SOCIAL PSYCHOLOGY
Feeling loved, optimistic or happy as a teen may lead to better health in adulthood
The way teens — especially Black youth — feel about their lives may impact their cardiometabolic health risk as adults, according to a new study in the Journal of the American Heart Association
Peer-Reviewed PublicationResearch Highlights:
- Teens who reported feeling optimism, happiness, self-esteem, belongingness and loved were more likely to reach their 20s and 30s in good cardiometabolic health compared to teens with fewer of these positive psychological assets.
- The association was especially strong among Black youth.
- Fostering positive psychological assets in teenagers may help prevent cardiometabolic disease in adulthood and may also play a role in addressing health inequities.
DALLAS, January 11, 2023 — Teenagers who reported feeling optimism, happiness, self-esteem, belongingness, and feeling loved and wanted were more likely to reach their 20s and 30s in good cardiometabolic health compared to teens with fewer of these positive mental health assets, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
Previous studies have found that psychological facets of mental well-being, such as optimism and happiness, may be important modifiable factors related to better cardiometabolic health over time. While most of this research was conducted among older adults, this study focused earlier in life and considered a broader measure of cardiometabolic health, which also included indicators of blood sugar levels and inflammation.
“We learned a lot in the last few decades about the impact of discrimination and other social risks youth of color face that may explain their elevated rates of cardiometabolic disease, however, much less attention is paid to the inherent strengths they possess and the ways those strengths may be leveraged to advance health equity,” said lead study author Farah Qureshi, Sc.D., M.H.S., an assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “In this study, we wanted to shift the paradigm in public health beyond the traditional focus on deficits to one that concentrates on resource building.”
Researchers examined data from the National Longitudinal Study of Adolescent Health, which enrolled nearly 3,500 U.S. high schoolers (average age 16 years) in 1994 and were followed for more than two decades. Nearly half were girls, 67% were white youth, 15% were Black teens, 11% were Latino teenagers and 6% reported their race as either Native American, Asian, or “other.” Researchers periodically collected data on the participants’ health and well-being, with the most recent wave of data collection occurring in 2018, when their average age was 38.
Using initial survey responses from when participants were teenagers, researchers identified five mental health assets related to better cardiometabolic health outcomes: optimism, happiness, self-esteem, a sense of belonging and feeling loved. This information was cross-referenced with health data recorded over 3 decades to assess whether teens who had more of these positive assets were more likely to maintain optimal cardiometabolic health in adulthood.
To examine cardiometabolic health in this study, researchers reviewed health measures for seven cardiovascular and metabolic disease risk factors collected during clinic visits when participants were in their late 20s and 30s. The factors included high-density lipoprotein (HDL), or “good” cholesterol; non-HDL cholesterol – calculated as total cholesterol minus HDL cholesterol; systolic blood pressure (top number); diastolic blood pressure (bottom number); hemoglobin A1c, a measure of blood sugar; C-reactive protein, a measure of inflammation; and body mass index, or BMI, the ratio of height to weight to estimate body fat.
The analysis found:
- Overall, 55% of youth had zero to one positive mental health asset, while 29% had two to three assets and 16% had four to five assets.
- As young adults, only 12% of participants maintained cardiometabolic health over time, and white youth were more likely to maintain good health later in life compared to Black or Latino youth.
- Teens with four to five positive mental health assets were 69% more likely to maintain positive cardiometabolic health as young adults.
- There was also a cumulative effect, with each additional mental health asset conferring a 12% greater likelihood of positive cardiometabolic health.
- Although psychological assets were found to be protective across all racial and ethnic groups, the largest health benefits were noted among Black youth. Black teens also reported having more positive mental health assets than youth of any other racial or ethnic groups.
Despite Black teens having the most assets and deriving the most health benefits from them, racial disparities in cardiometabolic health were still apparent in adulthood. Black individuals were the least likely to maintain good cardiometabolic health over time.
“These somewhat counterintuitive findings were surprising,” Qureshi said. “When we dug deeper, we found that the absence of psychological assets being was particularly health-damaging for Black youth.” She further elaborated that the findings point to the role structural racism plays in shaping cardiometabolic health patterns in the first decades of life: “For Black youth – who face numerous barriers to achieving and sustaining optimal cardiometabolic health in adulthood – not having these additional mental health resources makes a big difference.”
“This work suggests that early investments in youth mental health may be a critical new frontier in the advancement of cardiometabolic health equity,” according to Qureshi.
“We need more large-scale studies to monitor these and other positive mental health factors starting in childhood to understand how these assets may influence health and disease over the life course. This information may help us identify new ways to improve health and reduce disparities,” she said.
Limitations of the study include that there were relatively few participants who were Latino, Asian or Native American and there were variations in blood sample collection methods over time.
Health care professionals measure cardiovascular health with the American Heart Association’s Life’s Essential 8 tool, which measures 4 indicators related to cardiovascular and metabolic health status (blood pressure, cholesterol, blood sugar and body mass index); and 4 behavioral/lifestyle factors (smoking status, physical activity, sleep and diet). According to Life’s Essential 8 data:
- only 45% of U.S. adolescents have five or more indicators of ideal cardiovascular health, and the percentage declines in adulthood; and
- there are persistent differences in cardiovascular health levels by self-reported race and ethnicity, and these disparities are larger at younger ages.
Co-authors are Anne-Josee Guimond, Ph.D.; Elaine Tsao, M.P.H.; Scott Delaney, Sc.D.; Julia K. Boehm, Ph.D.; and Laura D. Kubzansky, Ph.D. Authors’ disclosures are listed in the manuscript.
The National Institutes of Health (NIH) funded this research.
Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.
Additional Resources:
- Multimedia is available on the right column of release link https://newsroom.heart.org/news/feeling-loved-optimistic-or-happy-as-a-teen-may-lead-to-better-health-in-adulthood?preview=c7477f8a760cf6913cc1c021598eb243
- After Jan. 11, 2023, view the manuscript online.
- AHA Presidential Advisory: Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health (June 2022)
- AHA health information: Life’s Essential 8™ Fact Sheet
- AHA news release: Structural racism causes poor health, premature death from heart disease and stroke (Nov. 2020)
- AHA news release: Individual psychological well-being may guard heart health in Black adults (Oct. 2020)
- AHA news release: Optimism reduces stroke severity, inflammation (Feb. 2020)
- Follow AHA/ASA news on Twitter @HeartNews
- Follow news from the Journal of the American Heart Association @JAHA_AHA
About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
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JOURNAL
Journal of the American Heart Association
ARTICLE TITLE
Adolescent Psychological Assets and Cardiometabolic Health Maintenance in Adulthood: Implications for Health Equity
Feeling depressed? Performing acts of
kindness may help
Study finds helping others reduces focus on your own symptoms
Peer-Reviewed PublicationCOLUMBUS, Ohio -- People suffering from symptoms of depression or anxiety may help heal themselves by doing good deeds for others, new research shows.
The study found that performing acts of kindness led to improvements not seen in two other therapeutic techniques used to treat depression or anxiety.
Most importantly, the acts of kindness technique was the only intervention tested that helped people feel more connected to others, said study co-author David Cregg, who led the work as part of his PhD dissertation in psychology at The Ohio State University.
“Social connection is one of the ingredients of life most strongly associated with well-being. Performing acts of kindness seems to be one of the best ways to promote those connections,” Cregg said.
Cregg conducted the research with Jennifer Cheavens, professor of psychology at Ohio State. Their study was published recently in The Journal of Positive Psychology.
The research also revealed why performing acts of kindness worked so well: It helped people take their minds off their own depression and anxiety symptoms.
This finding suggests that one intuition many people have about people with depression may be wrong, Cheavens said.
“We often think that people with depression have enough to deal with, so we don’t want to burden them by asking them to help others. But these results run counter to that,” she said.
“Doing nice things for people and focusing on the needs of others may actually help people with depression and anxiety feel better about themselves.”
The study involved 122 people in central Ohio who had moderate to severe symptoms of depression, anxiety, and stress.
After an introductory session, the participants were split into three groups. Two of the groups were assigned to techniques often used in cognitive behavioral therapy (CBT) for depression: planning social activities or cognitive reappraisal.
The social activities group was instructed to plan social activities for two days a week. Another group was instructed in one of the staples of CBT: cognitive reappraisal. These participants kept records for at least two days each week that helped them identify negative thought patterns and revise their thoughts in a way that could reduce depression and anxiety.
Members of the third group were instructed to perform three acts of kindness a day for two days out of the week. Acts of kindness were defined as “big or small acts that benefit others or make others happy, typically at some cost to you in terms of time or resources.”
Some of the acts of kindness that participants later said they did included baking cookies for friends, offering to give a friend a ride, and leaving sticky notes for roommates with words of encouragement.
Participants followed their instructions for five weeks, after which they were evaluated again. The researchers then checked with the participants after another five weeks to see if the interventions were still effective.
The findings showed that participants in all three groups showed an increase in life satisfaction and a reduction of depression and anxiety symptoms after the 10 weeks of the study.
“These results are encouraging because they suggest that all three study interventions are effective at reducing distress and improving satisfaction,” Cregg said.
“But acts of kindness still showed an advantage over both social activities and cognitive reappraisal by making people feel more connected to other people, which is an important part of well-being,” he said.
In addition, the acts of kindness group showed greater improvements than the cognitive reappraisal group for life satisfaction and symptoms of depression and anxiety, results showed.
Cheavens noted that just participating in social activities did not improve feelings of social connection in this study.
“There’s something specific about performing acts of kindness that makes people feel connected to others. It’s not enough to just be around other people, participating in social activities,” she said.
Cregg said that while this study used techniques of CBT, it is not the same experience as going through CBT. Those who undergo the full treatment may have better results than those in this study.
But the findings also show that even the limited CBT exposure given in this study can be helpful, Cheavens said.
“Not everyone who could benefit from psychotherapy has the opportunity to get that treatment,” she said. “But we found that a relatively simple, one-time training had real effects on reducing depression and anxiety symptoms.”
And beyond traditional CBT, acts of kindness may have additional benefits in creating social connections, Cregg said.
“Something as simple as helping other people can go above and beyond other treatments in helping heal people with depression and anxiety,” he said.
#
Contact: David Cregg, Cregg.3@osu.edu
Jennifer Cheavens, Cheavens.1@osu.edu
Written by Jeff Grabmeier, 614-292-8457; Grabmeier.1@osu.edu
JOURNAL
The Journal of Positive Psychology
METHOD OF RESEARCH
Randomized controlled/clinical trial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Healing through helping: an experimental investigation of kindness, social activities, and reappraisal as well-being interventions
Having strong social connections can improve your health, according to global study
The time people spent with family over the festive period could have improved their health, according to new research which examined how social bonds with close social circles and extended groups relate to health and psychological wellbeing.
The study, led by researchers at the University of Kent, Nottingham Trent University (NTU) and Coventry University, used self-reported data from more than 13,000 people across 122 countries, gathered during the first wave of the COVID-19 pandemic.
Surveys assessed people’s strength of bonding with close social circles, such as family and friends, as well as with extended groups, such as country, government and humanity. People’s pandemic-related health behaviours and mental health and wellbeing were also measured.
Results show that only bonding with family, rather than other groups, is linked to engaging positively with behaviour which can improve health; in this case, examples included washing hands, wearing a mask and social distancing.
For example, 46% of people who had strong family bonds washed hands at least “a lot”, compared to 32% who were not strongly bonded with their family. Moreover, 54% of people not bonded with their family reported they never wore a mask. Bonded people were vastly over-represented among those who engaged in health behaviours. Despite people with strong family bonds constituting only 27% of the entire sample, they constituted 73% of those who engaged in social distancing, 35% of those who washed hands, and 36% of those who wore a mask “a lot” or more.
The study also found that having strong bonds with both close social circles and extended groups is associated with better mental health and wellbeing. Importantly, the greater number of groups people had strong bonds with, the higher their engagement in health behaviours and the better their reported psychological wellbeing was, with less anxiety and depression.
The research recommends that public health messaging focus on smaller networks as well as multiple groups, particularly in times of crisis when individuals should be encouraged to share their positive health behaviours with their close social circles.
It is also suggested that healthcare systems can reduce the reliance on pharmaceutical treatments by using social prescribing to support individuals who do not have these bonds in their life.
The results of the study, which included a broad range of countries such as Bangladesh, Brazil and Peru, have implications for tackling negative physical and mental health effects from a global perspective. The study goes beyond the remit of traditional approaches in psychology by reaching so much of the global population.
Anthropologist at the University of Kent, Dr Martha Newson, said: ‘This research speaks to the universal need to belong – this is one of the reasons we felt it was so important to include a truly diverse sample from across the globe. Wherever you are in the world, other people matter to you.
‘We found that having lots of groups was important to encourage better health behaviours, including bonding to abstract groups like your country or government, but most important of all are our closest friends and family — groups that we have likely recognised as being important since the beginning of human history.’
Senior Lecturer in Psychology at NTU’s School of Social Sciences, Dr Bahar Tunçgenç, added: ‘At times of turmoil, such as during disasters, social crises, or pandemics, our social bonds can be key to receiving support. We look out to people we trust and identify with as we decide what course of action to take. That’s why our close bonds with family – the people many of us share significant life events with and learn from – can promote healthy behaviours.
‘At the same time, having strong social connections – no matter how abstract or distant these might be – is crucial for promoting mental health. Our research shows that close and extended social bonds offer different sources of support and direction.’
Assistant Professor at the Centre for Trust, Peace, and Social Relations at Coventry University, Dr Valerie van Mulukom, said: “In the West, we tend to think of ourselves as individuals who have to survive and conquer the world on our own. Our research demonstrates that in fact, humans are very much social animals, who benefit from, and rely on, their communities in more ways than one. In challenging times this is even more pronounced. It is advisable for government policies to consider these psychological needs and mechanisms and involve local authorities and grassroots organisations for maximum efficiency and wellbeing in times of disaster.”
The paper is published in the journal Science Advances.
Ends
Notes to editors
For interviews with Dr Martha Newson, please contact Heidi Pullig, Press & Public Relations Officer, at: h.pullig@kent.ac.uk
For all other enquiries, please contact Helen Breese, Public Relations Manager, on telephone +44 (0)115 848 8751, or via email.
More information, including a copy of the paper, can be found online at the Science Advances press package at https://www.eurekalert.org/press/vancepak/.
About the University of Kent
The University of Kent is a leading UK university producing world-class research, rated internationally excellent and leading the way in many fields of study. Our 20,000 students are based at campuses and centres in Canterbury, Medway, Brussels and Paris.
We are renowned for our inspirational teaching and our graduates are equipped for a successful future allowing them to compete effectively in the global job market.
We are committed to supporting outstanding research and innovation across the arts and humanities, sciences and social sciences. Our discoveries and research will emphasise existing and new signature areas, where we match the best in the world.
The University is a truly international community with over 40% of our academics coming from outside the UK and our students representing over 150 nationalities.
We are a major economic force in southeast England, supporting innovation and enterprise and through collaboration with partners, work to ensure our global ambitions have a positive impact on the region’s academic, cultural, social and economic landscape.
About Nottingham Trent University
Nottingham Trent University (NTU) received the Queen’s Anniversary Prize for Higher and Further Education in 2021 for cultural heritage science research. It is the second time that NTU has been bestowed the honour of receiving a Queen’s Anniversary Prize for its research, the first being in 2015 for leading-edge research on the safety and security of global citizens.
The Research Excellence Framework (2021) classed 83% of NTU’s research activity as either world-leading or internationally excellent. 86% of NTU’s research impact was assessed to be either world-leading or internationally excellent.
NTU was awarded The Times and The Sunday Times Modern University of the Year 2023 and ranked second best university in the UK in the Uni Compare Top 100 rankings (2021/2022). It was awarded Outstanding Support for Students 2020 (Times Higher Education Awards), University of the Year 2019 (Guardian University Awards, UK Social Mobility Awards), Modern University of the Year 2018 (Times and Sunday Times Good University Guide) and University of the Year 2017 (Times Higher Education Awards).
NTU is the 5th largest UK institution by student numbers, with nearly 39,000 students and more than 4,400 staff located across five campuses. It has an international student population of 7,000 and an NTU community representing over 160 countries.
Since 2000, NTU has invested £570 million in tools, technology, buildings and facilities.
NTU is in the UK’s top 10 for number of applications and ranked first for accepted offers (2021 UCAS UG acceptance data). It is also among the UK’s top five recruiters of students from disadvantaged backgrounds and was the first UK university to sign the Social Mobility Pledge.
NTU is ranked 2nd most sustainable university in the world in the 2022 UI Green Metric University World Rankings (out of more than 900 participating universities).
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
Managing emotions better could prevent pathological ageing
A UNIGE team deciphers how negative emotions durably modify brain activity in the older adults.
Peer-Reviewed PublicationIMAGE: THE TOP IMAGE DEPICTS THE VARYING BRAIN ACTIVATIONS BETWEEN 27 OLDER ADULTS AND 29 YOUNGER ADULTS DURING REST PERIODS FOLLOWING HIGH EMOTION (POST-HE) AND LOW EMOTION (POST-LE) VIDEOS IN EXPERIMENT 1. THE BOTTOM IMAGE ILLUSTRATES THE BRAIN REGIONS THAT RESPOND TO REST PERIODS FOLLOWING HE > LE, AS WELL AS THE OVERLAP OF THESE ACTIVATIONS WITH EMOTIONAL RESPONSES DURING THE HE > LE VIDEOS IN EXPERIMENT 2, WITH DATA FROM 127 OLDER ADULTS. view more
CREDIT: © FIGURE ADAPTED FROM BAEZ-LUGO ET AL., 2023, NATURE AGING.
Negative emotions, anxiety and depression are thought to promote the onset of neurodegenerative diseases and dementia. But what is their impact on the brain and can their deleterious effects be limited? Neuroscientists at the University of Geneva (UNIGE) observed the activation of the brains of young and older adults when confronted with the psychological suffering of others. The neuronal connections of the older adults show significant emotional inertia: negative emotions modify them excessively and over a long period of time, particularly in the posterior cingulate cortex and the amygdala, two brain regions strongly involved in the management of emotions and autobiographical memory. These results, to be published in Nature Aging, indicate that a better management of these emotions - through meditation for example - could help limit neurodegeneration.
For the past 20 years, neuroscientists have been looking at how the brain reacts to emotions. ‘‘We are beginning to understand what happens at the moment of perception of an emotional stimulus,’’ explains Dr Olga Klimecki, a researcher at the UNIGE’s Swiss Centre for Affective Sciences and at the Deutsches Zentrum für Neurodegenerative Erkrankungen, who is last author of this study carried out as part of a European research project co-directed by the UNIGE. ‘‘However, what happens afterwards remains a mystery. How does the brain switch from one emotion to another? How does it return to its initial state? Does emotional variability change with age? What are the consequences for the brain of mismanagement of emotions?’’
Previous studies in psychology have shown that an ability to change emotions quickly is beneficial for mental health. Conversely, people who are unable to regulate their emotions and remain in the same emotional state for a long time are at higher risks of depression. ‘‘Our aim was to determine what cerebral trace remains after the viewing of emotional scenes, in order to evaluate the brain’s reaction, and, above all, its recovery mechanisms. We focused on the older adults, in order to identify possible differences between normal and pathological ageing,’’ says Patrik Vuilleumier, professor in the Department of Basic Neurosciences at the Faculty of Medicine and at the Swiss Centre for Affective Sciences at the UNIGE, who co-directed this work.
Not all brains are created equal
The scientists showed volunteers short television clips showing people in a state of emotional suffering - during a natural disaster or distress situation for example - as well as videos with neutral emotional content, in order to observe their brain activity using functional MRI. First, the team compared a group of 27 people over 65 years of age with a group of 29 people aged around 25 years. The same experiment was then repeated with 127 older adults.
‘‘Older people generally show a different pattern of brain activity and connectivity from younger people,’’ says Sebastian Baez Lugo, a researcher in Patrik Vuilleumier’s laboratory and the first author of this work. ‘‘This is particularly noticeable in the level of activation of the default mode network, a brain network that is highly activated in resting state. Its activity is frequently disrupted by depression or anxiety, suggesting that it is involved in the regulation of emotions. In the older adults, part of this network, the posterior cingulate cortex, which processes autobiographical memory, shows an increase in its connections with the amygdala, which processes important emotional stimuli. These connections are stronger in subjects with high anxiety scores, with rumination, or with negative thoughts.’’
Empathy and ageing
However, older people tend to regulate their emotions better than younger people, and focus more easily on positive details, even during a negative event. But changes in connectivity between the posterior cingulate cortex and the amygdala could indicate a deviation from the normal ageing phenomenon, accentuated in people who show more anxiety, rumination and negative emotions. The posterior cingulate cortex is one of the regions most affected by dementia, suggesting that the presence of these symptoms could increase the risk of neurodegenerative disease.
‘‘Is it poor emotional regulation and anxiety that increases the risk of dementia or the other way around? We still don’t know,’’ says Sebastian Baez Lugo. ‘‘Our hypothesis is that more anxious people would have no or less capacity for emotional distancing. The mechanism of emotional inertia in the context of ageing would then be explained by the fact that the brain of these people remains ‘frozen’ in a negative state by relating the suffering of others to their own emotional memories.”
Could meditation be a solution?
Could it be possible to prevent dementia by acting on the mechanism of emotional inertia? The research team is currently conducting an 18-month interventional study to evaluate the effects of foreign language learning on the one hand, and meditation practice on the other. ‘‘In order to further refine our results, we will also compare the effects of two types of meditation: mindfulness, which consists of anchoring oneself in the present in order to concentrate on one’s own feelings, and what is known as ‘compassionate’ meditation, which aims to actively increase positive emotions towards others,’’ the authors add.
This research is part of a large European study, MEDIT-AGEING, which aims to evaluate the impact of non-pharmacological interventions for better ageing.
JOURNAL
Nature Aging
METHOD OF RESEARCH
News article
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Exposure to negative socio-emotional events induces sustained alteration of resting-state brain networks in older adults
How differences in diagnoses of mental disorders might affect clinical research outcomes for antipsychotics
Mental illnesses often have unclear definitions, and their diagnosis and treatment are susceptible to subjective interpretation. Japanese researchers have now clarified an important confounding factor in the evaluation of antipsychotics
Peer-Reviewed PublicationIMAGE: PATIENTS WITH BIPOLAR DISORDER WHO EXHIBITED PSYCHOTIC FEATURES DERIVED A CLEAR BENEFIT FROM ANTIPSYCHOTIC DRUGS (A) BUT NOT FROM MOOD STABILIZERS (B). view more
CREDIT: TARO KISHI, FUJITA HEALTH UNIVERSITY SCHOOL OF MEDICINE
Most physical disorders such as heart disease or muscular dystrophy have well-defined boundaries. Clinicians from across the globe regularly revise disease definitions to be on the same page as far as the diagnosis of these disease goes. This practice improves the corresponding clinical outcomes and helps maintain uniformity and common communication. However, this is not always possible. For instance, in the case of many psychiatric disorders, it is slightly challenging to draw lines and set hard boundaries with respect to clinical features of a particular illness. Owing to this limitation, the prescribed psychiatric therapies tend to vary to a certain extent, depending on the clinician’s perspective. Recently published research from Japan now aims to close this gap by identifying the source of this variance, and how to reduce its impact on patients with mental illnesses. This paper was made available online on August 13, 2022, and was published in Volume 76, Issue 11, of Psychiatry and Clinical Neurosciences on 5 November 2022.
Says lead author Masashi Ikeda, a Professor at the Department of Psychiatry, Fujita Health University School of Medicine, “Diagnosis of psychiatric disorders is based on symptoms identified by diagnostic criteria, such as those outlined by the Diagnostic and Statistical Manual of Mental Disorders. However, this diagnosis is not made based on objective test data. In fact, the diagnosis may differ depending on the psychiatrist's nuances and interpretation of the patient's symptoms.”
Is there, however, a way to make these diagnoses more objective?
Common links between psychiatric disorders
Prior work undertaken by the Japanese research team has shown that subtypes of bipolar disorder share certain features to a varying extent with two other psychiatric disorders: schizophrenia and depression. An analyses of Japanese and Caucasian patient databases indeed show surprising trends. Whereas the Caucasian data show that bipolar I disorder has features that are more in common with schizophrenia, the Japanese data show that it tends to have features that are more in common with depression. On the other hand, for bipolar II disorder, both Caucasian and Japanese data show a similar degree of commonality with schizophrenia and depression. Moreover, the study clearly establishes a genetic correlation between subtypes of bipolar disorder and schizophrenia/major depressive disorder in East Asian and European populations.
The study suggests that differences between Japanese psychiatrists and Western psychiatrists in their diagnostic tendencies, or in the tendencies of patients to whom the psychiatrists request to participate in research, contribute to the observed clinical discrepancies. For instance, Japanese psychiatrists, heavily influenced by classic German psychiatry, tend to believe that bipolar disorder is a mood problem. They also may not diagnose bipolar disorder in patients with delusions and certain other characteristics with careful attention. These specific differences in opinions mean that Japanese and Western psychiatrists may hold two differing opinions about the diagnosis of the same patient, based on their personal experience and perceptions.
Co-author Takeo Saito, a senior lecturer at the Department of Psychiatry, Fujita Health University School of Medicine, adds, “If this trend is also occurring in clinical trials, then it may affect the evaluation of drug responsiveness, especially second-generation antipsychotics. Therefore, caution may be required while analyzing the data.”
How is this so?
Clinical trials recruit patients with specific disorders, to see if a drug is beneficial for that particular disorder. Understandably, if the criteria for diagnosis of a mental illness is different across the globe, then the recruitment of patients in clinical trials will differ as well—the proportions of patients with a particular illness will vary among clinical trials in different countries, thereby affecting the results of the trial.
This can be remedied with new directions for clinical interventions
To test whether their hypotheses was correct or not, the researchers examined whether response rates to pharmacotherapy during acute mania in bipolar disorder differed based on the extent to which psychotic features were represented in the analyzed samples. In other words, they tried to determine the therapeutic efficacy of antipsychotics in patients with acute mania and bipolar disorder, who exhibited clear or no psychotic features.
To this end, the team performed meta-regression analyses of 28 double-blind randomized trials and compared the effects of classical mood stabilizers such as lithium and antipsychotics. The results were significantly startling: whereas classical mood stabilizers did not correlate with treatment response, antipsychotics showed relatively higher treatment response rates when the proportion of patients with psychotic features was also relatively higher. In other words, antipsychotics, but not mood stabilizers, were effective in treating patients with bipolar disorder who also exhibited psychotic features. As a result, the treatment effect of antipsychotic drugs under consideration got “underestimated” when patients with bipolar disorder seeking treatment hardly exhibited any psychotic features.
Co-author Taro Kishi, also an associate professor at the Department of Psychiatry, Fujita Health University School of Medicine, muses, “It is unclear whether the inclusion of patients with or without psychotic features in clinical trials reflects a sampling problem or a diagnostic problem. However, in clinical trials for bipolar disorder, the proportion of patients with and without psychotic features should always be included in the clinical background and considered during subsequent analyses, especially since it could be highly relevant to the evaluation of treatment efficacy of antipsychotic medications.”
This result has significant implications for psychiatric recommendations and future clinical trials. Senior author Nakao Iwata, also from the Department of Psychiatry, concludes, “Based on our studies, the presence of psychotic features in patients with bipolar disorder is clearly a confounding factor. Therefore, it is recommended that this be described and treated accordingly in future clinical studies.”
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Reference
DOI: https://doi.org/10.1111/pcn.13460
About Fujita Health University
Fujita Health University is a private university situated in Toyoake, Aichi, Japan. It was founded in 1964 and houses one of the largest teaching university hospitals in Japan in terms of the number of beds. With over 900 faculty members, the university is committed to providing various academic opportunities to students internationally. Fujita Health University has been ranked eighth among all universities and second among all private universities in Japan in the 2020 Times Higher Education (THE) World University Rankings. THE University Impact Rankings 2019 visualized university initiatives for sustainable development goals (SDGs). For the “good health and well-being” SDG, Fujita Health University was ranked second among all universities and number one among private universities in Japan. The university became the first Japanese university to host the "THE Asia Universities Summit" in June 2021. The university’s founding philosophy is “Our creativity for the people (DOKUSOU-ICHIRI),” which reflects the belief that, as with the university’s alumni and alumnae, current students also unlock their future by leveraging their creativity.
Website: https://www.fujita-hu.ac.jp/en/index.html
About Professor Masashi Ikeda from Fujita Health University
Dr. Masashi Ikeda is a Professor affiliated with the Department of Psychiatry at Fujita Health University School of Medicine. He specializes in interdisciplinary research combining psychiatric disorders with genetics. He has over 200 publications to his name on such topics, with more than 18400 citations. He is also President of Genonics Ltd., a company that offers genetic testing services.
JOURNAL
Psychiatry and Clinical Neurosciences
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Proportion of subjects with psychotic features in bipolar disorder correlated with treatment response by antipsychotics for acute mania
