The impact of biological factors and adverse childhood experiences on psychopathology and suicidal behaviour among university students.

Transcription

1 The impact of biological factors and adverse childhood experiences on psychopathology and suicidal behaviour among university students. Margaret McLafferty, Dr Elaine Murray UU Student Wellbeing Study

2 Presentation Plan Student Mental Health Risk factors #UlsterWellbeing Aims of the study Methodology Results Mental Health Prevalence and adverse childhood experiences Biological Studies Discussion

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4 Student mental health & wellbeing High levels of mental health problems have been found in university students (The American College Health Association, 2014). Healthy Minds Study (Eisenberg, Hunt & Speer, 2013) >14,000 American students Positive screening for: depression 17.3% panic disorders 4.1% self harm 15.3% suicide ideation 6.3% My World Study (Dooley & Fitzgerald, 2012) > 8,000 Irish Students 7% attempted suicide 21% engaged in self harm

5 Risk factors Some students may have pre existing mental health problems which can be aggravated during their transition to university but the stress of university life may trigger psychopathology for others. (Royal College of Psychiatrists, 2011) key life transition living away from home exam stress new social life self directed learning finances pressure to excel caring responsibilities employment

6 Risk factors Adverse Childhood experiences impact negatively on mental health and wellbeing (McLafferty et al., 2015, 2016). Childhood adversities are common, have a cumulative effect and are predictive of further adversities, accounting for 29.8% of mental health disorders globally (Kessler et al., 2010). Parental Maladjustment parental mental health problems & suicidal behaviour, criminality, substance disorders, family violence Parental Maltreatment physical abuse, emotional abuse, sexual abuse, neglect

7 #UlsterWellbeing The WHO World Mental Health International College Student Project (WMH ICS) was established to: obtain cross national information about the prevalence and correlates of student mental health and suicidality assess patterns of help seeking target students in need of outreach evaluate the effects of interventions generate reliable screening estimates for a broad range of mental disorders

8 Aims of the study The study aimed to examine risk and protective factors for student mental health and wellbeing during their time at university. It considered the impact of adverse childhood experiences on psychopathology and suicidal behaviour. Saliva sample were collected to examine genetic and biological factors affecting mental and physical health and medication response.

9 Methodology Design: Recruitment: A longitudinal study to identify risk and protective factors for mental health and wellbeing in the student population. Following registration across 4 UU campuses. Commenced September 2015 Participants: Undergraduate 1 st year students, over 18. 1,646 (40%) recruited in year 1. (739 fully completed) Instrument: On line survey developed by the WMH International College Survey consortium using Qualtrics software WMH CIDI. DNA collection: A saliva sample was collected from each participant (4ml, using Oragene kits).

10 Methodology Saliva/DNA collection Storage

11 Methodology Survey Background information Childhood experiences Health and family history Health behaviours Attention and concentration Emotional problems Substance use Self harm Seeking treatment Medication Stressful events Sexuality How you see yourself Expectations for university

12 Results Gender: 62.9% female 36.6% male 0.6% other Age: Average age 21, range Lifetime prevalence of mental health and substance disorders Total (739) Male (274) Female (462) Other (3) Disorders n % n % n % n χ 2 Mood - MDE ** Anxiety GAD Panic Disorder * Broad Mania Alcohol dep Drug abuse/dep **

13 Results Suicidal Ideation and Behaviour Did you ever have thoughts of killing yourself? 31.0% make a suicide plan? 19.6% engage in deliberate self harm? 19.6% attempt suicide? 7.7% (48.6% made more than one attempt, 15 attempted suicide in the past year) 257 received automated response informing them about services 84 triggered alert and were contacted by Carecall (Inspire)

14 Results The impact of early childhood experiences Latent profile plot of childhood adversity indicators

15 Results Demographics N = 739 Lifetime Mood (n=186) OR (95% CI) Gender Female (462) 1.604* ( ) Lifetime GAD (n=173) OR (95% CI) Suicide Ideation (n=237) OR (95% CI) Suicide Plan (n=149) OR (95% CI) Suicide Attempt (n=60) OR (95% CI) 1.627* 1.803** ( ) ( ) ( ) ( ) Male (274) Age 21 and over (178) 1.784** ( ) * ( ) ( ) ( ) ( ) Under 21 (561) Sexuality Non-heterosexual (66) 2.915*** ( ) 3.553*** 5.366*** 5.934*** 5.835*** ( ) ( ) ( ) ( ) Heterosexual (669) Self-Harm (n=151) OR (95% CI) 2.363*** ( ) ( ) 5.404*** ( ) Childhood Adversities Moderate risk (77) High risk (19) Low risk (643) 2.944*** ( ) 3.112* ( ) *** ( ) 5.941*** ( ) *** ( ) 8.579*** ( ) *** ( ) 8.489*** ( ) 1.0 Note: OR = odds ratios, CI = confidence intervals, significance values *p<.05, **p<.01, ***p< * ( ) 7.945*** ( ) ** ( ) 5.532** ( ) 1.0

16 Gene Environment Interactions Epigenetics Biological Genes Nutrition Change in phenotype without a change in genotype e.g. DNA Methylation Social Stress Trauma Environment Psychological Emotions Behaviours

17 DNA Methylation Analysis Sample Summary Age, mean (Range ± SD ) Gender Smoking Status Demographics Male (%) Female (%) Past(%) Daily (%) Occasional (%) Never (%) Healthy (n=16) 23 (18 32 ± 5.4) 4 (12.5) 28 (87.5) 1 (6.2) 6 (37.6) 1 (6.2) 8 (50) Depression (n=16) 23 (18 32 ± 5.0) 4 (12.5) 28 (87.5) 1 (6.2) 6 (37.6) 1 (6.2) 8 (50)

18 Relative similarity and differences of DNA methylation profiles between samples Separation by gender Separation in cases vs controls in females.

19 Microbiome and Depression

20 Oral Microbiome Depression? Figure from Think outside the gut: Probiotics for oral health

21 Discussion High levels of pre existing mental health problems were revealed in students commencing first year at Ulster University. Adverse early childhood experiences have a very negative impact on mental heath and suicidal behaviour Depression is associated with significant effects on DNA methylation, and the genes most affected are related to immune function in the female cohort. Significant changes in the oral microbiome in individuals with depression, leading to imbalance of microbes associated with inflammation. These data suggest an immune component to the aetiology of depression, consistent with the accumulating evidence supporting a relationship between inflammation and depression

22 Discussion The study will assist in the development and implementation of intervention strategies, helping address the needs of students. The study highlights the need to address mental health problems at an early age.

23 Acknowledgements UU Student Wellbeing Team NI Centre for Stratified Medicine and UU Psychology Professor Siobhan O Neill Coral Lapsley Professor Tony Bjourson Dr Edel Ennis Professor Cherie Armour Dr Sam Murphy Professor Brendan Bunting BMSRI Genomics Group (Methylation Analysis) Dr Rachelle Irwin Sara Jayne Thursby Professor Colum Walsh Intelligent Systems Research Centre (Microbiome Analysis) Benjamin Wingfield Prof Sonya Coleman Prof Martin McGinnity This work was supported by a grant of 11.5M awarded to Professor Tony Bjourson from European Union Regional Development Fund (ERDF) EU Sustainable Competitiveness Programme for N. Ireland; Northern Ireland Public Health Agency (HSC R&D) & Ulster University

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