lecture 1-5

evidence based

best empirical evidence (evidence based does not mean evidence informed)

evidence informed

local context, doctor recommendations, patient values

Best available evidence

systematic research, peer review, empirical data, replicability, general consensus in scientific community

Quality of information (best to worst)

1. meta analysis

2. systematic review

3. randomized controlled trials

4. cohort studies

5. case series/reporrs

6. background info / expert opinion

meta analysis

compile lots of studies and stats to analyze relationship

systematic review

summaries of multiple studies

randomized controlled trials

randomly assign ppl a placebo/intervention and look for associations

cohort studies

observational longitudinal studies that track group of ppl w common characteristics

Case series/reports

track group of patients with common disease

bradford hill criteria (guidelines)

• strength

• consistency

• specificity

• temporality

• biological gradient

• plausibility

• coherence

• experiement

• analogy

strength (bradford hill)

large associations are more likely causal but small associations dont disprove causal effect

consistency (bradford hill)

finding repeats across studies and populations

specificity (bradford hill)

causation is more plausible if association is highly specific to population, disease, without any other explanations

temporality (bradford hill)

exposure must come before effect otherwise causation cant be established (MOST IMPORTANT)

biological gradient (bradford hill)

biological gradient between exposure and magnitude of an effect increases confidence in causality

plausiblity (bradford hill)

a biological mechanism exists (is it believable?)

coherence (bradford hill)

fits with lab and epidemiological evidence (absence of lab evidence doesnt disprove epidemiological findings) - fit existing knowledge?

experiment (bradford hill)

experimental evidence (intervention) increases plausibility of causation

analogy (bradford hill)

using analogies/similarities to other known associations can support causation

science literacy

engage with scientific concepts, principles, info to comprehend, evaluate, and apply scientific information to various aspects of life

important for: informed decision making , global challenges, public policy, health + wellness

science IS

slow process used to acquire and update knowledge thats self correcting and open to new evidence

science is NOT

an easy system of beliefs or list of facts, nor is it a body of knowledge

Pseudoscience

no empirical evidence, not scientifically rigorous, no peer review

Misinformation strategies

• sensationalism

• impersonation

• emotion

• polarization

• conspiracy

• discredit

• trolling

Inheritance

physical traits directly from parents

low danger nutrient rich environment

anxious rat: low social standing, suffer from chronic disease

calm rat: high social standing, not worried about meals

high danger environment

anxious rat: guarded and does well because it responds fast to stress and keep a low profile

calm rat: too relaxed and gets eaten by predators

early life stressors

negative experiences/events during childhood impacts physical, emotional. psychological, well-being

early brain development

brain development (emotional/neurological regulation, stress response) comes from:

• relationships, education/learning, lifelong patterns, mental health foundations

critical window

certain experiences/inputs that r CRUCIAL for normal development (missing this causes permanent deficits and difficulties with developing)

Sensitive window

increased susceptibility and sensitivity to experiences/influences (environment)(missing causes optimal development - not as bad as missing critical window)

developmental windows

• prenatal: maternal stress/exposure to trauma

• infant attachment (0-2): emotional development/attachment between baby/primary caregivers

• early childhood (2-6): development coping strategies, emotional reg, social skills

• middle childhood (6-12): cognitive development + form self identity, impacting self esteem

• adolescence (12-18): development of autonomy & identity which increases risk to developing mental health issues

• puberty (10-14): developing sex characteristics, influencing emotional wellbeing & self esteem

types of impacts on wellbeing

mental health issues, high risk behaviours, cognitive impairment, attachment issues

stress-body connection

impact immune system, chronic health conditions, long-term health consequences

adverse childhood experiences (ace’s)

negative health/social outcomes - more ace = higher likelihood of negative impacts (high prevalence of at least one during childhood)

• awareness of long-term impact on childhood trauma, influencing policies, programs, interventions

toxic stress

prolonged stress without support to buffer - in USA: leading cause of death carry into adulthood

• biological: malnutrition, prenatal substance abuse, injury, disability

• psychosocial: witness violence, stigma, poverty, maltreatment

aces study

common bc 64% US adults experience before 18 years old and 1 in 6 report 4+ aces

• 1.9 mil heart disease + 21 mil depression can be avoided

• higher risk of ace if experience 1

• $748 bill econ burden (bermuda, usa, canada)

• takes off 20 yr of life exp

• 4+ ace = 7.4x al alcoholism, 12.2x suicide

• 2+ ace = 3x repeat grade

• juvenile kids experience multiple aces

intergenerational impacts

transmit stress generationally, ability to nurture offspring, epigenetic changes

petal programming hypothesis

stressors exp in utero (caused by mom like diet, nutrients, env) can permanently alter child structure, physiology, metabolism (shapes long-term health/disease risk)

helsinki birth cohort

evacuated kids from Finland, put in foster homes in Denmark & Sweden (evacuees are 20% more depressed)

helsinki intergenerational effects on women

daughter of evacuees are 4x likely hospitalized for depression

epigenetics

heritable changes in cellular phenotype (gene expression) that DONT alter underlying DNA sequence

• chemical modifications to dna associated with proteins like histones (tags/markers) that influence gene regulation

• passed to offspring and effect future generations (many r reversible and responsive environmental cues)

DNa in epigenetics

dna stays stable whereas histones choose what to/not express and epigenetic info is carried by gametes (sperm/egg cells) effecting gene expression in developing embryo

gene regulation

control when/what extent genes are turned on/off in cells

cell identity

maintain/establish cell identity during development ensuring different call types perform distinct functions

environmental response

organism adapts to environmental factors (diet, stress, toxins, hormonal signals)

imprinting

genes are expressed differently if inherited by mom or dad, impacting development and growth

lifestyle & epigenetics

diet/nutrition, exercise, sleep

dutch hunger winter

ww2 in metherlands, german blockage caused severe shortages bc cut from supplies bc war = severe famine (starvation)

• study long-term effects prenatal malnutrition

• increased risk for chronic disease with famine exposed ppl & second generation show higher risk of cardiovascular diseases

ACE prevention

remove stressors and reduce other stressors

• during critical early years: targeted support to kids with developmental, emotional, behavioural issues

• address issues before more complex (holistic development)

bucharest early interview project

randomized control in orphanage in romania

• non orphaned (control)

• children randomized to foster care or stay in orphanage

institutionalization caused developmental days (sensitive period development with late vs early placement)

better quality of foster care = higher cog, social dev, enhanced attachment, language skills, iq scores

relationships / support systems

• increased social support as adult = less depression with high lvl stress in workplace/finances

• positive parenting = less depression/anxiety, hyperactivity, suicidal thought (among girls)

• harsh discipline = higher dep/anx, hyperactivity, suicidal thought (among boys)

• parenting buffers other stressors & you can reverse effects of prenatal stress

• social cohesion = better health and less likely to develop health problems in presence of significant stressors

mental health

emotional, psychological, social wellbeing

mental illness/disorder

disturbances in thoughts, feelings, perceptions (severe = effects day 2 day functioning

country w highest prevalence of MH disorder

africa

• high depression: poverty, disease, conflict

• low anxiety: underreported bc expressed differently (anxiety varies by culture)

age and mental disorders

varies by age and higher age means more stressors- higher depression in mid-life

why do high income countries have high anxiety

bc higher anxiety awareness and diagnoses, sensitive tools, social inequities/econ security, social fragmentation

why is geographical data not as strong as survey data

good for trends but geographical data makes estimates

why higher depression in women

gender based violence (gender socializing) which internalize (anxiety) or externalized (conduct disorder: women = emotional + men = angry)

• access to power is limited for women

• could be biological but cant explain gaps

why higher suicide in men

highest @ 50-64 y/o

because stigma in showing emotion and more likely to own firearms

DALY’s

calculate #’s of potential life lost from premature death

• all ages: depression is last outta 10 things

• 10-14: 2nd place is depression

• 15-19: 1st place is depression, 2nd is drugs

mental disorder comorbidity

follows individual in their life of being diagnosed/relieved of mental health issues

sanghi disgram

flows and follows individual as time flies (higher age = lower number of sample isnt diagnosed anymore: common for ppl to experience mental health issues)

multifactorial causation

health condition is caused by interaction of multiple factors

mental health interventions

prevention, promotion, treatment

treatment gaps woth beds

higher income is higher available beds, lower income is lower number of beds

inequities

• hard to identify those in need (criteria for young children)

• limited skills, resources, funds

• costs more money in europe and higher mental health workforce members

• lower quality costs less in low income countries and less mental health workforce members (psychiatrists)

task shifting

train lay workers (can read/write) to deliver community based programs (psychosocial support in marginalized communities)

grandmother health providers

in zimbabwe: bench outside health centre and chat : screening, referral, treatment w/ problem-solving therapy

digital technology

higher access to care in places with limited mental health workforce

technology assisted cascaded training and supervision (TACTS)

trained to deliver Thinking Healthy Programme = no significant difference btwn face-to-fave and digital supervision

suicide , income, and men

Low income men have highest suicide rates

• 15-24 y/o first nations men have highest suicide rates

multisectorial action

households, education/school, workplaces, care for elderly

positive psychology

path to inner peace to increase happiness

learned helplessness

create our own barriers because we believe theres no other solutions (bc we wont overtake barriers)

attribution theory (carol dweck)

Growth mindset: take failure as something to learn from and increase effort to do better (helps with academic achievement)

fixed mindset: baseline abilities to prove something and failure means you suck

national achievement test (chile)

too 20% = growth mindset

bottom 20% = fixed mindset

dr ann masten and resilience

the capacity of a dynamic system like family/community to adapt successfully to challenges that threaten its survival or development (how ppl work together)

ERP evidence (the sticky things with circles and wires on your head)

brain activation recorded when told right or wrong and when told correct answer

fixed: care more if right and has lower brain activation

growth: increased brain activation

RECURSIVE PROCESS

Challenge/failure = growth mindset = more effort = more achievement (cycle)

challenge/failure = fixed mindset = lower effort = lower achievement (cycle)

negatives of growth mindset

cultivates negative emotion and blame/pressure to succeed

not everything should be changed

7th graders taught abt neuroplasticity

increase grades and gpa of those abt to fail

interactions shape mindset

language: what we believe/value

feedback: whats expected/foals we should have

person praise = fixed mindset (ur so smart) (number of problems solved decreased)

process praise = growth mindset (youre a deep thinker) (number of problems solved increased) (not just about effort but you need good strategy and mentorship)

control praise = relatively same number of questions solved before and after

neuro

neurons

plasticity

malleability

neuroplasticity

brain adapting to changes in environment

neurological nihilism

belief that brain only develops in childhood and declines in later life

• brain cells fail to develop properly/injured/died cant be replaced

• brain cant alter structure or function if part of it us damaged (brain conditions cant be treated)

beliefs that fuelled neurological nihilism

• brain damage patients would rarely make a recovery

• inability to see inside brain because lack of technology

• belief brain is a machine (like hard-drive on computer, when it gets fried, cant self correct and develop)

late 1960/ early 1970 neuroplasticity

brain change structure with different activities and increase synapse connection

neurogenesis

neuroplasticity revolution: understand that brains can change and mould

• birth of new neurons and glial cells in adult hunan brain

neuroplasticity is either:

structural: physical structure of brain changes

functional: brain function moves from

damaged area to undamaged area

ten principles of experience-dependant plasticity

• use it or lose it : understimulated neural pathways will weaken/get lost overtime (synaptic pruning)

• use it or improve it : repeated practice strengthen neural pathway associated with that behaviour

• specificity : specific behaviour increases neural connections associated with that skill or activity

• repetition : lasting neural changes require repetition and practice

• intensity : higher training means higher neuroplastic adaptation

• time: timing of intervention (longer = less recovery, immediate = more neural change)

• salience : more meaningful experience = strengthened neural connection

• age: responsiveness to inputs needed for neural connections change w age (older increases effort to learn new things)

• transference : neural gains from a learned skill can transfer to another skill

• interference : maladaptive; learning skill hinders acquisition of another

the hibbian principle

neurons that fire together wire together

hemispheric communication / cross-lateral training

left: language + analytical skills

right: creativity + spatial awareness

brain growth @ birth

rapid brain development (plateaus by 30)

early brain dev

• genetics: provide basic structure + function of brain

• learning environment: sensory/motor experiences that carry into adulthood (same experience can alter brain at different ages)

• psychoactive drugs: prenatal/postnatal (lasting long-term impacts on plasticity into adulthood)

• early stress: post/prenatal (maternal separation effects synaptic organization in brain)

• parent/child relationship: long term development effects adulthood (first week impacts signalling and stress response)

• peer relationships: play effects later adult life because prefrontal development

• intestinal flora: microbiomes in signalling pathways, neurotransmitter turnover, production of synaptic related proteins

• physical activity: brain/cognitive function improve

• sleep: baby brains develop in slesp

• nutrition: essential nutrients necessary for brain development (omega-3, iron, protein)

neuroplasticity for healing

stroke recovery (constant induced movement therapy), traumatic brain injury, neurodegenerative disease

constant induced movement therapy

stroke recovery: side is functioning, other hand isnt (create neural connections with hand not functioning well - 7hrs per day, 7 weeks)

examples of maladaptive neuroplasticity

chronic pain, ptsd, addiction, ocd

phantom limbs

60-80% amputees: individual feels pain in removed limb (cortical maps of limbs r still engaged and the area of the cortex is being activated and misinterpreted as activation of limb) - MIRROR THERAPY