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Benefits of playing video games for your well-being

This blog was written by Iain Donald, Senior Lecturer at the Abertay University’s School of Design and Informatics.

In November 2020, it was widely reported in The Guardian, The Times, Sky News, Daily Mail and elsewhere that time spent playing video games can be good for players wellbeing. A study undertaken by academics (Niklas Johannes, Matti Vuorre, and Andrew K. Przybylski), at the Oxford Internet Institute, gained significant attention largely because the results focus on the positive aspects of game playing. Historically, when the mainstream press has featured videogames it has often focused on long-standing debates about whether violence in video games leads to real-world aggression, or whether video game ‘addiction’ is a health concern (in May 2019 the World Health Organization officially voted to include an entry on “gaming disorder” as a behavioural addiction to its International Classification of Diseases), or more recently whether ‘loot boxes’ are a form of gambling and require regulation.

What did the study do?

The study included adult players of two popular video games, Plants vs Zombies: Battle for Neighborville and Animal Crossing: New Horizons. The researchers conducted an online survey on players’ well-being by asking questions about frequency of negative and positive feelings over a two-week period. Participants were also assessed on self-reported play time, as well as using objective telemetry data obtained on time spent playing from the Electronic Arts and Nintendo of America, for their respective game titles. Results showed that players with higher objective playtime reported experiencing higher well-being across both games. Notably, participants tended to overestimate time spent playing by two hours, and self-reported play time was only significantly related to well-being of those playing Animal Crossing. The authors concluded that self-reports of play time (on which much previous research in this area relies) might not be accurate indicators of actual play time.  The study concluded that time spent playing video games can be good for players wellbeing. This research may seem to some as common sense or less than ground-breaking largely because we know that billions of people worldwide play games because they enjoy them. What is novel about the research was that it was based on data from two of the leading publishers of games.

Notably, the study is limited in scope. It only looks at two games and a tiny portion of the respective player bases with the datasets of some 471 players Plants vs Zombies: Battle for Neighborville and 2,756 of Animal Crossing: New Horizons. Nevertheless, represents a significant academic-industry engagement, although one that has garnered more attention because of the games, and arguably the University, rather than the output. Participants were from a limited geographical spread (Canada, UK and the US) and, as such,  may only be generalisable to these populations. The study was also correlational which doesn’t always imply causation, as discussed in our previous blog entry.

How well did the media cover the findings?

Reading or hearing about games or gaming in the news is often focused on the more negative aspects. This study was widely reported on, as having found a positive correlation between time spent gaming and people’s wellbeing. Depending on the publication and the intended audience, the same study was headlined in a variety of different ways. The Guardian’s succinctly put this as “Video gaming can benefit mental health, find Oxford academics” whereas The Daily Mail preferred to shout “Good news for gamers: Playing video games BENEFITS mental health, Oxford University scientist claims”.  Others brought a wry smile to my face (emphasis mine), I liked Business Insider’s “Video games might actually be good for you, Oxford study finds” and Time 24 News’ accurate yet underwhelming “There are two games that can be positive for mental health, according to Oxford study”. Just two everybody, all the others can’t be any good!

Understandably the media have represented the findings as somehow going against established but undefined norms. That somehow, somewhere, it had previously been decided or decreed that videogames are bad for our health. I’ve grown up with video games and consider myself fortunate to have worked in the industry, and now to teach and research them. I think most people that play video games probably think that it’s great that Oxford are catching up. Keza MacDonald reflecting on the study in The Guardian succinctly sums this up as “For anyone who actually plays video games, this is hardly news. Video games are fun and interesting, and doing fun, interesting things makes you happy.”

Looking past the headlines, some reports were lighter on the details than others. The researchers admit the study only provides a snapshot. They also acknowledge that a player’s subjective experiences during play might be a bigger factor for wellbeing than mere play time. Andrew Przybylski, one of the authors of the study noted that “Previous research has relied mainly on self-report surveys to study the relationship between play and wellbeing,” and that “Without objective data from games companies, those proposing advice to parents or policymakers have done so without the benefit of a robust evidence base.” Working with games publishers is a significant advance. Most major games companies have, for a variety of commercial and competitive reasons, been reluctant to share sales, never mind player data. This was summed up in The British Psychological Society’s Research Digest where it stated that the most interesting and exciting part of the study was not necessarily the findings, but the fact that the “researchers have collaborated with industry and obtained real data on people’s playing habits. The lack of access to data from media companies has long been a major obstacle to this kind of work”.

There were other revelations which could have profound impacts. Andrew Przybylski noted that “Players tend to overestimate the amount of time they play, a pattern which is similar to what we see in smartphone/social media/news research.” This finding was undersold, and one that I think most game players, would be surprised at. As Keza MacDonald stated “There are so many more interesting conversations to be had than “are video games somehow bad for you?” and “gosh, look how much money this industry makes”. Try talking to people who actually play them, which these days is 85% of people under 35 and plenty of older folks too, and you’ll find the real stories.”

Key conclusions and other things to keep in mind

Games are more than entertainment now. The use of video games in health and care settings is an established yet growing area of research. Various types of video games have been used in these settings to support players’ physical, cognitive, and emotional health, aligning with desirable clinical outcomes, such as enhanced motivation, empowerment, and improved cognitive functions. Bespoke experiences – termed “serious games” or “applied games” – have been developed based on the identification of, and focus on, a specific purpose in an individual’s personal wellbeing. One such example is SuperBetter (2015), a mobile game in which the player self-reports on the completion of real-world challenges in order to earn points. SuperBetter utilises techniques such as self-determination and cognitive behavioural therapy to build the player’s mental and emotional resilience. Studies suggest that the use of SuperBetter improved symptoms of depression, anxiety, and motivation after a thirty-day period, as well as rating among the most-effective mobile applications for pain management. Equally, there are also examples of ‘traditional’, commercial games that have evidenced many health benefits: from encouraging players to walk in order to locate and catch virtual monsters in Pokemon GO! to performing dance routines in Just Dance 2020.I’ve seen the power that games have on my own children from inviting them to build and explore vast new virtual worlds in Minecraft, through to the unrestrained laughter and unbridled chaos of the massively multiplayer party game, Fall Guys: Ultimate Knockout, where up to 60 players online battle it out in a free-for-all struggle. When the pandemic stopped all football, FIFA20 became a substitute. Not quite the same, but enough to keep football-obsessed children engaged and has somehow led to a certain Edson Arantes do Nascimento (Pelé) establishing himself as my 8-year olds favourite footballer. The fact that Pelé last played 43 years ago is no longer an obstacle due to the virtual football world.

Will the planned water releases from the Fukushima Dai’ichi nuclear plant be harmful to people?

This blog was written by Leslie Mabon, a Senior Lecturer in Social Science at the Scottish Association for Marine Science-University of the Highlands and Islands and a Future Earth Coasts Fellow.

In October 2020, it was reported in The Guardian, Japan Times, New Scientist and elsewhere that the government of Japan intends to approve plans to release treated water stored at the site of the Fukushima Dai’ichi nuclear plant into the north-west Pacific Ocean. The Great East Japan Earthquake and Tsunami of 11 March 2011 disabled cooling systems at the power station, triggering hydrogen explosions and causing three of the plant’s reactors to suffer meltdowns. Since then, water used to keep the damaged reactors cool, plus recovered groundwater, has been treated to remove the most harmful radioactive substances and then retained on-site in storage tanks. However, plant operator Tokyo Electric Power Company claims they will run out of space by 2022. An expert panel has concluded that releasing the treated water into the sea is the most effective response. Yet a breadth of news sources report that local fishers and environmental NGOs object to the releases on the grounds of potential health effects and/or stigmatization of Fukushima seafood. In one Guardian article, Greenpeace even claimed that the water could damage human DNA if released.

The Fukushima Dai’ichi nuclear power plant (source: Leslie Mabon)

What does the underpinning science say?

One of the most up-to-date overviews of the situation at the Fukushima Dai’ichi plant was published by Ken Buesseler of Woods Hole Oceanographic Institution in Sciencein summer 2020. Buesseler explains that tritium – the radioactive substance most commonly cited as a cause for concern when the releases are discussed – is relatively harmless and does not exist at the Fukushima Dai’ichi site at a volume higher than what would normally be released by a nuclear power station. However, Buesseler also points out that the storage tanks may also contain other radioactive substances such as ruthenium-106, cobalt-60, and strontium-90. These materials may behave differently to tritium in the ocean, and may be more readily incorporated into marine species or the seabed. Buesseler concludes that to fully understand the consequences of releasing treated water into the sea, a full assessment of what is contained in the tanks needs to be undertaken.

Although the science addressing the material contained in the tanks at Fukushima Dai’ichi is still emerging, there is a wider body of research addressing the effects of radioactivity on the marine environment since the 2011 accident. For example, in a 2016 commentary, Jordi Vives i Batlle summarises that whilst the risks to humans and marine species are low, the contamination of the marine environment in Fukushima is significant. A team of researchers led by Fukushima University and Fukushima Prefecture’s fisheries experimental station similarly concluded in 2016 that with the procedures and regulations that are in place for monitoring and screening of Fukushima produce, the risk of consumption of Fukushima seafood is low or negligible, with no additional radiological effects for consumers.

In sum, whilst it is true that radioactivity from the plant exists in the Fukushima environment and that uncertainties over the treated water remain, the peer-reviewed science suggests it is very unlikely that humans will be exposed to harmful radiation. Nonetheless, a team led by the Scottish Association for Marine Science and Tokyo University of Marine Science and Technology interviewed local fishers in Fukushima to understand their views towards the releases, publishing their results in autumn 2020 in the International Journal of Disaster Risk Reduction. They found that fishers in Fukushima were worried about the future of the plant, and about the effects of treated water releases on public perceptions of Fukushima seafood given their pride in the fish they caught. Crucially, this paper found that more than concerns over the safety of treated water or of marine produce, fishers very much valued the opportunities that trial-scale fishing had given them to rebuild their livelihoods post-disaster. Accordingly, anything that jeopardised this fragile recovery was viewed as having the potential to undo the gains made since 2011 in helping Fukushima fishers to rebuild their lives.

How well does the media describe the science?

New Scientist carries the views of a breadth of marine scientists on the releases. It reports a general consensus that the releases are unlikely to pose risks to humans or marine species, but also acknowledges Buesseler’s concern over remaining uncertainties around what is contained in the tanks and also the need for close monitoring once treated water is released. The Guardian’s reporting around the subject touches on the views of fisheries officials from Fukushima Prefecture, but otherwise engages to only a limited extent with the peer-reviewed literature whilst reporting the assessments of a Greenpeace investigation. Deutsche Welle similarly reports the scientific assessment of Greenpeace and also a study carried out by a local newspaper, but does not carry the views of scientists working at academic research organisations or refer to peer-reviewed studies.

Abalone caught in Fukushima waters post-disaster for sale in Iwaki City, Fukushima Prefecture (source: Leslie Mabon)

Other points to bear in mind

The concerns expressed by fishers and citizens of Fukushima Prefecture are not only about the safety of treated water or of local seafood. Fisheries are a significant component of local identity on the Fukushima coast. Efforts to rehabilitate local fisheries following the 2011 nuclear accident have gone a long way to re-establish a sense of pride and purpose among fishers and coastal communities. Catching and selling high-quality seafood is not only an economic activity, but rather a whole way of life for those involved, and an important part of a sense of belonging for those that live on the Fukushima coast. Consequently, anything such as a release of treated water that may jeopardise this recovery or lead to Fukushima fish being viewed as ‘tainted’ is likely to be met with concern.

Similarly, there is a strong body of social science research which tells us that people’s perceptions of radioactivity are complex, and thus that it is a mistake to dismiss concerns as ‘irrational’ or ‘wrong’. Different groups of people may interpret uncertainties and unknowns differently, depending on what they consider an acceptable level of risk. Our interpretation of risks can be informed by a breadth of factors, including whether we trust the individual or organisation taking the risk on our behalf, what our political views are, and whether we consider the distribution of risks and benefits (or the decision-making process) to be fair. Providing ‘more’ or ‘better’ science alone is unlikely to be effective when it is issues of value that are at stake.

Useful links

An explainer about the Fukushima Dai’ichi treated water situation on Leslie Mabon’s research blog

A virtual tour of the Fukushima coast on Leslie Mabon’s research blog

Fukushima InFORM – monitoring the effects of the Fukushima nuclear accident on Canada’s oceans

Woods Hole Oceanographic Institution – Center for Marine and Environmental Radioactivity

‘The Sea of Fukushima Will Not Give In’ – short film about Fukushima fisheries produced by Fukushima Prefecture

Leslie Mabon’s current work on the coasts and seas of Fukushima Prefecture is supported by Economic and Social Research Council-Arts and Humanities Research Council UK-Japan Social Sciences and Humanities Connections Grant ES/S013296/1, ‘Building social resilience to environmental change in marginalised coastal communities.

How long does immunity last after having COVID-19?

This blog was co-authored by Allison Jackson & Fiona Henriquez

The coronavirus pandemic has affected the lives of everyone in 2020. People are, quite rightly, wanting to know if they catch the virus, and are they then protected from further infections? Recently, a team of researchers at Imperial College London and their collaborators published a pre-print showing a survey they conducted looking at the prevalence of antibodies against the virus that causes COVID-19, the novel coronavirus SARS-CoV2, decreases over time. In many media outlets, including the Guardian, the Herald Scotland and the BBC Science Focus Magazine the headlines screamed that immunity to coronavirus could be lost in months. But is this really true?

What did the study do?

The Real-time Assessment of Community Transmission (REACT) Study surveyed 365,000 adults in England using a home testing kit to see whether they had antibodies to SARS-CoV2. They sampled three random groups of adults in England using a self-administered home antibody testing kit. Each sample was a different group of adults that had volunteered for the study.

What is an antibody?

An antibody (also known as immunoglobulin –Ig) is a molecule produced by our immune system in response to infection. Antibodies are created to be highly specific to a part of an invading microbe, such as SARS-CoV2. There are five different classes of antibodies in the human body and they are produced for distinct purposes and in specific locations. When you get infected by a microbe for the first time, for example with the novel coronavirus, the first antibody that is produced is IgM. It is highly efficient during new and early infections. Upon secondary exposure to the same microbe, the body’s immune system has acquired a memory from the first exposure and now the most abundant antibody that is produced is IgG. IgG will be present at low levels after an initial infection. SARS-CoV2 predominantly affects the respiratory system and as a result IgA is also produced. Like any other molecule secreted from cells, antibodies degrade after a period of time. IgG has the longest half-life of 20-24 days.

What were the results?

The first survey of 105,000 individuals in June 2020 found that 6% of the adult population had detectable IgG antibodies. The third and final survey, conducted in September 2020, showed the levels had decreased to 4.4%.

What did the researchers conclude?

The researchers conclude the prevalence of antibodies decreased between rounds 1 and 3 – but not in healthcare workers, presumably due to repeated exposure. They suggest this is consistent with evidence that immunity to seasonal coronavirus declines after infection, but that the relevance of this decrease has not been determined for SARS-CoV2. They also suggest their first sample may have underestimated the total of those infected in the first UK wave. The limitations of their study are described – namely the possibility that people exposed to the virus were less likely to take part over time, which may explain the decrease in antibody prevalence.

What does this mean for people’s immunity to the virus that causes COVID-19?

Viruses must replicate inside a host cell. They hijack host cell machinery so that the virus can replicate, produce its own components and be packaged up into about a thousand (in the case of SARS-CoV2) new virus particles in order to be released from the host cell before going on to infect other cells. Damaged host cells release signals that flag to the immune system that a viral infection is present and needs to be eliminated. Antibodies are only part of this process.

The main cells that are effective in eliminating viral infections are actually T cells, which develop in the thymus, hence the “T”. A subset of T cells, cytotoxic T cells, target infected host cells to kill them. Cytotoxic T cells are activated through a cascade of events that is initiated by ingestion of the virus by a dendritic cell. The dendritic cell proceeds to present the virus through specialised cellular pathways to a T helper cell, that in turn activates the cytotoxic T cell. T helper cells also provide a signal to make more of the antibody-producing cells. All these check points are necessary and highly regulated because, if not, there is a surge of immune over-activity that can lead to the so-called ‘cytokine storm’. There is evidence that suggests that a subgroup of COVID-19 patients do experience the ‘cytokine storm’ and, it is in these cases that the anti-inflammatory drug dexamethasone works well to reduce the over-active immune response.

Once the infection is resolved, the immune system returns to a resting state with only specific antibodies (for a brief period) and memory cells that recognise the virus, in circulation. Memory cells are those cells that vaccination seeks to create, so that the next time a person becomes infected, the immune system responds efficiently and rapidly to the virus infection. At this point, antibodies are generated swiftly and act to block entry of the virus to the host cell (Figure 1) or surround the virus so it is easily identified by the other cells of the immune system.

This image has an empty alt attribute; its file name is picture1.png
Figure 1: Antibodies that bind to surface proteins can block virus entry into host cells. Created with biorender.com

What did the media say?

Given that we have only known about SARS-CoV for less than a year, and the huge disruption it is having on our lives, one of the main questions researchers are searching for answer to is ‘will someone who has been infected, be protected from further infections?’. This study is in important step on the way to answering this question, however it is only a small part of the answer. The media headlines however have misrepresented the story and said that immunity wanes in months, without explaining that they are really talking about antibodies, which is not the same thing. This is frustrating because if you read the University’s press release, it is clear the researchers are talking about antibodies decreasing and not immunity. The sensationalist headlines will mean that the many people who have already been infected will undoubtably be concerned about what this really means for them.

Almost all the articles we read made claims that the researchers themselves did not make – particularly in their headlines or the first paragraphs. The Guardian suggested ‘the virus could reinfect people year after year, like common colds’. The Herald Scotland said ‘immunity to coronavirus in recovered patients may only last a few months’. The BBC was more accurate, saying ‘antibodies fall rapidly after infection’ but the Metro said ‘immunity to coronavirus may only last a few months’.

Points to remember

Immunity is a complicated process. The researchers do not discuss other mechanisms of immunity, namely cytotoxic T cells in their pre-print. They also only detected IgG antibodies, and as you can see, there are multiple types, although IgG is the dominant type. You would expect that antibody levels decrease over time after infection, but they would increase again if the person encounters the virus for a second or third time.

One thing to note is that these results of this study are, for now, a pre-print, which is a full draft research paper that is shared publicly before it has been peer-reviewed. Pre-prints allow rapid data and information sharing, which is particularly important in helping researchers to understand how SARS-CoV spreads, causes disease, and how the body responds to infection. However, this means that the results have not been submitted for peer-review and have not been scrutinised to ensure the research has been conducted to the highest quality standards.

The bottom line

Currently we don’t know how antibody levels relate to protection from re-infection of this novel coronavirus. Until researchers unpick all the complex components of the immune system and their roles, everyone should play it safe and follow the government guidelines on social distancing, hand washing and wearing face coverings, and getting a test if you have symptoms.

Does having irregular periods increase your risk of early death?

This blog was written by Rocío Martínez Aguilar (Post-doctoral Research Fellow) and Jacqueline Maybin (Senior Research Fellow and Consultant Gynaecologist). Both work at the MRC Centre for Reproductive Heath at the University of Edinburgh.

This month the media reported an increased risk of early death in women who have irregular periods, based on the findings from a recent study from Harvard University published in the British Medical Journal. This study is a very welcome addition to the medical literature, adding much needed data about menstruation and its impact on women’s lifelong health. However, media reports may also have caused distress for the millions of women experiencing irregular menstruation. In addition to the negative physical, social, mental and economic effects of having problematic periods, these women may now be worried that they are going to die earlier than those with trouble-free menses. The concern such headlines cause is exacerbated by the stigma and shame surrounding menstruation that prevents open, honest conversations. Here we explore the science behind the headlines and decode the language used regarding menstruation to give context to these findings.

What did this study do?

In this study, 79505 women were asked to report the regularity and frequency of their periods during three timepoints in their life: at 14 to 17 years old, 18 to 22 and 29 to 46. The frequency of menstruation is defined as the usual length of time from the first day of one period to the first day of the next period. Regularity is the amount of variation that occurs in this time from one period to the next. Women in the study described the regularity of their periods as either: very regular (occurring within 3-4 days of the expected date), regular (within 5-7 days), usually irregular, or always irregular/no periods. The frequency was categorised as 25 days or less, 26-31 days (considered ‘normal’), 32-39 days, or more than 40 days (too irregular to estimate).

The researchers then examined the number of premature deaths (that is, a death below the age of 70 years old) in each group and found this was greater in women with ‘always irregular/no periods’ than in women with ‘very regular’ menstruation. In addition, women with very infrequent periods ( more than 40 days/too irregular to estimate) had a small but statistically significant increased rate of premature death. This association remained when the data were corrected for factors such as BMI, physical activity or smoking. These relations were strongest for deaths due to cardiovascular disease (e.g. heart attack, stroke).

Other things to keep in mind

First, it is  is crucial to remember that irregular periods are a symptom (something you experience) rather than a diagnosis (something that causes the symptom). If irregular periods really did cause premature death, correction of the irregular menstruation should reverse the risk of dying early. The most common way of regulating menstruation is to take the oral contraceptive pill. However, in this study women who took the oral contraceptive pill during adolescence were actually more likely to have an early death. Therefore, it is possible that an underlying cause of irregular bleeding results in the increased risk of premature death, rather than having irregular periods, per se. We already know that women with polycystic ovarian syndrome (PCOS), a leading cause of irregular periods, have an increased risk of diabetes, high blood pressure and cancer of the womb. There are ways to reduce these risks and it is important that women with PCOS speak with their doctor. 

Second, in 2011 the International Federation of Gynaecology and Obstetrics (FIGO) first published guidance to standardise the language used for menstruation and introduce a classification system for abnormal periods. They recommended that doctors and scientists should assess menstrual duration, frequency, regularity, and volume. This study examined just two of these criteria but used a slightly different definition of regularity and frequency. This is likely to be due to the timing of data collection in this study, perhaps commencing prior to 2011. However, it is important to standardise such terms so that global data can be combined to find important conclusions regarding the impact of menstruation on health.

Lastly, the characteristics of the women who took part in this study were not representative of the diversity frequently seen in most societies, making it more difficult to apply the study findings to individual women seeking medical advice.  The majority  participants were white and they all worked as nurses. Some nurses work irregular hours, including nightshifts. This will have a significant impact on the natural body clock and previous studies have shown a link between shift work,  irregular periods and poor health. This was not accounted for in the study.

How well did the media cover the findings?

The study was covered in media outlets such as The Guardian, Daily Mail and CNN. Overall, the articles clearly described the key points of the study. The headlines summarised the most attractive findings but did not fall into the trap of confusing association with causation. The body of most articles clearly stated that there was an association between irregular periods and early deaths but explained that this does not mean that early deaths are caused by irregular periods. The importance of emphasising an association is not necessarily causal is an issue we have advised on within our Top Tips series at Research the Headlines. Most of the articles used quotes from independent experts alongside quotes from those who performed the study, an issue we have also previously highlighted. This provides a balanced overview and assessment of the research and highlights the positives of the study as well as the limitations that may otherwise go unnoticed by a non-scientifically trained audience.

The balanced reporting of these important findings highlights the benefits of good communication between scientists and the media. For researchers, engagement with the media facilitates an active role in public discourse about science, giving context to new discoveries, preventing sensationalism and limiting misconceptions. Perhaps it should be viewed as a moral duty for researchers to help society understand the latest scientific findings. Creating a media profile as a researcher is also an opportunity to inspire the next generation. As the saying goes, ‘if you can’t see it, you can’t be it’ and researchers who represent society in all its shapes and forms can, and will, have a significant positive impact on diversity and excellence in academia.

Conclusions

This study is a real step forward to close the huge data gap that exists regarding menstruation and its impact on lifelong health. As with all good research studies, it throws up many questions and areas of further study. It is imperative that we delineate how the menstrual cycle may affect, predict or be impacted by other diseases. Use of FIGOs standardised terminology and classification system will facilitate such research. After all, menstruation affects over 50% of the population and its relative invisibility in current scientific literature needs to be addressed. It is time to obtain good data on women and their menstrual cycles to improve their health across the lifespan.

Useful links

HOPE. Healthy Optimal Periods for Everyone.

Latest guidance on the language used for menstruation and the classification of causes for abnormal periods.


Does trauma lead to faster ageing in children?

This blog was written by Julie Cameron, Associate Director for Mental Health Foundation (Scotland and Northern Ireland).

Improving our understanding of how experiences of trauma and adversity in childhood impact on health outcomes as adults is of increasing interest and importance.  Trauma and adversity would include a wide range of factors including the experience of abuse, neglect, sudden death or abandonment, parental alcohol or drug misuse, parent being in jail, divorce, poverty, violence within the family unit and wider community. This sits within the broader context of the significant health inequalities in our society where people living in poverty are more likely to experience mental health problems, physical health problems, and die younger than those from more affluent backgrounds.

The role of adversity and trauma within this picture came to prominence following the US Adverse Childhood Experience (ACEs) survey which found that as the number of ACEs increased so did the risk of experiencing negative health conditions in adulthood.  This included mental health problems such as anxiety and depression, as well as physical health conditions like cardiovascular disease, diabetes, and cancer.  The relationship between mental health and physical health conditions is not fully understood.  Studies exploring this association have cited the impact of trauma on wider behavioural and relational factors, experiences of stigma, and discrimination, as well as neurobiological research on the impact of ‘toxic stress’ on brain development.  A recently published study provides further insight into the association between childhood trauma and later life experiences of poor physical and mental health.

What did this study do?

The study, led by Dr Katie McLaughlin at Harvard University, reported that children who suffer trauma from abuse or violence biologically age faster than children who have never experienced adversity. The study built on previous mixed findings on whether childhood adversity is linked to premature ageing.  The authors more clearly defined adversity into two categories (1) threat-related adversity of violence or abuse, and (2) deprivation related adversity of neglect and poverty. The study also used three signs of biological aging – early puberty, cellular aging, and changes in brain structures – to undertake a meta-analysis of almost 80 studies.  A meta-analysis is a systematic approach to the review of findings from multiple studies, which explore the same question or area of interest, to identify whether there are statistically significant common findings or conclusions that can be drawn. The study found that threat-related trauma was associated with all three signs of premature biological aging, but deprivation-related adversity was not significantly associated with premature aging.

How well does the media describe the study?

The study was covered in many media reports, including The Guardian and science news outlets.  Although the ‘science’ behind the association was reported in varying levels of detail what is interesting to note is the strong inequalities focus within the reporting.  This was clearly led by the author who highlights in her quotes the implications this study has for understanding health disparities and the need to focus prevention in the early years.  However, there are gaps in how these findings are presented.  Overall, there is a strong emotional detachment from the findings and little clarity into whether particular sub-groups are more or less impacted

This study provides evidence that exposure to violence makes children grow up faster, not only emotionally but biologically.  The severity of this situation within the articles is at times hidden behind terms such as trauma and adversity with little insight into the human cost.  There is no clarity within the reports as to whether particular sub-populations, particularly girls, are more or less impacted.  This is interesting as two of the media reports mention early onset of puberty in girls.  

The findings are also emphasised within a medical model, with little discussion on the implications of the findings on public mental health – the art and science of improving mental wellbeing and preventing mental health problems via organised efforts and informed choices of society, organisations, public and private, communities, and individuals. This is evident in the reporting of the lead author’s view of the findings. Quotes from Dr. McLaughlin frame implications of the study as the need to use existing evidence-based treatments to improve mental health in children experiencing trauma to slow down the pattern of accelerated biological aging.  There is no reporting into what this means from a public mental health perspective.  In particular,  for breaking cycles of violence and abuse so that fewer children and young people are exposed to these in the first place.  This would move the analysis and implications of the study from a very individualised approach to one that explores the policy and community supports required to create strong family units and thriving communities. 

Another important point to keep in mind is that the results of the meta-analysis were of a small effect, rendering them as potentially trivial. Even the authors themselves acknowledge that the findings are preliminary and so further research will be needed in the area before it can be stated that ‘Children who suffer violence or trauma age faster’. Additionally, the meta-analysis only focused on combining results from studies that have been published. Publishing non-significant findings (i.e. where results don’t show a strong relationship) can be more difficult to publish. As such, it cannot be ruled out that including unpublished scientific data could have changed the results.

Useful links:

www.cdc.gov/violenceprevention/aces

Adverse childhood experiences in context briefing paper (Aug 2019) Public Health Scotland: http://www.healthscotland.scot/population-groups/children/adverse-childhood-experiences-aces/overview-of-aces

Tackling Social Inequalities to reduce mental health problems: how everyone can flourish equally (Jan 2020) Mental Health Foundation: https://www.mentalhealth.org.uk/publications/tackling-social-inequalities-reduce-mental-health-problems

Do anxious mothers pass their stress on to their babies?

This post was co-authored by Margarita Kanevski and Sinead Rhodes.

Anxious mums can pass on their stress to their babies — leaving them with an ’emotional imprint’ that can scar them for life, scientists warn

In amidst of a global pandemic with many existing and expectant mothers already finding themselves in a heightened state of uncertainty, this recent headline by The Daily Mail would itself be more than enough to scar anyone for life. Upon a closer look, however, this attention-grabbing headline certainly calls for scrutiny in the context of the science behind it.

What did the actually study do?

The study was recently presented as an abstract at the European College of Neuropsychopharmacology congress. Researchers administered the famous Still Face Paradigm to 50 mothers and their three-month-old babies. During this paradigm mothers first interacted with their infant in a playful and engaging manner (playful phase) following which they were instructed to stare at their infant and remain still (stressful phase). The stressful phase, during which the mother acts distant, has been consistently shown to invoke signs of distress in children. Following the stressful phase, mothers were asked to resume engaging playfully with their child. To measure stress, researchers monitored heart rate activity of infants and their mothers throughout the task (where higher heart rates reflected increased stress levels). 

Mothers were interviewed using the Diagnostic Interview for Mental Disorders to assess if they met criteria for an affective disorder, also known as a psychiatric/mood disorder. In total, 20 of the mothers met criteria for one or more affective disorders and were included in the experimental group (a group with a condition of interest). The remaining 30 of the mothers did not meet criteria for an affective disorder and therefore formed the control group (a group without a condition of interest). Researchers compared the heart rates of infants and mothers across these two groups. Additionally, the researchers asked mothers to rate infants’ general temperament including things like smiling, laughter, fear, and distress.  

Results showed that babies of mothers with one or more affective disorders had higher heart rates during the stressful phase of the experiment, than babies in the control condition. The babies of mothers with an affective disorder were also rated by their mothers as being more negative in their general temperament. Importantly, researchers accounted for other important factors that could have been driving this difference between the groups, including maternal age at time of birth, income, and children’s birthweight. The authors concluded that babies with mothers suffering from an affective disorder struggle to deal with stressful situations.

How well did the media cover the findings?

The headline asserts that anxious mothers ‘pass’ on their stress to their babies. To infer that mothers ‘pass’ any traits to their offspring would require a complex examination of mother-child genetics which was not done in this specific study. Based on this, we cannot infer that mothers ‘pass’ on their stress to their infants. Notably, mothers in the control group (without an affective disorder) were found to have higher heart rates across all three phases of the study, which would actually suggest that these mothers were experiencing more stress during the experiment than mothers with affective disorders.

The headline also misleads the reader to infer that mothers were exclusively anxious. Rather, mothers were assessed using the Diagnostic Interview for Mental Disorders for affective disorders, which covers other debilitating conditions such as bipolar disorder and major depressive disorder. The study abstract did not provide a breakdown of which affective disorders mothers in the experimental group met criteria for the most. As such, asserting that findings relate to anxious mothers is misleading and is especially concerning given that postpartum anxiety or, in other words, excessive worry following giving birth, has been estimated to affect 13 to 40% of mothers, making it relatively common. The article goes on to state that having an anxious or depressed mother can scar children for life.  However, the study did not follow infants up over time and so no conclusions can be drawn regarding their well-being across the lifespan.

Other things to keep in mind

The first important point to consider is that the findings of the study are preliminary. This means that the work around the experiment is likely still ongoing and these are only the initial emerging findings. Indeed, the researchers themselves state that further work with a larger number of participants will be required before any final conclusions can be drawn.

Second, for findings of a study to be deemed as consequential and not occurring simply by chance, scientists typically rely on a statistical significance value (known as a p-value) being smaller than 0.05. If we look at the reported significance values for the group difference between the heart rates of infants across the two groups, these fall marginally just below this threshold (0.048 to be specific). This, coupled with the small sample size, challenges any conclusions that can be made based on the findings of this single study. Replication of this research, particularly by other independent research groups, is important before we can generalise the findings to mothers and infants in general.

Lastly, the study has not yet been peer-reviewed. It was presented at a conference and picked up by the media rather than being in a final peer reviewed publication. Peer review refers to the assessment of scientific work by other experts in the field and represents a critical aspect of validation of the quality of any research. Until this study is finalised and peer reviewed, we must be careful about interpreting its findings.

Useful links

https://www.nhs.uk/conditions/post-natal-depression/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/about-maternal-mental-health-problems/

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