COOPERATE: Empowering minoritized patients with chronic back and other musculoskeletal pain to receive the care they need

Tools facilitate health equity, autonomy, control over individual’s own healthcare

Peer-Reviewed Publication

REGENSTRIEF INSTITUTE

INDIANAPOLIS – A new study led by a U.S. Department of Veterans Affairs, Regenstrief Institute and Indiana University School of Medicine researcher focuses on empowering minoritized patients with chronic back and other musculoskeletal pain to receive care best suited to their individual values and preferences. Black patients continue to experience greater pain severity, worse pain outcomes and inadequate pain treatment compared to White patients, despite national priorities focused on health equity.

COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) is one of the first studies to test and evaluate equipping Black adults who have chronic pain with tools to facilitate autonomy and control over their own care. Through six telephonic coaching sessions over 12 weeks, the randomized controlled trial provided 125 Black veterans with tools focused on increasing knowledge and confidence to self-manage their pain and on optimizing communication of their needs, preferences and desires to their physicians. An additional 125 Black veterans participated in the study’s control group and did not receive coaching. Average age of participants in both arms of the study was 61 years, and 83 percent were male.

The researchers found that the coaching produced significant improvement in patient activation (having the knowledge and confidence to manage their health and healthcare), which has been linked in other research to better treatment adherence, more positive experiences with healthcare, and better quality of life. In addition, patients who received the coaching experienced increased confidence in expressing themselves and communicating their pain-related goals to their clinicians. This improvement remained or improved after coaching ended.

Lower patient activation is associated with negative health outcomes, including depression and anxiety, as well as with poorer physical health. Poor patient-clinician communication is a known barrier to high-quality care.

“COOPERATE is focused on Black individuals with chronic pain. There are racialized disparities in chronic pain treatment at both the individual and system levels,” said Regenstrief, VA and IU School of Medicine researcher Marianne Matthias, PhD, who led the study. “Increasing patient activation is a novel way to improve pain self-management and it's an understudied path toward improving health equity and ultimately achieving the best possible care for each patient.”

COOPERATE coaches helped individuals think about how their pain management goals fit into their larger life goals, such as being more active with their children or grandchildren or participating in a physical activity. The coaches also focused on making communication with clinicians as clear and effective as possible by practicing techniques such as agenda setting to help patients get the most out of their medical appointments. 

“Pain improved in the short term after coaching ended, which is interesting because coaching focused on patient activation and communication—not specifically on pain itself. And we were pleased to see an improvement in depression and anxiety, which actually worsened over time for those in the control group who didn’t receive coaching,” said Dr. Matthias. “COOPERATE coaching participants gained confidence in talking with their clinicians, including explaining their concerns and preferences, ultimately giving them more control of their chronic pain care. It clearly made a difference.”

The COOPERATE study was conducted at the Richard L. Roudebush VA Medical Center. The researchers hope to expand the study to multiple sites in the future.

“Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics" is published in the peer-reviewed journal Pain.

Authors and affiliations:

Marianne S. Matthias, PhD.1,2,3; Joanne K. Daggy, PhD.4; Anthony J. Perkins, M.S.4; Jasma Adams, M.P.H.1; Matthew J. Bair, M.D., M.S.1,2,3; Diana J. Burgess, PhD.5,6; Johanne Eliacin, PhD.1,2,7; Perla Flores, B.S.1; Laura J. Myers, PhD.1,2,3; Tetla Menen1; Philip Procento, M.S.8; Kevin L. Rand, PhD.8; Michelle P. Salyers, PhD.8; Mackenzie L. Shanahan, Ph.D.9; and Adam T. Hirsh, PhD.8

1VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN

2Regenstrief Institute, Indianapolis, IN

3Department of Medicine, Indiana University School of Medicine, Indianapolis, IN

4 Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN

5Department of Medicine, University of Minnesota, Minneapolis, MN

6 Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN

7National Center for PTSD, VA Boston Healthcare System, Boston, MA

8Department of Psychology, Indiana University-Purdue University, Indianapolis, IN

9 VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

This work was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review Award to Dr. Matthias (IIR 17-032).

Marianne S. Matthias, PhD
In addition to her role as a research scientist at Regenstrief Institute, Marianne S. Matthias, PhD, is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis. She is also a senior research professor of medicine at Indiana University School of Medicine.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About Veteran Health Indiana and CHIC        
The Richard L. Roudebush VA Medical Center is the flagship medical center for Veteran Health Indiana, the VA’s healthcare system in central and southern Indiana. The medical center is located in downtown Indianapolis, and is collocated with three large community hospitals and the campus of the Indiana University Schools of Medicine and Nursing. The health system has been serving Hoosier Veterans since 1932. As Indiana’s Level 1a, tertiary care Veteran facility, the medical center serves as home base for a system of inpatient and outpatient care locations serving more than 62,000 Veterans.

The VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) group is a diverse cadre of researchers based at Roudebush VA Medical Center who work together to transform the healthcare system, both within and outside the VA so every patient receives consistent, high-quality care.

About IU School of Medicine 
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

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JOURNAL

Pain

DOI

10.1097/j.pain.0000000000003021 

ARTICLE TITLE

Communication and activation in pain to enhance relationships and treat pain with equity (COOPERATE): a randomized clinical trial

ARTICLE PUBLICATION DATE

29-Sep-2023

 

Racial/ethnic minority patients may be less likely than white patients to receive palliative care during breast cancer treatment

Palliative care use increased among all racial/ethnic groups from 2004 to 2020

Reports and Proceedings

AMERICAN ASSOCIATION FOR CANCER RESEARCH

ORLANDO, Fla. – Despite a steady increase in palliative care utilization from 2004 to 2020, non-Hispanic Black, Hispanic, and Asian or Pacific Islander patients with metastatic breast cancer were less likely to receive palliative care than non-Hispanic white patients, according to results presented at the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 29-October 2, 2023.

Palliative care consists of treatments or procedures intended to relieve pain and other side effects associated with cancer or cancer therapy. According to the National Cancer Institute’s fact sheet, rapid integration of palliative care into a patient’s care plan can potentially improve mood, quality of life, and overall survival.

In line with these observations, the National Comprehensive Cancer Network’s (NCCN) guidelines for palliative care state that all cancer patients should be screened to determine their palliative care needs, both at intake and throughout treatment. Further, patients, families, and caregivers should be informed that palliative care is an integral part of their treatment.

“It is essential to identify the needs of these patients, particularly racial/ethnic minority populations, and evaluate how oncology programs can integrate palliative care early into the cancer care continuum while ensuring equitable access,” said Jincong Freeman, MPH, MS, a doctoral student in the Department of Public Health Sciences at the University of Chicago, who presented the study.

Freeman and colleagues wanted to assess how palliative care use in the U.S. has changed over time for patients with metastatic breast cancer. They also wanted to evaluate differences in utilization between different racial and ethnic groups to better understand potential disparities.

The researchers analyzed data from the National Cancer Database (NCDB), which contains deidentified patient data from over 1,500 cancer treatment centers around the U.S. The records used in this study were collected between 2004 and 2020 and consisted of 148,931 patients with de novo metastatic breast cancer—breast cancer that had already metastasized at the time of diagnosis.

The study showed that palliative care use increased significantly over time, from 14.9% in 2004 to 27.6% in 2020. Increases were observed across all racial and ethnic groups, Freeman said.

However, non-Hispanic Black, Asian or Pacific Islander, and Hispanic patients were 13%, 26%, and 35% less likely to receive palliative care, respectively, than non-Hispanic white patients after adjusting for clinical and sociodemographic factors. There was no significant difference in palliative care use between non-Hispanic white patients and patients who identified as American Indian, Alaska Native, or other.

Freeman emphasized that despite the increase, palliative care use remained suboptimal, as over 70% of patients did not receive palliative care in 2020. While the NCDB did not assess the reasons underlying skipped palliative care opportunities, Freeman speculated that lack of awareness, cultural beliefs, and physician preferences may play a role. More research will be necessary to understand the contributing factors, he said.

In order to further increase uptake across demographic groups, Freeman suggested adherence to NCCN’s call to integrate palliative care early into the cancer care continuum for all patients. He also called on physicians and patients to dispel some of the myths and misunderstandings associated with palliative care, such as confusing it with hospice or end-of-life care, or assuming it cannot be combined with active cancer treatment.

“Our findings underscore the importance of promoting the benefits of palliative care and addressing racial/ethnic disparities to improve the quality of life of metastatic breast cancer patients,” Freeman said.

Limitations of this study include potential underreporting or misclassifications of palliative care in the NCDB, necessitating future prospective studies to confirm the findings. Furthermore, while the researchers adjusted for clinical and sociodemographic factors, they did not have information on other factors, such as patients’ symptoms or treatment side effects, that might determine whether palliative care is necessary.

This study was funded by the Breast Cancer Research Foundation, the National Cancer Institute of the National Institutes of Health, and the Susan G. Komen Breast Cancer Foundation. Freeman declares no conflicts of interest.

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COI STATEMENT

This study was funded by the Breast Cancer Research Foundation, the National Cancer Institute of the National Institutes of Health, and the Susan G. Komen Breast Cancer Foundation. Freeman declares no conflicts of interest.

 

Structural racism may play a role in increased cancer mortality rates among racial minorities

Reports and Proceedings

AMERICAN ASSOCIATION FOR CANCER RESEARCH

ORLANDO, Fla. – Structural racism was associated with increased county-level cancer mortality rates among minority populations compared with whites, according to results presented at the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 29-October 2, 2023.

“Applying measures that attempt to capture the multiple and compounding ways racism presents in policies, laws, and practices at a population level shows how racism manifests beyond interpersonal interactions to negatively impact cancer outcomes,” said presenter Joelle N. Robinson-Oghogho, PhD, MPH, a postdoctoral fellow at Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society. “Studying the impact of structural racism on cancer outcomes allows us to further understand the persistent racial disparities in cancer and broaden our scope of intervention.”

Robinson-Oghogho and colleagues explored the association between structural racism and cancer mortality rates in 1,026 U.S. counties and investigated whether this association differed by race among non-Hispanic Black, white, Asian/Pacific Islander, and American Indian and Alaskan Native populations.

The researchers used publicly available data on 2015-2019 cancer mortality rates from the U.S. Cancer Statistics Data Visualization Tool and obtained information on factors associated with cancer mortality rates from the 2019 County Health Rankings and Roadmaps, the U.S. Environmental Protection Agency’s 2006-2010 Environmental Quality Index report, and 2015-2019 estimates from the U.S. Census American Community Survey.

The team measured county-level structural racism by applying a previously developed standardized index that takes into account residential segregation, incarceration, employment, economic status/wealth, and education. The county-level structural racism factor scores obtained through this method represent the number of standard deviations that separate the structural racism value for a given county from the mean value for all counties.

After adjusting for environmental quality, adult smoking, obesity, excessive alcohol consumption, health insurance coverage, rates of sexually transmitted infection, mammography screening rates, primary care physician-to-population ratio, rurality, and geographic mobility, higher county structural racism scores were associated with higher rates of cancer mortality: Overall, every standard deviation increase in the score was associated with 3.3 additional cancer deaths per 100,000 people.

Furthermore, the increase was higher among historically minoritized populations compared to white populations. Specifically, for every standard deviation increase in the score, compared to white populations, cancer mortality rates increased by 11.9 deaths per 100,000 people for non-Hispanic Blacks, 4.7 deaths per 100,00 people for Asian/Pacific Islanders, and 17.4 deaths per 100,000 people for American Indian/Alaskan Natives. “This finding demonstrates how racial groups can be differentially impacted by the social characteristics of their environment,” said Robinson-Oghogho. “Addressing these disparities will require incorporating processes and tools that tackle structural racism.”

The limitations of this study include that the analysis was based on a subset of U.S. counties, which likely limited the number of counties with available data for American Indian/Alaskan Natives and certain other populations.

This research was supported by the National Cancer Institute, the National Institute on Aging, and the National Institute for Minority Health Disparities. The authors declared no conflicts of interests.

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COI STATEMENT

This research was supported by the National Cancer Institute, the National Institute on Aging, and the National Institute for Minority Health Disparities. The authors declared no conflicts of interests.

 

Racial and ethnic minorities may be less willing than others to participate in clinical trials

Survey found that most people are open to participating, and motivation varied by racial and ethnic group

Reports and Proceedings

AMERICAN ASSOCIATION FOR CANCER RESEARCH

ORLANDO, Fla. – A survey conducted in one cancer center’s catchment area found that while a majority of respondents would be willing to participate in a clinical trial, members of racial and ethnic minority groups were significantly less likely to participate than non-Hispanic whites, according to results presented at the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 29-October 2, 2023. Reasons to participate or not participate varied across the groups, suggesting that tailored approaches to enrolling patients in clinical trials could lead to more diverse patient populations.

Clinical trials are a pivotal part of the drug approval process, but previous research has shown that only about 5% of Americans have ever participated in a clinical trial. Most racial and ethnic minority groups are underrepresented, exacerbating disparities in many areas of health care, including cancer diagnosis and treatment. 

“This lack of representation means that most clinical trials do not show the full range of people that are afflicted by cancer and, therefore, are not fully informing our treatments,” explained the study’s lead author, Amy L. Shaver, PhD, PharmD, MPH, a postdoctoral research fellow at Thomas Jefferson University in Philadelphia. “We need to understand how to better attract and retain a more representative sample of people so that the care we deliver is best suited to the people it is delivered to.”

In order to assess people’s willingness to participate in clinical trials, Shaver and colleagues utilized data from an online survey of 2,744 adult residents in the Sidney Kimmel Cancer Center’s catchment area, which includes Philadelphia, Delaware, Bucks, and Montgomery counties in Pennsylvania as well as Camden, Burlington, and Gloucester counties in New Jersey. The Sidney Kimmel Cancer Center and Thomas Jefferson University are both part of the Jefferson Health system. The survey, conducted from July to August 2022, assessed lifestyle behaviors, cancer screening frequencies, cancer attitudes or beliefs, health literacy, and numeracy. The survey was administered in English, Spanish, and Chinese. A majority of respondents (57.8%) were white; 19% were non-Hispanic Black, 9.3% were Hispanic, and 14% identified as “other,” including Asian ethnic groups.

The survey showed that overall, 69.8% of respondents were willing to participate in clinical trials. However, distinct differences emerged in various racial and ethnic groups. Key highlights:

• Respondents answering in Chinese were 40% less likely than those answering in English to say they would participate in clinical trials;
• Hispanic and non-Hispanic Black respondents were more than 30% less likely to say they would participate than white respondents;
• The most common reason given for not participating in clinical trials was fear of side effects (25.6%). Other reasons were concerns that the drug may not be effective; lack of awareness of trial locations; mistrust in doctors and/or drug companies; and worries about the time commitment.

The survey also asked participants about their personal experiences with discrimination. Shaver said she was surprised to discover that respondents reporting a high level of discrimination were 48% more likely to participate in a clinical trial than those who reported a low level of discrimination. She said the respondents who reported a high level of discrimination cited wanting to “learn more about their health and medical condition” (66.3%) and a desire to “help my community” (54.5%) as potential motivating factors for clinical trial participation. Shaver suggested that a history of discrimination may fuel some respondents’ desire to gain access to medical knowledge for themselves and for their broader community.

Shaver said the survey provides valuable information to researchers at both Thomas Jefferson University and the Sidney Kimmel Cancer Center, and could be replicated in other cancer centers to inform clinical trial recruitment.

“Our findings highlight the importance of catchment assessment when designing recruitment methods,” she said. “Proactively engaging the community in study design may help repair the relationship between science and the people it serves.”

Shaver also said the survey results highlight the importance of holding frank conversations with people to fully understand why they may or may not be willing to participate in clinical trials. “It is important to ask people what motivates them; don’t assume you know,” she said.

Shaver noted that as a cross-sectional study, this survey did not fully assess causality between discrimination and clinical trial interest. Also, this survey specifically targeted people in the U.S. mid-Atlantic region. Further research would be necessary to determine if these results are generalizable to a broader population

This study was funded by the National Cancer Institute. Shaver declares no conflicts of interest.

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COI STATEMENT

This study was funded by the National Cancer Institute. Shaver declares no conflicts of interest.

 

Neighborhood factors, individual stressors, and cardiovascular health among Black and white adults

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In this study of Black and white U.S. adults ages 45 and older, neighborhood-level factors, including safety and physical and social environments, and individual-level factors, including discrimination, attenuated racial disparities in cardiovascular health. Interventional approaches to improve ideal cardiovascular health that separately target neighborhood context and discrimination by gender and race are warranted. 

Authors: Anika L. Hines, Ph.D., M.P.H., of the Virginia Commonwealth University School of Medicine in Richmond, is the corresponding author. 

 To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2023.36207)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

Embed this link to provide your readers free access to the full-text article 

 http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.36207?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=092923

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JOURNAL

JAMA Network Open

 

Are opioid prescription rates changing for US adolescents?

Peer-Reviewed Publication

WILEY

A new analysis reveals that rates of opioid prescribing to US adolescents have decreased in recent years, primarily limited to non-surgery indications. Opioid prescription rates for surgery have remained stable.

The analysis, which is published in Pediatric Anesthesia, assessed data from the 2015–2020 Medical Expenditure Panel Surveys, which are nationally representative, large-scale surveys conducted annually by the Agency for Healthcare Research and Quality.

Among 26,909 children aged 10–19 years, 4.7% underwent a surgical procedure in 2015–2020. The surgery rate remained stable between 2015 (4.3%) and 2020 (4.4%) and was lower among minorities.

The combined rate of opioid prescribing for surgical and nonsurgical indications decreased from 4.1% of adolescents in 2015 to 1.4% in 2020. Opioid prescribing for surgery remained relatively stable, however (1% in 2015 and 0.8% in 2020), indicating that the surgical population is becoming a more prominent source of adolescents’ overall opioid prescriptions.

The authors call for studies to explore whether associations exist between postsurgical opioid prescribing and the development of problematic opioid use behaviors in youth.

“Adolescence is a critical period for brain development, placing them at increased risk for opioid misuse. Opioids can be highly addictive, so understanding prescribing patterns is crucial for mitigating risks,” said corresponding author Cornelius B. Groenewald, MB, ChB, of Seattle Children’s Hospital. “There are increasing data suggesting that opioid prescription post-surgery can lead to problematic opioid use, even in previously opioid-naïve patients; however, undertreatment of postsurgical pain is also a significant problem among adolescents. As surgical procedures are often the first encounter adolescents may have with opioid medications, understanding these prescriptions is important.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/pan.14753

 

Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.

About the Journal
Pediatric Anesthesia's mission is to advance the science and clinical practice of paediatric anaesthesia, pain management and peri-operative medicine through dissemination of research, education and quality improvement.

About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.

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JOURNAL

Pediatric Anesthesia

DOI

10.1111/pan.14753 

ARTICLE TITLE

Opioid prescription rates associated with surgery among adolescents in the USA from 2015-2020

ARTICLE PUBLICATION DATE

4-Oct-2023

 

How parents’ work stress affects family mealtimes and children’s development

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS COLLEGE OF AGRICULTURAL, CONSUMER AND ENVIRONMENTAL SCIENCES

 

IMAGE: (L TO R): SEHYUN JU, QIUJIE GONG, AND KAREN KRAMER.< view more 

CREDIT: COLLEGE OF ACES

URBANA, Ill. – Family mealtimes are important for parents and children as a space to communicate, socialize, and build attachment relationships. But it can be difficult for busy parents to balance family and work life. A new study from the University of Illinois Urbana-Champaign explores how parents’ job stress influences their attendance at family mealtimes, and in turn, children’s socioemotional development.

“We all struggle to maintain the balance between work life and family life. But this might be especially challenging for parents, who are engaging in childcare after a busy and stressful day at work. And when it comes to co-parenting in dual-earner families, which comprises 65% of families with children in United States, we do not know much about how mothers and fathers share caregiving roles under work stress,” said lead author Sehyun Ju, doctoral student in the Department of Human Development and Family Studies (HDFS) in the College of Agricultural, Consumer and Environmental Sciences (ACES) at U. of I.

The study included data from more than 1,400 dual-earner families, consisting of heterosexual married couples with children, in a nationally representative survey that traced children’s development across family, home, child care, and school environments from 9 months to kindergarten. The researchers focused on the interplay of child characteristics, family mealtimes, and parents’ job and financial dissatisfaction.

“We found that children of parents who expressed higher work-related stress when the children were 2 years old had lower socioemotional competency at age 4 to 5, measured by lower positive and higher negative social behaviors,” Ju explained. 

There were significant differences regarding the impact of mothers’ and fathers’ work stress. For mothers, higher job dissatisfaction did not impact frequency of family mealtimes; however, it was directly associated with lower socioemotional competency in their children. 

On the other hand, fathers who had higher job and financial dissatisfaction were less likely to attend family mealtimes with their children, and this in turn resulted in the children having lower socioemotional competency at age 4 to 5. 

“Even when the mother increased her mealtime presence to compensate for the father’s absence, the child’s socioemotional development was still negatively impacted. This indicates fathers may have a unique influence that cannot be replaced by the mother. Future intervention programs should help both parents obtain a better balance between work and family, and highlight the importance of family routines to promote healthy child development,” stated co-author Qiujie Gong, a doctoral student in HDFS.

The findings speak to the pervasiveness of traditional gender roles, added Karen Kramer, associate professor in HDFS and co-author on the study. “Mothers are considered primary caregivers, and they are expected to be present and feed their children no matter what. The study showed they didn't adjust their mealtime frequencies in response to job dissatisfaction as fathers did.”

Kramer notes the study is unique in combining topics from different disciplines, including psychology, sociology, economics, and nutrition, and connecting them in a holistic way that provides insights for policy measures.

“We have to acknowledge the challenges that families face in creating consistent routines. It’s not just an outcome of individual influences. Outside factors, such as parents’ work environment and financial situation can affect their interactions, mealtimes, and child development. For example, dinner time for young kids is typically around five or six o'clock, but the expectation that parents are home early in the day doesn’t align with being an ideal worker. Policy initiatives to help provide a work environment and community support that facilitate family mealtimes would be important,” Kramer concluded.

The paper, “Association of parents’ work-related stress and children’s socioemotional competency: Indirect effects of family mealtimes” is published in Journal of Family Psychology. [DOI: 10.1037/fam0001147]. Authors are Sehyun Ju, Qiujie Gong, and Karen Z. Kramer. The research was supported by the National Institute of Food and Agriculture, Grant ILLU-793-914

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JOURNAL

Journal of Family Psychology

DOI

10.1037/fam0001147 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association of parents’ work-related stress and children’s socioemotional competency: Indirect effects of family mealtimes

 

Increased risk of depression and anxiety when in higher education

Peer-Reviewed Publication

UNIVERSITY COLLEGE LONDON

Young people who are in higher education in England face a small increased risk of depression and anxiety, compared to their peers who are not attending higher education, finds a new study led by UCL researchers.

The research paper, published in The Lancet Public Health, is the first to find evidence of higher levels of depression and anxiety among higher education students compared with their peers.

The authors found that by age 25, the difference had disappeared between graduates and non-graduates.

Lead author Dr Gemma Lewis (UCL Psychiatry) said: “In recent years in the UK we have seen an increase in mental health problems among young people, so there has been an increased focus on how to support students. Here we have found concerning evidence that students may have a higher risk of depression and anxiety than their peers of the same age who are not in higher education.

“The first couple of years of higher education are a crucial time for development, so if we could improve the mental health of young people during this time it could have long term benefits for their health and wellbeing, as well as for their educational achievement and longer-term success.”

The researchers used data from the Longitudinal Studies of Young People in England (LSYPE1 and LSYPE2). The first study included 4,832 young people born in 1989-90, who were aged 18-19 in the years 2007-9. The second study included 6,128 participants born in 1998-99, who were aged 18-19 in the years 2016-18 (i.e., prior to the disruption of the COVID-19 pandemic). In both studies, just over half attended higher education.

Participants in the studies have completed surveys about their general mental health, to investigate symptoms of depression, anxiety, and social dysfunction, at multiple time points over the years.

The researchers found a small difference in symptoms of depression and anxiety at age 18-19 between students (including those at university and other higher education institutions) and non-students.

This association persisted after adjustment for potentially confounding factors including, among others, socioeconomic status, parents’ education, and alcohol use.

The analysis suggests that if the potential mental health risks of attending higher education were eliminated, the incidence of depression and anxiety could potentially be reduced by 6% among people aged 18-19.

First author Dr Tayla McCloud (UCL Psychiatry) said: “Based on our findings, we cannot say why students might be more at risk of depression and anxiety than their peers, but it could be related to academic or financial pressure. This increased risk among students has not been found in studies in the past, so if the association has only recently emerged, it may be related to increased financial pressures and worries about achieving high results in the wider economic and social context.

“We would have expected higher education students to have better mental health than their non-student peers as they tend to be from more privileged backgrounds on average, so these results are particularly concerning. More research is needed to clarify the mental health risks facing students.

“Improving our understanding of modifiable risk factors for depression and anxiety is a global health priority, and it is clear that supporting the mental health of our young people is vitally important.”

The study was commissioned and funded by England’s Department for Education.

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JOURNAL

The Lancet Public Health

DOI

10.1016/S2468-2667(23)00188-3 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The association between higher education attendance and common mental health problems among young people in England: evidence from two population-based cohorts

ARTICLE PUBLICATION DATE

28-Sep-2023

 

New research reveals link between childhood mental health problems and quality of life for young adults

Peer-Reviewed Publication

RCSI

Children with mental health issues are more likely to have poor mental and physical health in their late teens and early 20s, and are at greater risk of social isolation, low educational attainment, financial difficulties and heavy substance use. That’s according to new research led by RCSI University of Medicine and Health Sciences, which examined a wide range of data from more than 5,000 children and young adults in Ireland. 

The findings, published today in JAMA Network Open, are drawn from the ‘Growing up in Ireland’* study. The researchers from Ireland, the UK, and Australia followed trends of mental health throughout childhood (ages 9-13) for 5,141 people. 

The vast majority (72.5%) of participants whose data were analysed reported no significant mental health difficulties, but more than 1,400 individuals appeared to have some type of mental health or behavioural issue across childhood. 

“Mental health symptoms often come and go throughout childhood and adolescence, so we do not want to over-rely on symptom levels at one point in time. We decided to investigate children who had persistent reports of mental health symptoms, regardless of whether they met the criteria for an official diagnosis,” said study lead author Dr Niamh Dooley from the RCSI Department of Psychiatry.

The study looked at how these patterns of childhood mental health affected a range of outcomes in late adolescence and early 20s. The study took a broad approach to life outcomes, examining aspects such as Leaving Certificate results, social isolation and how often they used health services as young adults, poor physical health issues (e.g. obesity, sleep difficulties), heavy substance use (alcohol, smoking), and/or the young person’s general feelings of well-being. 

Importantly, the researchers also took different types of childhood symptoms into account, such as whether a child tended to internalise their symptoms (as in depression and anxiety), externalise their symptoms (as in hyperactivity and behavioural problems), or both. 

The research found that children with externalising symptoms are at increased risk of heavy substance use as young adults. Children with internalising symptoms are at the highest risk of poor physical health in their late teens and early 20s. 

“Our analysis shows that mental health problems in childhood are linked with a wide range of functional issues in adulthood, beyond the realms of mental health. And some groups were at particular risk for specific outcomes. For instance, females with persistent symptoms across childhood, particularly internalising symptoms, had very high rates of poor physical health by young adulthood,” said Dr Dooley.

The data also showed that those who had mental health issues in childhood were as likely to encounter educational/economic difficulties in young adulthood as they were to face further mental health problems. 

“Over 50% of children with mental health issues had at least one educational or economic difficulty by young adulthood, compared to around 30% of those without mental health issues in childhood,” said Dr Dooley.

The findings point to the need for better screening and treatment of mental health problems in childhood and adolescence, which may prevent problems later on in life, according to study co-author Professor Mary Cannon, who is RCSI Professor of Psychiatric Epidemiology and Youth Mental Health. 

“Our study shows that mental health symptoms in childhood can cast a long-lasting shadow on adult life,” said Professor Cannon. “If we understand more about which children in the general population are at greatest risk of poor outcomes, it will help to inform and improve early screening and approaches to support those children.” 

Professor Cannon is a member of a working group tasked with implementing the “Sharing the Vision” mental health policy recommendations, with a particular focus on improving transition of young people from child to adult mental health services.

The study was funded by the Health Research board through an Investigator Led Project to Professor Mary Cannon.

* Growing up in Ireland was commissioned by the Irish Government and funded by the Department of Health and Children, the Department of Social and Family Affairs, and the Central Statistics Office.

ENDS

For further information:

Rosie Duffy, Communications Officer, RCSI University of Medicine and Health Sciences 

+353 83 302 4611 | rosieduffy@rcsi.ie

About RCSI University of Medicine and Health Sciences

 

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2023.36520 

ARTICLE TITLE

Functional outcomes among young people with trajectories of persistent childhood psychopathology

ARTICLE PUBLICATION DATE

29-Sep-2023