 406 pregnant women, whose ages ranged from 14-38 and were recruited from 16 weeks gestation.

One study included non-depressed women, and 5 studies included either at risk or participants depressed at baseline (Daley et al, 2014).

Meta-analysis results

  • There was a reduction in depression scores in the exercise groups versus the comparator groups (SMD -0.46, 95%CI -0.87 to 0.05, p=0.03, I2= 68%)
  • There was no difference between women who were:
    • Non-depressed at baseline (SMD -0.74; 95% CI -1.22 to -0.27, p=0.002)
    • Depressed at baseline (SMD -0.41; 95% CI -0.88 to 0.07, p=0.09, I2=70%)
  • There was no difference between:
    • Aerobic exercise interventions (SMD -0.74: 95% CI -1.22 to -0.27 p=0.002)
    • Non-aerobic exercise interventions (SMD -0.41; 95% CI -0.88 to 0.07, p=0.09, I2 =70%)

Exercise during pregnancy may be effective at reducing depression, but bigger and better RCTs are needed before we can be sure of this finding.

Exercise during pregnancy may be effective at reducing depression, but bigger and better RCTs are needed before we can be sure of this finding.

Discussion

Daley et al (2014) present the first meta-analysis of trials investigating the effectiveness as a treatment for antenatal depression. NICE (NICE, 2006), Royal College of Obstetricians and Gynaecologists (RCOG, 2006), and the American College of Obstetricians and Gynaecologists (Artal & O’Tool, 2006) have all stated that women should consider exercise during pregnancy for mental health benefits, and this review provides evidence to support those guidelines.

However, there are a number of limitations that should be considered:

  • The results show a small to moderate effect size, based on a small number of low to moderate quality studies
  • The studies varied greatly and contained large confidence intervals, which may result in imprecise estimates
  • 5 of the 6 studies were based on women with depression, so the authors cannot conclude whether exercise can be used to prevent depression in pregnancy
  • Tests of subgroup differences in exercise category were based on a single trial, therefore future studies should examine a larger range of exercises (aerobic and non-aerobic)
  • No studies reported on adverse events
  • Publication bias was not investigated due to the small number of trials

Future research should be based on a larger sample, include a wider range of exercise categories, investigate possible adverse events, and include non-depressed women.

While we're waiting for the new research into antenatal depression, don't forget that exercise in pregnancy has all sorts of other important benefits.

While we’re waiting for new research to be published, don’t forget that exercise in pregnancy does of course have all kinds of other undeniable benefits.

Links

Daley AJ, Foser L, Long G, Paler C, Robinson O, Walmsley H, Ward R. The effectiveness of exercise for the prevention and treatment of antenatal depression: a systematic review with meta-analysis. BJOG 2014; DOI: 10.1111/1471-0528.12909 [PubMed abstract]

Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106:1071–83. [PubMed abstract]

Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 2009;24:146–53.

Mancuso RA, Schetter CD, Rini CM, Roesch SC, Hobel CJ. Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery. Psychosom Med 2004;66:762–9. [PubMed abstract]

Field T, Deeds O, Diego M, Hernandez-Reif M, Gauler A, Sullivan S, et al. Benefits of combining massage therapy with group interpersonal psychotherapy in prenatally depressed women. J Body Mov Ther 2009;13:297–303. [PubMed abstract]

Rethorst CD, Wipfli BM, Landers DM. The antidepressive effects of exercise: a meta-analysis of randomized trials. Sports Med 2009;39:491–511. [PubMed abstract]

Einerson A, Choi J, Einerson TR, Koren G. Adverse effects of antidepressant use in pregnancy: an evaluation of fetal growth and preterm birth. Depress Anxiety 2010;27:35–8 [PubMed abstract]

Parker GB, Crawford J, Hadzi-Pavlovic D. Quantified superiority of cognitive behavioural therapy to antidepressant drugs: a challenge to an earlier meta-analysis. Acta Psychiatr Scand 2008;118:91–7 [PubMed abstract]

Royal College of Obstetricians and Gynaecologists. Exercise in Pregnancy. Statement No. 4. London: RCOG, 2006.

Antenatal and postnatal mental health: Clinical management and service guidance. NICE CG45, Feb 2007.

Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003;37:6–12. [PubMed abstract]

– See more at: http://www.thementalelf.net/mental-health-conditions/depression/exercise-for-the-prevention-and-treatment-of-antenatal-depression/#sthash.oDvrzRsY.dpuf

How I ended up on the other side of the world

Posted on by oliviamaynard

By Sarah Griffiths

My New Year’s resolution this year was to get out of Bristol for a bit. I love living in Bristol and enjoy my PhD research, which is what brought me to the city in the first place. But the weather was pretty miserable in January and, after a year and a half, perhaps I was starting to take the place for granted. I decided that it would be a good time to look into some of the great opportunities there are to travel in academia.

I had heard that it was possible to get funding to visit a foreign university through the Worldwide Universities Network (WUN) during your PhD. The WUN is an association of 16 universities around the world who have decided to cooperate to promote international research collaboration. I looked at the research that was being done at each of these universities to see if any fitted with my PhD topic and found Face Lab at the University of Western Australia. Face Lab, I learned, was doing some fascinating research on the nature of emotional expression coding in typical development and in autism. Perth also looked like a pretty fun place to spend some time so I decided to apply.

I got in touch with Professor Gill Rhodes who leads Face Lab and asked if she would have me for a visit for a few months and she kindly agreed. I then went ahead and filled in the application form. This involved writing a research proposal, including details of how the exchange would benefit the university and myself. Additionally I was to submit a CV and supporting statements from my supervisor and the Head of School in Bristol, and Gill at UWA. There are two calls for applications a year: one in February, which I went for, and one in November. A few months later I heard that my application had been accepted and I was going to be spending 3 months in Perth in the autumn!

Cycle path

I’ve now been in Perth for 2 weeks and I’m so glad that I decided to come. The people I have met both in the University and out have been incredibly friendly and helpful. I’ve found accommodation in a great area in a complex that has a pool (!) Everyday I get to cycle along the river to the university, looking out for dolphins that supposedly live there.

I’ve also found that working in a different lab has renewed my interest in research. A change of environment and the opportunity to discuss new ideas with experts you wouldn’t otherwise meet is a great remedy for any mid-PhD disenchantment. Here I’m working on a project about recognition of emotion in a crowd of faces. This is a topic that is complimentary to my PhD research but different enough to be new and exciting. I hope that when I return to Bristol I will bring back new ideas and fresh enthusiasm to my PhD, as well as a tan! I will let you know in 10 weeks time. In the meantime, if this has inspired you to take part in some “academic tourism” (as one other WUN funded visitor I met this week called it), the next deadline for the WUN researcher mobility funding is in 7th of November so get applying!

Sarah is a PhD student in TARG researching emotion recognition in children with autism spectrum disorder. You can follow her on Twitter @SarahGriff90 and see her academic profile on the University of Bristol website.

 

Welcome to the Real World

Posted on by oliviamaynard

Dave Troy 

Taking laboratory studies into the ‘real world’ is every scientist’s nightmare. We love the lab – it’s where we feel safe, where we can control our world, our variables, our environment, and our interventions. However, lab studies can only tell us so much; eventually we need to know whether the findings from our lab studies apply in the real world. This is what the Tobacco and Alcohol Research Group (TARG) has endeavored to do. Findings in our lab suggest that individuals drink beer slower from a straight-sided glass compared to a curved glass. As a first step towards testing this effect in the real world, we carried out a small feasibility study to investigate whether a large-scale study might be possible. We needed to find out what outcome measure we could use to measure alcohol consumption, whether pubs and customers would be willing to take part, and what the logistical challenges of running a study of this nature might be. With this in mind, we contacted the owner of Dawkin’s Ales. He was open to the prospect of stocking three of his pubs (The Portcullis, Clifton Village; The Victoria, Clifton; and the Green Man, Kingsdown) with differently shaped pint glasses over a couple of weekends, using monetary takings as a proxy measure of the amount of alcohol consumed. He was extremely supportive of the endeavor and we would like to thank him for all his help. He seemed to be genuinely interested in the outcome of the study and in science in general. The feasibility study was a success: we showed that this type of drinking rate study can be carried out in a pub environment. However, there were some teething problems. Variables such as the size of a dishwasher caused unforeseen complications. Only when you get into the real world, do you realise how unstandardised it is.

Green Man Pub, Kingsdown
Green Man Pub, Kingsdown

What we learned on our adventures in the real world is that communication is key. Cultivating good relationships with pub landlords and staff was vital to the success of the feasibility study. Naturalistic studies are unpredictable – nothing goes to plan. Good communication and rapport with stakeholders is vital and can assist in acquiring high quality data. Pub staff are also a great source of industry knowledge. We were educated on the extent of research by the drinks industry into the effect of different glass shapes on drinking behavior, which is extensive in their opinion. They were also full of ideas regarding what other experiments could be carried out. One of the landlords mentioned that people “drink with their eyes”, which piqued an interest in me about how our other senses may play a role in our drinking behaviour. Another comment was that people tend to drink more quickly when they are standing up. This hadn’t occurred to me before, but I was told that it has grabbed the attention of policy makers, who want to discourage ‘vertical drinking’ by demanding pub license holders supply more seating. Another topic that came up again and again is the use of “nucleated” beer glasses. These have marking at the bottom of beer glasses to promote the formation of bubbles, maintaining the head for longer. The importance attached to it by pub staff and customers suggests it might be an important factor in people’s drinking. All of these are ideas that we may take forward in our lab studies. Pub staff also made valuable suggestions on how to improve future pub studies. One landlady said that we should do it over a whole week to get a better picture of the cadence of an average drinking week.

Nucleation vs Non-nucleation
Nucleation vs Non-nucleation

On a personal level, I learned more as an experimenter helping with this study than in all my previous lab studies. Perhaps surprisingly, the attention to detail and organisation required is above the requirements of a lab study. The logistics involved are greater and an ability to think on your feet is essential. The real world is a challenging place to do research but the advantages are clear. The data collected reflects more natural behavior of participants and therefore your findings have greater relevance. Activity that would have otherwise have gone unnoticed can be observed. Qualitative data collected can inform future research. Another advantage is that you can interact with professionals who have their ear to the ground, which can lead to ideas for new studies. There are also some challenges. There is a greater probability that an external variable, not controlled for in your study, has influenced your findings. Natural environments lack the control of lab studies. It may be difficult to replicate a study when there are so many variables at play. Nevertheless, lab and naturalistic studies complement each other and there is a need for both in science. Advances in technology, such as tablet computers and smartphones, have made acquiring vast amounts of data in the ‘real world’ much easier. Researchers in TARG will continue to engage with the public in natural settings in the future and hopefully capture data that will inform people’s lifestyles and public health policy.

Quitting smoking is associated with decreased anxiety, depression and stress, says new systematic review

Posted on by oliviamaynard

It is well known that tobacco is the leading cause of preventable death in the world (WHO, 2011). However, the associations between smoking and mental health are less well established.

Smokers often want to quit, but the belief that cigarettes can be used to regulate mood can often deter them, and this is especially true for individuals with mental health problems (Zhou et al, 2009; Thompson et al 2005). However, this is somewhat paradoxical because smoking is often associated with poor mental health (Coulthard et al, 2002). So it’s interesting to report on this new study by Taylor et al (2014) who reviewed the current literature evaluating changes in mental health in those who quit smoking compared with those who continued to smoke.

Methods

The authors conducted a systematic review by searching Web of Science, Cochrane, Medline, Embase & PsychINFO, as well as contacting authors for missing data, and translating non-English papers.

Eligibility was determined using the following criteria:

  • Studies took smokers from the general population or from populations with a defined clinical diagnosis
  • They were longitudinal studies collecting data on mental health prior to quit attempts and again 6 weeks after

A meta-analysis was performed using a random effects model to pool the standard mean difference (SMD) between the change in mental health in quitters and continued smokers from baseline to follow-up. The SMD was used, as different scoring systems couldn’t be standardised across studies.   The mental health outcomes they measured were anxiety, depression, mixed anxiety/depression, positive affect, psychological quality of life & stress.

Results of systematic review

After data extraction, 15 full text articles were included:

Study type

11 cohort studies, 14 secondary analyses of cessation interventions, and 1 randomised controlled trial.

Participant population

14 studies included the general population, 3 included patients living with chronic physical condition, 2 with pregnant patients, 1 included postoperative patients, 2 studies included either chronic physical or psychiatric conditions, and 4 studies included patients with psychiatric conditions.

48% of participants were male with a median age of 44, and on average smoked 20 cigarettes per day. The average participant scored as moderately dependent to nicotine on a dependence test.

Results of meta-analysis

Compared with continuing to smoke:

People who quit smoking were less anxious, depressed and stressed than those who continued to smoke

People who quit smoking were less anxious, depressed and stressed than those who continued to smoke

  • Quitting was associated with a decrease in anxiety (SMD -0.37, 95% CI  -0.70 to -0.03; P=0.03)
  • Quitting was associated with a decrease in depression (SMD -0.25, 95% CI -0.37 to -0.12; P<0.001)
  • Quitting was associated with a decrease in mixed anxiety and depression (SMD -0.31, 95% CI -0.47 to -0.14; P<0.001)
  • Quitting was associated with a decrease in stress (SMD -0.27, 95% CI -0.40 to -0.13; P<0.001)
  • Quitting was associated with an improved psychological quality of life (SMD 0.22, 95% CI 0.09 to 0.36; P<0.001)
  • Quitting was associated with increased positive affect (SMD 0.40, 95% CI 0.09 to 0.71; P=0.01)

Subgroup Analyses

  • Analyses for study quality did not change summary estimates
  • Studies which adjusted for covariates showed a larger difference between quitters and those who continued to smoke compared to studies which did not adjust

Additional Analyses

  • There was no evidence that effect size differed across different clinical populations
  • There was no evidence of subgroup differences between study designs
  • The studies were ordered according to length in a forest plot and no clear chronological pattern in effect estimates was found

Discussion

This review shows that quitting smoking is associated with reduced depression, anxiety and stress, and improved psychological quality of life and positive affect compared to continuing to smoke. The strength of the association was similar for all populations; both general and clinical. The authors suggest three possible interpretations of the data:

  1. Quitting smoking results in improved mental health
  2. Improved mental health causes an individual to quit smoking
  3. There is a common factor that explains both the improved mental health and smoking cessation

The authors hypothesise that quitting smoking improves mood is supposed by a biological mechanism caused by brain changes in the nicotinic pathways due to chronic smoking (Wang & Sun, 2005). These brain changes result in low mood (irritation, anxiety, and depressed mood) after smoking a cigarette. While an individual is actually feeling withdrawal symptoms, they are misattributed to low mood, and more cigarettes are smoked to alleviate their symptoms (Benowitz, 1995; Benowitz, 2010).

However, not all of the data supports this interpretation.  For example, a study using Mendelian randomisation- an instrumental variable approach that uses gene relating to smoking behaviour to examine health related outcomes, did not find a causal association between smoking and mental health (Bjorngaard et al 2013).

While this review displays that there are strong associations between quitting smoking and mental health, the authors recommend future studies examining this association to help strengthen causal inferences which come from observation research. The authors suggest further epidemiological studies using Mendelian randomisation, or using statistical analysis of observational data using propensity score matching to reduce the bias of confounding variables.

Conclusion

Many people believe that quitting smoking can have adverse psychiatric effects. This high quality research suggests the opposite

Many people believe that quitting smoking can have adverse psychiatric effects. This high quality research suggests the opposite

These are important findings as smokers can find reassurance in the fact that quitting is likely to result in improved mental wellbeing. Additionally, these findings are important as they show that quitting smoking is likely to improve your mental health if you are mentally ill or mentally well.

Hopefully these findings will help overcome some of the current barriers within the mental health field; for example the continued belief that quitting smoking or certain pharmacological treatments can have adverse psychiatric effects.  See our recent Lee Cook et al (2013) blog, which showed that individuals with mental illness treated as outpatients were more likely to decrease and quit smoking than those in inpatient facilities.

Furthermore, the NICE guidelines on smoking cessation, which we blogged about here, recommend that all NHS hospitals and clinics should become smoke-free, as well as identifying smokers and offering behavioural and pharmacotherapy onsite. Additionally, the guidelines suggest staff should be trained on stop-smoking services and should abstain from smoking on-site themselves (NICE, 2013).

Links

Taylor G et al. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 2014;348:g1151 doi: 10.1136/bmj.g1151

Coulthard M, Farrell M, Singleton N, Meltzer H. Tobacco, alcohol and drug use and mental health (PDF). Office for National Statistics, 2002.

World Health Organization. WHO report on the global tobacco epidemic. WHO, 2011.

Zhou X, Nonnemaker J, Sherrill B, Gilsenan A, Coste F, West R. Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMP cohort study (PDF). Addict Behav 2009;34:365-73.

Thompson B, Thompson LA, Thompson J, Fredickson C, Bishop S. Heavy smokers: a qualitative analysis of attitudes and beliefs concerning cessation and continued smoking. Nicotine Tob Res 2003;5:923-33. [PubMed abstract]

Le Cook B, Wayne GF, Kafali EN, Lui Z, Shu C Flore M. Trends in Smoking Among Adults with Mental Illness and Association Between Mental Health Treatment and Smoking Cessation. JAMA. 2014; 311 (2): 172-182. [Abstract]

Smoking cessation: acute, maternity and mental health services: guidance (PDF). NICE, PH48, 27 Nov 2013.

Wang H, Sun X. Desensitized nicotinic receptors in brain. Brain Res Rev 2005;48:420-37. [Abstract]

Benowitz NL. Nicotine addiction. Prim Care 1999;26:611-31 [PubMed abstract]

Benowitz NL. Nicotine addiction. N Engl J Med 2010;362:2295 [Abstract]

Bjorngaard JH, Gunnell D, Elvestad MB, Davey-Smith G, Skorpen F, Krokan H, et al. The causal role of smoking in anxiety and depression: a Mendelian randomization analysis of the HUNT study. Psychol Med 2013;43:711-9 [PubMed abstract]

This article first appeared on the Mental Elf website on 13 March 2014 and is posted by Meg Fluharty. Follow Meg on Twitter @MegEliz_

– See more at: http://www.thementalelf.net/mental-health-conditions/anxiety-disorders/quitting-smoking-is-associated-with-decreased-anxiety-depression-and-stress-says-new-systematic-review/#sthash.z8TIWuMV.dpuf

From ‘Canadia’ to Bristol and Back Again – My Adventures with TARG

Posted on by oliviamaynard

By Meghan Chenoweth

I didn’t realize it at the time, but my connection with TARG, where I performed a one-month research exchange in the fall of 2013, started when I was a neophyte Pharmacology PhD student. In 2011, I had co-written a chapter with my supervisor Rachel Tyndale in the book “Genetic Influences on Addiction – An Intermediate Phenotype Approach”, for which Marcus Munafò served as an editor. Fast-forward a year later, and I am sitting in my living room in Toronto on a Saturday afternoon reading an email from Rachel asking if I would want to do a stint of training in the UK with Marcus. Opportunities included: working with data from a large cohort (1000s!) of adolescents, learning new analytical approaches, gaining perspectives on tackling research questions from a novel angle, and living in a new city for a month. My first response was: “When can I start?”

Marcus and I met at SRNT in early 2013 to discuss the opportunity in person, and over the next several months, plans were set in motion. With excitement and anticipation, I arrived in Bristol on a Saturday morning in October 2013 and checked into my accommodations on campus. My initial awe at what would be my home for the next month quickly turned to panic as I realized I forgot to pack a travel adapter. In quick succession, my laptop and cell phone died. I set out into the sunshine, jet-lagged and completely unfamiliar with my new surroundings, determined to find a travel adapter. I happened upon a local shop operated by an electrician and his wife, and after providing me with a travel adapter, they thanked me for bringing the sunshine with me from ‘Canadia’. They then proceeded to draw several maps of Bristol, recommending things to do and sights to see. This was only the beginning of an incredibly long list of kind people I either met or had the pleasure of working with in Bristol.

As I reflect on my time working and socializing with members of TARG, I realize I could probably fill an entire blog. I think it may be more palatable to summarize my more scholastic experiences in four short “lessons” I have learned. These, I think, are applicable to many fields and disciplines, not just research.

Bristolian Christmas steps
Bristolian Christmas Steps

Lesson #1: It is important to focus not only on the end result, but also the process used to get there

 One of the many great things about working in a talented epidemiology research group like TARG is gaining a true appreciation for the elegance of the analytic approaches used in epidemiologic studies. This is particularly true for longitudinal studies like ALSPAC, where repeated observation at the individual level occurs over many years. I am fortunate to have previously gained some exposure to longitudinal data analysis techniques through working with Jennifer O’Loughlin at the University of Montreal on the NDIT cohort. Fully immersing myself in TARG for a month was an excellent way to not only learn, but also to utilize these approaches in a hands-on manner. I enjoyed writing an ALSPAC research proposal, and having regular meetings with Marcus and Jon Heron. This, together with regular email contact with Rachel, helped guide our ideas and approach to set the collaboration in motion.

I feel that this experience broadened my view of how good research is conducted, in terms of study design and analytic approaches, and I find myself reading papers more critically now. There can be a natural tendency to focus on the outcome and interpretation of the outcome, rather than the process used to generate it. Without a sound process, however, the results are likely meaningless. This lesson was solidified for me by David Nutt during his plenary lecture at the Bristol Neuroscience Festival. In describing how the definition of ‘drug’ changes across disciplines, David Nutt humorously pointed out that pharmacologists define a drug as a substance, that when given to a rat, results in a scientific paper. After I had finished laughing and could hear myself think again, I realized it was a fine teachable moment for me as a budding researcher: never lose sight of the process.

Clifton Suspension Bridge
Clifton Suspension Bridge

Lesson #2: New perspectives on your own work can arise from sharing ideas with individuals from a variety of disciplines

 I learned rather quickly that TARG members are experts in social networking, after Jen Ware sent me my itinerary for the month. We later joked that I would be well hydrated, with daily coffee mornings and weekly pub nights with the School of Experimental Psychology. These were welcoming forums to chat with people from a variety of training levels and areas of expertise within psychology. In a formal conference setting, I have often felt intimidated to approach faculty members, even if I had rehearsed a specific question I wanted to ask (which never comes out quite how you intend). The informal psychology coffee mornings and pub nights, which junior graduate students through to senior faculty members attend, were settings very much conducive to conversation and the sharing of ideas.

View from Clifton Suspension Bridge
View from Clifton Suspension Bridge

Lesson #3: Planning and performing work in a novel environment is refreshing and restorative

Toward the end of my last week with TARG, I was completely surprised to feel so refreshed and ready to continue my projects back home. Working with TARG stimulated new ways of thinking about science and approaches I could use with my existing projects, which gave me a new energy with which to tackle them. I showed up to work early every morning during my first week back in Toronto, which I like to attribute to my newfound zest as opposed to jet lag…

Lesson #4: New collaborations continue long after they begin

This has to be the best part about establishing a new collaboration. I am happy to report that I am continuing to work on an analysis using ALSPAC data. I am too scared to count the number of times I have emailed Jon Heron asking for help, but he is always incredibly responsive. It continues to be a great learning exercise for me and I can honestly say I now view setbacks in a more positive light, as so much more is learned through active trouble-shooting.

I am indebted to Marcus and his group for warmly welcoming me to TARG and I am looking forward to staying in touch with them in the years to come. I think it goes without saying that I would highly recommend an exchange to any trainee that is presented with an opportunity to research abroad, especially with a group like TARG.

Meghan Chenoweth is currently completing her PhD in Pharmacogenetics at University of Toronto.

MRC celebration of international collaboration

Posted on by oliviamaynard

Amy Taylor’s research, which relies heavily on international collaboration, has been awarded by the Medical Research Council in their Celebration of International Collaboration poster competition. Amy describes this work and the importance of international collaboration in her debut blog for TARG.

The Medical Research Council, one of the largest funding bodies for scientific research in the UK, celebrated its 100th birthday this year. To mark the occasion they have hosted a series of events in 2013, showcasing some of the incredible and life-changing discoveries that have been made by MRC scientists over the last century.

I was lucky enough to be part of the final event, a reception at the Royal Society on 10th December, celebrating a key aspect of the MRC’s work: international collaboration. They had invited MRC-funded early career researchers to submit abstracts explaining the importance of international collaboration to their work.  As one of the 10 shortlisted applicants, I was asked to turn this into a poster to display at the event.

Amy Taylor MRC international collaboration

My poster focused on CARTA, the consortium for Causal Analysis for Research in Tobacco and Alcohol, which is made up of over 30 studies from 9 different countries. We are investigating whether smoking causes a range of physical and mental health outcomes. To do this, we use a method of analysis called Mendelian randomisation, which uses a genetic variant related to smoking heaviness in the population. This type of analysis often requires large sample sizes and we can achieve this by combining information from different studies. To date, CARTA has data on over 100,000 individuals.  Forming CARTA has been one of my key roles in my first year since finishing my PhD and has taught me a great deal about the collaborative approach to scientific research.

The reception was a fantastic experience, highlighting the amazing breadth of the work of the MRC both past and present. We were treated to talks by eminent MRC researchers (including a Nobel prize winner) on developmental origins of disease, osteoporosis, HIV and TB and the structure of the ribosome.

Amy Taylor receiving her prize

For me personally, the event served as a reminder of why I have chosen this career path, which was sometimes easy to forget in the depths of PhD thesis writing! My fellow poster presenters worked on a diverse range of topics including bacterial motility, genetics of speech and language, childhood rickets in Bangladesh, zoonoses detection in Kenya and ageing in schizophrenia. It is easy to become very focused on your own tiny area of research, so it was great to have the opportunity to learn about other MRC-funded work from researchers at similar stages in their careers.

I was awarded second prize for my poster and received some funding to enable further collaboration. This can hopefully be used towards visits to meet some of my international CARTA colleagues, without whom the research I do would not be possible.

Dr Amy Taylor is a post-doc in TARG.

Mental heath and behaviour in early adulthood can be predicted by conduct problems in childhood

Posted on by oliviamaynard

We’ve known for some time that there is a lot of variation in children’s emotional and behavioural development. For example, if we think of conduct problems (such as lying, stealing, and fighting), then some children already show high levels in early childhood and this carries through into adolescence, whilst for other children this behaviour may be limited only to a period in adolescence when they briefly “go off the rails”, and not persist beyond this. But what happens to these different groups as they grow up? Put another way, can these different conduct problem pathways distinguish young adults in terms of various mental health problems? In our recent study, we found that they do indeed.

Those children who stand out with serious conduct problems throughout their childhood will more often drink, smoke, and take illegal drugs, as well as show criminal behaviour during early adulthood. These individuals also have a greater risk for depression, anxiety, and self-harm than young adults who showed no conduct problems when they were younger.

On the other hand, those children whose conduct problems begin in adolescence but are low in childhood still smoked more and used more illegal drugs than those without conduct problems and were more likely to engage in risky sexual behaviour. Worryingly, this group overall only fares marginally better than those with stable high conduct problems.

Our study suggests that adolescent conduct problems are not merely a fleeting issue but may result in a range of problems that make a healthy and well-adjusted start into adulthood less likely. These teenagers may need attention from parents, teachers, and youth workers who should not dismiss their conduct problems as something that will sort itself out over time. Moreover, our study serves as a reminder that children who present with high levels of conduct problems throughout their childhood years need a lot of support to improve their chances of growing into happy and healthy adults. The knowledge gained from our study might help inform the development of targeted interventions. The findings should certainly remind us that childhood conduct problems have a long reach and are reflected in mental health and behaviour several years later.

This blog was posted by Tina Kretschmer @DocTinaK