Victims of childhood bullying at higher risk of cardiovascular disease in later life « King’s College London

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People who experienced bullying in childhood are more likely to be overweight and show higher levels of blood inflammation in later life, finds new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London. This puts them at higher risk of heart attack and various age-related conditions, including type-2 diabetes, according to the study authors. 

The findings are based on data from the British National Child Development Study (NCDS), a long-term study of all children born in England, Scotland and Wales during one week in 1958. The study, published today in Psychological Medicine, includes 7,102 children whose parents provided information on their child’s exposure to bullying when they were aged 7 and 11. Measures of blood inflammation and obesity were obtained from information and samples collected when participants were aged 45.


Professor Louise Arseneault
, senior author from the IoPPN at King’s College London, said: ‘Our research has already shown a link between childhood bullying and risk of mental health disorders in children, adolescents and adults, but this study is the first to widen the spectrum of adverse outcomes to include risks for cardiovascular disease at mid-life. Evidently, being bullied in childhood does get under your skin.’

Researchers found that 26 per cent of women who had been occasionally or frequently bullied in childhood were obese at the age of 45, compared to 19 per cent of those who had never been bullied. A second measure of abdominal fat was calculated by dividing waist measurements by hip size (waist-hip ratio). Both men and women who suffered childhood bullying showed greater waist-hip ratio at 45 years old than non-bullied participants. Findings remained significant when controlling for childhood risk factors including parental social class, participants’ BMI and psychopathology and also key adult variables such as social class, smoking, diet and exercise.

Frequent bullying in childhood also led to higher levels of inflammation at mid-life in men and women. Researchers found that 20 per cent of those who had been frequently bullied, compared to 16 per cent of those who had never been bullied, had C-reactive protein (CRP) levels of more than 3mg/L. High CRP levels increase risk of heart disease by promoting atherosclerosis, a condition where arteries become clogged up by fatty substances. Those who were frequently bullied in childhood also had raised levels of fibrinogen, a protein which promotes the formation of blood clots.

Bullying is characterised by repeated hurtful actions by other children, where the victim finds it difficult to defend themselves. In the NCDS, 28 per cent of participants were bullied occasionally in childhood and 15 per cent were bullied frequently. These figures are consistent with prevalence rates of childhood bullying victimisation today.

Professor Louise Arseneault said: ‘Bullying is a part of growing up for many children from all social groups. While many important school programmes focus on preventing bullying behaviours, we tend to neglect the victims and their suffering. Our study implies that early interventions in support of the bullied children could not only limit psychological distress but also reduce physical health problems in adulthood.’

Dr Andrea Danese, a co-author from the IoPPN at King’s, said: ‘Taking steps to tackle obesity and high blood inflammation is important because both can lead to serious and potentially life-threatening conditions, such as type-2 diabetes and cardiovascular disease.

‘The effects of being bullied in childhood on the risk for developing poor health later in life are relatively small compared to other factors. However, because obesity and bullying are quite common these days, tackling these effects may have a real impact.’

He added: ‘The main focus of prevention for age-related disease has traditionally been on unhealthy adult behaviours, such as smoking, physical inactivity, and poor diet. These are clearly important but our research highlights the need to trace the roots of these lifelong risk trajectories back to psychosocial experiences in childhood.’

This research was funded by the British Academy and the Royal Society.

via King’s College London –Victims of childhood bullying at higher risk of cardiovascular disease in later life

The full paper, published in Psychological Medicine, “Bullying victimization in childhood predicts inflammation and obesity at mid-life: a five-decade birth cohort study” by  R. Takizawa, A. Danese, B. Maughan and L. Arseneault is can be viewed here free of charge until 15th July 2015 .

 

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Cardiovascular risk factors extremely high in people with psychosis « King’s College London

Extremely high levels of cardiovascular risk factors have been found in people with established psychosis, with central obesity evident in over 80 per cent of participants, in a study by researchers from the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London.

In the largest study of its kind in the UK, drawing on a sample of more than 400 outpatients with psychosis, it was discovered that nearly half of the sample were obese (48 per cent), with a body mass index (BMI) of 30 or more. Additionally, nearly all women and most men had a waist circumference above the International Diabetes Federation’s (IDF) threshold for central obesity. According to this measure 83 per cent of patients were centrally obese: 95 per cent of females and 74 per cent of males. Central obesity refers to excessive fat around the stomach and abdomen, to the extent that it is likely to have a negative impact on health.

The majority of participants tested (57 per cent) met the IDF’s criteria for metabolic syndrome, which is a cluster of biochemical and physiological abnormalities associated with the development of heart disease, stroke and type-2 diabetes. A fifth met the criteria for diabetes and 30 per cent showed a higher risk of going on to develop diabetes.

Although cardiovascular risk factors are common in psychosis, this UK study reports some of the highest rates worldwide, reinforcing the need to incorporate weight and cardiovascular risk assessment and management into the routine care of people with psychosis.

Data was collected as part of the NIHR-funded IMPaCT trial and the study took place within community mental health teams in five mental health NHS Trusts in urban and rural locations across England.

The study, published in Psychological Medicine, also identified lifestyle choices likely to add to cardiovascular risk, with 62 per cent of the sample reported to be smokers, greatly in excess of the general UK population smoking rates of 20 per cent. Lack of exercise was also commonplace, with only 12 per cent of participants engaging in high intensity physical activity.

Dr Fiona Gaughran, senior author from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, and the National Psychosis Unit at SLaM, said: ‘We already know that diagnosis of a psychotic illness such as schizophrenia or bipolar disorder is associated with a reduced life expectancy of between 10 to 25 years. This mortality gap is largely due to natural causes, including cardiac disease. The worryingly high levels of cardiovascular risk shown in our study indicate that a much greater emphasis on physical activity is needed for those with severe mental illnesses, as well as a more significant focus on supporting attempts to quit smoking.

‘While previous research has demonstrated that people gain weight on starting anti-psychotics, our study of people who have had psychosis for nearly 16 years on average found no difference in the rates of cardiovascular risk between the various different anti-psychotic medications. Research is urgently needed into the best ways to reduce existing cardiovascular risk in people with psychosis, prevent weight gain and promote healthy lifestyles in the early stages of the illness.’

The research paper summarises independent research funded by the National Institute for Health Research (NIHR) under its IMPaCT Programme Grant (Reference Number RP-PG-0606-1049).

via King’s College London –Cardiovascular risk factors extremely high in people with psychosis

 

The full paper, published in Psychological Medicine, “Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial” by P. Gardner-Sood, J. Lally, S. Smith et al. is published open access and can be viewed here.

Dodo bird verdict given new life by psychosis therapy study | The University of Manchester

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A study by researchers at The University of Manchester and the University of Liverpool has examined the psychological treatment of more than 300 people suffering from psychosis, showing that, whatever the therapy, it is the relationship between the patient and therapist which either improves or damages wellbeing.

The research relates to one of the more controversial ideas in psychotherapy research – the Dodo bird conjecture.  Named after a bird in Alice’s Adventures in Wonderland which sent several characters on a race and then declared them all winners, this conjecture states that all types of psychotherapy, even though often appearing to be very different from each other, are equally beneficial to patients.

In this case, the research showed that it is the quality of the relationship between the therapist and patient which causes improvement and not the different techniques employed in the two therapies that were compared.

Many studies have looked at types of talking treatment which can help people recover from psychotic episodes.  These include cognitive behavioural therapy (CBT) and family therapy. High quality research uses a comparison group which also receives some kind of less structured treatment, for example supportive counselling or befriending.

Surprisingly, patients in these comparison groups often benefit from the comparison treatment as much as those receiving the specific, targeted therapies (CBT or family therapy). Both groups who receive a psychosocial treatment fare much better than those offered only medication and usual care.

The researchers explored in depth the causative effect of the ‘therapeutic alliance’ or relationship of trust between patient and psychologist when schizophrenia patients were treated during a trial of this kind.

Lucy Goldsmith, a PhD candidate from The University of Manchester’s Institute of Brain, Behaviour and Mental Health, carried out the research in collaboration with the researchers who had carried out the original trial: Manchester professors Shôn Lewis and Graham Dunn, and Liverpool professor Richard Bentall. She said: “The quality of the therapeutic relationship has been linked to outcomes before, but we wanted to see whether the it really causes the changes in wellbeing occurring during therapy.

“Does successful treatment make patients feel well disposed towards their therapist or is the relationship actually at the heart of whether therapy succeeds?”

By using already established rating systems of these relationships and taking data from the earlier study of 308 patients, the researchers found that a good level of therapeutic alliance had a beneficial impact on wellbeing, but where the relationship was poor, the treatment could actually be damaging.

“The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate,” Lucy said.  “More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued.

“The study clearly shows that the two types of therapy are equally beneficial to the patient – as long as the trust, shared goals and mutual respect between client and psychologist are in place.”

The paper, ‘Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis,’ was published in the journal, Psychological Medicine.

via Dodo bird verdict given new life by psychosis therapy study | The University of Manchester.

The paper, “Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis” has been published gold Open Access, and can be found using this link. 

 

Common mental disorders prevalent in UK military « King’s College London

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Symptoms of anxiety and depression appear to be twice as frequent in the UK military as in the general working population, according to research carried out at the King’s Centre for Military Health Research (KCMHR), King’s College London and published in Psychological Medicine.

The study compared data from over 7,000 personnel serving in the UK Armed Forces with 7,000 people from the general population identified as being in employment from the Health Survey for England. Both surveys used the General Health Questionnaire (GHQ) and it was found that symptoms of common mental disorders (CMD) (i.e. anxiety and depression), appeared to be twice as frequent in the military as in the general working population. In fact, 18% of men and 25% of women serving in the Armed Forces reported symptoms of CMD compared to 8% of men and 12% of women in the general working population.  This difference was apparent at both time points of the study, 2003 and 2008.

Lead author, Dr Laura Goodwin from KCMHR said ‘This is the first formal comparison of common mental disorders between the serving military and the general working population. Whilst symptoms of common mental disorders appear to be twice as common in the military after accounting for age, gender and social class, there is more to be done to understand these differences.’

The researchers had previously found that there is a tendency for over reporting of symptoms of anxiety and depression in occupational studies aimed at specific groups such as police, teachers and social workers. The Health Survey for England was a population study in which an individual’s occupation was not the main focus, which is likely to have had some effect on the results.

One way it was a considerable improvement on earlier research was that previous studies have all been forced to compare different measures of CMD, which is a major limitation, whereas in this study all participants completed the same questionnaire, the GHQ. Also, some previous surveys have included individuals who are unemployed and those with long-term health problems and disabilities and these groups are more likely to report symptoms of depression and anxiety, so this comparison of military employees with only those in employment from the general population is a fairer like-for-like comparison.

The survey included questions such as whether the subject felt they were ‘playing a useful part in things’, and military respondents were almost three times more likely to disagree with this statement than the general population at both time points. On the other hand, the smallest difference between the military and general population was found for the statement ‘felt constantly under strain’.

The researchers suggest that differences in the prevalence of symptoms of depression and anxiety in this extensive study could be explained by the frequency and intensity of stressful events experienced by military personnel and that military life requires extended periods spent away from family and friends, for training and exercises as well as for deployment.

Professor Nicola Fear, KCMHR concludes: ‘This highlights that symptoms of depression and anxiety are common in the Armed Forces, in fact, they are more common than alcohol misuse or post-traumatic stress disorder (PTSD).  The findings draw attention to the need for Defence Medical Services to continue to focus on identifying and treating depression and anxiety in addition to PTSD.’

Paper reference: Goodwin, L. et al. ‘Are common mental disorders more prevalent in the UK serving military compared to the general working population?’ published in Psychological Medicine DOI: http://dx.doi.org/10.1017/S0033291714002980

via King’s College London – Common mental disorders prevalent in UK military.

Male sexual orientation influenced by genes

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Results of a five-year study of 409 independent pairs of homosexual brothers in 384 families find that genetics play a key role in male sexual orientation. Alan Sanders, M.D., a psychiatrist who studies behavioral genetics at NorthShore University HealthSystem Research Institute, was the principal investigator of the molecular genetics study that scanned the entire human genome to search for evidence of genetic links to variation in sexual orientation in men.

“We found two strong links in chromosome 8 and chromosome Xq28, which supports that this is not a one-gene, one-trait scenario,” said Dr. Sanders. “These genetic variations contribute to the development of the important psychological trait of male sexual orientation.

The new evidence “is not proof but it’s a pretty good indication” that genes on the two chromosomes have some influence over sexual orientation.”

Participants in the study were gay men with at least one living gay brother (full brothers, half brothers or fraternal twins). They were asked to provide DNA samples through blood or saliva and to complete a questionnaire about their sexual and personal history and that of immediate family members. The study was funded by the US National Institutes of Health from the National Institute for Child Health and Human Development.

“Understanding the origins of sexual orientation enables us to learn a great deal about sexual motivation, sexual identity, gender identity and sex differences,” Dr. Sanders added.

The full paper, “Genome-wide scan demonstrates significant linkage for male sexual orientation”, which is published in Psychological Medicine can be read free of charge for a limited time here.

40% of women with severe mental illness are victims of rape or attempted rape

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Women with severe mental illness are up to five times more likely than the general population to be victims of sexual assault and two to three times more likely to suffer domestic violence, reveals new research led by UCL and King’s College London funded by the Medical Research Council and the Big Lottery.

The study found that 40% of women surveyed with severe mental illness had suffered rape or attempted rape in adulthood, of whom 53% had attempted suicide as a result. In the general population, 7% of women had been victims of rape or attempted rape, of whom 3% had attempted suicide. 12% of men with severe mental illness had been seriously sexually assaulted, compared with 0.5% of the general population.

The findings are based on a survey of 303 randomly-recruited psychiatric outpatients who had been in contact with community services for a year or more, 60% of whom had a diagnosis of schizophrenia. They were interviewed using the British Crime Survey questionnaire for domestic and sexual violence, and their responses were compared to those from 22,606 respondents to the 2011/12 national crime survey. The results were adjusted for a wide range of socio-economic factors including age, ethnicity and marital status.

“The number of rape victims among women with severe mental illness is staggering,” says lead author Dr Hind Khalifeh of UCL’s Division of Psychiatry. “At the time of the survey, 10% had experienced sexual assault in the past year, showing that the problems continue throughout adulthood. Considering the high rate of suicide attempts among rape victims in this group, clinicians assessing people after a suicide attempt should consider asking them if they have been sexually assaulted. Currently this is not done and so patients may miss opportunities to receive specialist support.”

Men and women with mental illness were also found to be more likely to be victims of domestic violence than the general population. Domestic violence includes emotional, physical and sexual abuse. 69% of women and 49% of men with severe mental illness reported adulthood domestic violence.

Domestic violence from family members (other than partners) made up 63% of total domestic violence cases against psychiatric patients compared with 35% of the general population.

“Most domestic violence prevention policies for adults focus on partner violence, but this study shows that interventions for psychiatric patients also need to target family violence,” says Dr Khalifeh.

The study shows a strong association between mental illness and sexual and domestic violence, but the direction of causality is not certain. In some cases, experiences of violence may have contributed to the onset of mental illness. However, violence experienced in the past year would have been after diagnosis of severe mental illness since all participating patients had been under the care of mental health services for at least a year.

The results were adjusted for drug and alcohol use in the past year, but this did not significantly affect the outcomes and causality is hard to determine. Drug and alcohol use may increase the risk of being a victim, but equally victims of violence may turn to drugs or alcohol as a way of coping.

Senior author Louise Howard, Professor in Women’s Mental Health at King’s College London, says: “This study highlights that patients with severe mental illness are at substantially increased risk of being a victim of domestic and sexual violence. Despite the public’s concern about violence being perpetrated by patients with severe mental illness, the reality for patients is that they are at increased risk of being victims of some of the most damaging types of violence.”

Read the full Open Access paper, “Domestic and sexual violence against patients with severe mental illness”, published in Psychological Medicine, free of charge here.

 

This post is taken from the press release issued by UCL.

 

Autism rates steady for two decades

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A University of Queensland study has found no evidence of an increase in autism in the past 20 years, countering reports that the rates of autism spectrum disorders (ASDs) are on the rise.

The study was led by Dr Amanda Baxter from UQ’s Queensland Centre for Mental Health Research at the School of Population Health, and was a first-of-its-kind analysis of research data from 1990 to 2010. Dr Baxter and her colleagues found that rates had remained steady, despite reports that the prevalence of ASDs was increasing.

“We found that the prevalence of ASDs in 2010 was one in 132 people, which represents no change from 1990,” Dr Baxter said.

“We also found that better recognition of the disorders and improved diagnostic criteria explain much of the difference in study findings over time.”

Part of the Global Burden of Disease project, this is the largest study to systematically assess rates and disability caused by ASDs in the community, using data collected from global research findings in the past 20 years.

ASDs are chronic, disabling disorders that stem from problems with brain development. They affect people from a young age and are among the world’s 20 most disabling childhood conditions.

The study shows that about 52 million children and adults around the globe meet diagnostic criteria for an ASD.

Dr Baxter said researchers hoped the study would help guide health policy and improve support for those with ASD and their families.

“As ASDs cause substantial lifelong health issues, an accurate understanding of the burden of these disorders can inform public health policy as well as help allocate necessary resources for education, housing and employment.”

The study was a collaboration with the University of Leicester and the University of Washington’s Institute for Health Metrics and Evaluation, and is published in the journal Psychological Medicine.

 

The full paper “The epidemiology and global burden of autism spectrum disorders” can be viewed free of charge for a limited time here.

 

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