Nature: Issues on Mental Health PDF

The international journal of science / 14 October 2021 End the neglect This week’s collection of review articles dives deep into...

The international journal of science / 14 October 2021 End the neglect This week’s collection of review articles dives deep into the state of knowledge of interventions — those that work and those that don’t — for preventing and treating anxiety of young people’s and depression in people aged 14–24. For example, researchers have been investigating poten- mental health tial links between depression and inflammatory disorders — such as asthma, cardiovascular disease and inflammatory bowel disease. This is because, in many cases, adults with depression also have these disorders. Moreover, there’s The pandemic, a UNICEF report and a review evidence that, in mice, changes to the gut micro­biota dur- of the latest research highlight the urgent ing development reduce behaviours similar to those linked need for better prevention and treatment to anxiety and depression in people3. That suggests that targeting the gut microbiome during adolescence could be of youth anxiety and depression. a promising avenue for reducing anxiety in young people. W Kathrin Cohen Kadosh at the University of Surrey in Guild- orldwide, at least 13% of people between ford, UK, and her colleagues reviewed existing reports of the ages of 10 and 19 live with a diagnosed interventions in which diets were changed to target the mental-health disorder, according to the gut microbiome. These diets were found to have had min- latest State of the World’s Children report, imal effect on youth anxiety4. However, the authors urge published this week by the United Nations caution before such a conclusion can be confirmed, citing children’s charity UNICEF. It’s the first time in the organ- limitations such as small sample sizes in the studies they ization’s history that this flagship report has tackled the Young reviewed. They say the next crop of studies will need to challenges in and opportunities for preventing and treating people involve larger-scale clinical trials. mental-health problems in young people. It underscores By contrast, researchers have found that improving the complexity of adolescent mental health and how it is need to be young people’s cognitive and interpersonal skills can be understudied and underfunded. These findings are echoed involved in more effective in preventing and treating anxiety and in a parallel collection of review articles published this all aspects of depression under certain circumstances5. In addition, week in a number of journals published by Springer Nature, Alexander Daros at the Campbell Family Mental Health which also publishes Nature. the research Institute in Toronto, Canada, and his colleagues report a Anxiety and depression constitute more than 40% process.” meta-analysis of 90 randomized controlled trials. They of mental-health disorders in young people (those found that helping young people to improve their emo- aged 10–19). UNICEF also reports that, worldwide, sui- tion-regulation skills, which are needed to control emo- cide is the fourth most-common cause of death (after tional responses to difficult situations, enables them to road injuries, tuberculosis and interpersonal violence) cope better with anxiety and depression6. However, it is in adolescents aged 15–19. In eastern Europe and central still unclear whether better regulation of emotions is the Asia, suicide is the leading cause of death for young people cause or the effect of these improvements. in that age group — and it’s the second-highest cause in western Europe and North America. Co-production is essential Sadly, psychological distress in young people seems It’s uncommon — but increasingly seen as essential — that to be rising. One study found that rates of depression researchers working on treatments and interventions are in a nationally representative sample of US adolescents directly involving young people who’ve experienced men- aged 12–17 increased from 8.5% to 13.2% between 2005 and tal ill health. These young people need to be involved in all 2017 (ref. 1). There’s also initial evidence that the coronavi- aspects of the research process, from conceptualizing to rus pandemic is exacerbating this trend in some countries. and designing a study, to conducting it and interpreting For example, in a nationwide study2 from Iceland, adoles- the results. Such an approach will lead to more-useful sci- cents aged 13–18 reported significantly more symptoms ence, and will lessen the risk of developing irrelevant or of mental ill health during the pandemic than did their inappropriate interventions. peers before it. And girls were more likely to experience Two young people are co-authors in a review from Karo- these symptoms than were boys. lin Krause at the Centre for Addiction and Mental Health in Although most mental-health disorders arise during Toronto, Canada, and her colleagues. The review explored adolescence, UNICEF says that only one-third of the invest- whether training in problem solving helps to alleviate ment in mental-health research is targeted towards young depressive symptoms7. The two youth partners, in turn, people. Moreover, the research itself is fragmented — sci- convened a panel of 12 other youth advisers, and together entists involved tend to work inside key disciplines, such they provided input on shaping how the review of the evi- as psychiatry, paediatrics, psychology and epidemiology, dence was carried out and on interpreting and contextu- and the links between research and health-care services are alizing the findings. The study concluded that, although often poor. This means that effective forms of prevention problem-solving training could help with personal chal- and treatment are limited, and lack a solid understanding lenges when combined with other treatments, it doesn’t of what works, in which context and why. on its own measurably reduce depressive symptoms. Nature | Vol 598 | 14 October 2021 | 235 © 2 0 2 1 S p r i n g e r N a t u r e L i m i t e d. A l l r i g h t s r e s e r v e d.  Editorials The overarching message from these reviews is that there those who chose to respond to Nature’s survey, which was is no ‘silver bullet’ for preventing and treating anxiety and based on a poll conducted by the Australian Science Media depression in young people — rather, prevention and treat- Centre, an organization that connects scientists to journal- ment will need to rely on a combination of interventions ists. Other science media centres around the world sent that take into account individual needs and circumstances. Nature’s survey on to researchers in the United Kingdom, Higher-quality evidence is also needed, such as large-scale Canada, Taiwan, New Zealand and Germany, and Nature trials using established protocols. sent it to scientists in the United States and Brazil. Because Along with the UNICEF report, the studies underscore those who have received threats might have been more the transformational part that funders must urgently play, motivated to respond, the overall proportion of scientists and why researchers, clinicians and communities must experiencing abuse might be lower. work together on more studies that genuinely involve But the results are shocking, nonetheless. Intimidation young people as co-investigators. Together, we can all do is unacceptable on any scale, and the findings should be of better to create a brighter, healthier future for a generation concern to all those who care about scientists’ well-being. of young people facing more challenges than ever before. Such behaviour also risks discouraging researchers from contributing to public discussion — which would be a huge 1. Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E. & Binau, S. G. J. Abnorm. Psychol. 128, 185–199 (2019). loss, given their expertise, during the pandemic. 2. Thorisdottir, I. E. et al. Lancet Psychiatr. 8, 663–672 (2021). Institutions at all levels must do more to protect and 3. Murray, E. et al. Brain Behav. Immun. 81, 198–212 (2019). defend scientists, and to condemn intimidation. Of those 4. Cohen Kadosh, K. et al. Transl. Psychiatr. 11, 352 (2021). 5. Bennett, M. P. et al. Transl Psychiatr. 11, 288 (2021). respondents who told their employers about death threats 6. Daros, A. R. et al. Nature Hum. Behav. https://doi.org/10.1038/s41562-021- — and not all did — some 20% said their employers were 01191-9 (2021). not at all supportive. The proportion was similar for those 7. Krause, K. R. et al. BMC Psychiatr. 21, 397 (2021). Intimidation who had experienced trolling or personal attacks online, risks although in these cases respondents were less likely to have notified their employer in the first place. Of those who discouraging Protect COVID researchers had received death threats, more than 80% had told their employer, compared with just over half of those who had from scientists in been subject to trolling or personal attacks. Respondents rightly said that scientific societies, funders and govern- contributing ments should talk about the problem and condemn attacks. the public eye to public discussion.” Most of the respondents were in Europe and the United States, but threats are being made against researchers all over the world, by both individuals and organized anti- science or anti-vaccination campaigns. The findings show Researchers are facing harassment for the need for more support, protection and training for speaking out during the pandemic. Their scientists in the public eye. institutions must do more to support them. Some researchers in other high-profile fields, such as climate change and animal research, have had to deal with T harassment and abuse for many years (see, for instance, he COVID-19 pandemic has seen more scientists Nature 562, 449–450; 2018); partly as a result, their institu- than usual enter the public arena, many of them tions have built up some level of understanding on how to for the first time. Every day, researchers are support scientists. The Science Media Centre in London is interviewed in the media, advise policy­makers among organizations that have published advice for those and write social-media posts. They might be experiencing harassment, including when, whether and discussing the latest coronavirus data; explaining and how to engage with critics, and who to turn to for support interpreting new research; or commenting on government (see go.nature.com/3lyyqlj). Support and information can policies. Some are now as recognizable as celebrities. also be gained from many other fields, ranging from jour- Clear, accurate public communication from scientists is nalism to sport, in which people are targeted by toxic online essential in a pandemic. But for a significant minority, the threats and sometimes real-world attacks. attention has had unpleasant consequences. Nature has Taking steps to support scientists who face harassment surveyed a subset of researchers who have spoken to the does not mean silencing robust, open criticism and dis- media about COVID-19, and found that 47 people — some cussion. The coronavirus pandemic has seen plenty of 15% of the 321 respondents — had received death threats disagreement and changing views as new data have come and that 72 had received threats of physical or sexual vio- in, as well as differing stances on which policies to adopt. lence (see page 250). In response to other survey questions, Scientists and health officials should expect their research the researchers who reported the highest frequency of to be questioned and challenged, and should welcome trolling or personal attacks were more likely to say that critical feedback that is given in good faith. But threats of it had affected their willingness to speak to the media in violence and extreme online abuse do nothing to encour- the future. age debate — and risk undermining science communication The results are not a random sample: they represent at a time when it has never mattered more. 236 | Nature | Vol 598 | 14 October 2021 © 2 0 2 1 S p r i n g e r N a t u r e L i m i t e d. A l l r i g h t s r e s e r v e d.