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Teenage depression: The potential pitfalls of too much social media use

By guest blogger, on 14 January 2019

A new mobile phone will be in the pockets of many teenagers as they head back to school in the coming days. The period between Xmas and New Year will have been spent signing up for social media apps where they can chat, share photos and videos with friends, all part of the excitement of owning a new device. But how many of these young people and their parents are aware of the potential pitfalls of spending too much time on social media sites?  And what can parents, teachers and young people themselves do to maximize the benefits of life online whilst minimising those pitfalls? It’s a question that Yvonne Kelly, Director of the ESRC International Centre for Life course Studies at UCL and colleagues have been asking as part of a major programme of research on social media use and young people’s wellbeing. Today they publish key new research, which provides much-needed new evidence on the links between heavy social media use and depression in teenagers. The research shines light on the underlying processes that could be at work and that might explain the link between the two. Here, Yvonne explains how their research might help policymakers, educators, parents and young people themselves better understand and prevent the potential pitfalls of living too much of their life on social media platforms.

2018 has seen a growing chorus of voices including those of the former and current Health Secretaries, Jeremy Hunt and Matt Hancock calling for a thorough investigation of the links between social media use and the growing numbers of young people struggling with mental health issues. Indeed Matt Hancock issued “an urgent warning” on the potential dangers of social media on children’s mental health, stating that the threat of social media on mental health is similar to that of sugar on physical health.

The Chief Medical Officer, Dame Sally Davies has been tasked by the Government with leading that investigation and with coming up with evidence based recommendations around what constitutes safe social media use and what changes need to be made and by whom to make that a reality. The Royal College of Paediatrics and Child Health (RCPCH) recently issued the first ever guidance on managing children’s screen time, calling for further research particularly into social media.

In recent months, we and others have submitted written and oral evidence to two Parliamentary inquiries in this area and had discussions with the Royal Society for Public Health which is campaigning actively  to get us all thinking harder about our social media use.

We’ve talked about our early research  showing that 10 year-old girls who used social media sites for chatting had more social and emotional problems at age 15 than their peers who used them less or not at all. Those problems continued to get worse as they got older.

Our new research published in The Lancet’s EClinical Medicine draws stronger links between heavy social media use and depressive symptoms in girls and boys at the age of 14.  We look at the possible ways in which social media use might linked to depressive symptoms. We consider 4 potential pathways – through young people’s sleep patterns, their experiences of online harassment, body image and self-esteem. It is the first research to look at all of these potential pathways at the same time.

Our data for this research came from the Millennium Cohort Study, which has followed the lives of some 19,000 children born at the turn of the century. This piece of research, looked at the social media use and mental health of nearly 11,000 of the study’s participants.

Social media use

In line with our earlier research, we saw that girls were heavier users of social media than boys with two fifths of them using it for more than 3 hours per day (compared with one fifth of boys). Girls were a lot less likely NOT to use social media at all (4 per cent girls and 10 per cent boys).

Examining the underlying processes that might be linked with social media use and depression, we saw a number of really striking findings including:

  • 40 per cent of girls and 25 per cent of boys had experience of online harassment or cyberbullying
  • 78 per cent of girls and 68 per cent of boys were unhappy with their body/weight and 15 percent girls and 12 per cent of boys were unhappy with their appearance
  • 13 per cent of girls and 9 per cent of boys had low self-esteem
  • 13 per cent of girls and 11 per cent of boys reported getting fewer than 7 hours sleep per night and 40 per cent of girls and 28 per cent of boys said their sleep was often disrupted

Girls, it seems from these findings, are struggling more with these aspects of their lives than boys – in some cases considerably more. When we turned our attention to the signs of depression exhibited by our participants, we could see that here too girls fared worse with scores on average twice as high as those of boys.

The link between social media use and depressive symptoms was stronger for girls compared with boys. For girls, greater daily hours of social media use corresponded to a stepwise increase in depressive symptoms and the percent with clinically relevant symptoms. For boys, higher depressive symptom scores were seen among those reporting 3 or more hours of daily social media use.

There was a clear link between social media use and all the pathways we investigated – more time spent on social media related to having poorer sleep, more experiences of on-line harassment, unhappiness with the way they look and low self esteem. In turn, these things were directly related to having depressive symptoms.

A closer look at the pathways was also revealing. The most important routes from social media use to depressive symptoms were shown to be via poor sleep and online harassment.

Social media use linked directly to having poor sleep which in turn was related directly to having more depressive symptoms. The role of online harassment was more complex, with multiple pathways through poor sleep, self-esteem and body image, all of which linked directly to depressive symptoms.

Potential pitfalls and key routes

Our findings add weight to the growing evidence base on the potential pitfalls associated with lengthy time spent engaging on social media. In particular they point to poor sleep and online harrassment as being key routes between social media use and depression.

These findings are highly relevant to current policy development on guidelines for the safe use of social media and calls on industry to more tightly regulate hours of social media use for young people. They add weight to the Screen Time Guidance issued by the RCPCH today, particularly the suggestion to set and agree child appropriate time limits on screen use.

When it comes to social media use specifically, our research indicates that the a similar approach could be useful. Clinical, educational and family settings are all potential points of contact where young people could be encouraged and supported to reflect not only on their social media use, but also other aspects of their lives including on-line experiences and their sleep patterns.

At home, families may want to reflect on when and where it’s ok to be on social media and agree limits for time spent online. Curfews for use and the overnight removal of mobile devices from bedrooms might also be something to consider. School seems an obvious setting for children and young people to learn how to navigate online life appropriately and safely and for interventions aimed at promoting self-esteem. Clearly a large proportion of young people experience dissatisfaction with the way they look and how they feel about their bodies and perhaps a broader societal shift away from the perpetuation of what are often highly distorted images of idealised beauty could help shift these types of negative perceptions.

As we head into 2019, millions of young people will be getting their first experiences of life online using the devices they got for Xmas. They will rapidly become expert at downloading apps, posting photos and interacting with their peers. With the gift there was no instruction manual to help them understand and navigate some of the pitfalls our research outlines. We hope our work brings, at least, some guidance for all those keen to ensure these children continue to thrive and do well, so that they enjoy the benefits that new digital technology brings whilst staying safe and happy.

Social media use and adolescent mental health: Findings from the Millennium Cohort Study is research by Yvonne Kelly, Afshin Zilanawala, Cara Booker and Amanda Sacker and is published in The Lancet’s EClinicalMedicine journal.

My Research was mentioned in Parliament, and yours can be too.

By guest blogger, on 10 December 2018

In this blog piece, Emily Murray (IEHC’s Research Department of Epidemiology and Public Health) provides some helpful advice on how to get research mentioned in Parliament.

The 13th of December 2017 dawned like any other day.  I was sitting at my desk with my favourite coffee preparing to dive into another day of researching…when a Twitter notification popped up:

Professor Jenny Head, my supervisor and head of our research group at the time, had provided a link to a video recording of the all parliamentary meeting of the Women’s & Equality sub-committee. I clicked over & started to listen.  Fifteen minutes into the recording, something wonderful happened:

Someone mentioned my research.  My research.  MY. RESEARCH.  In a parliamentary meeting.

To put it mildly, I was elated.

Isn’t this what we as researchers aspire to in our work?  That the findings of our work makes its way into the ears of the people who make the decisions?  That someday, hopefully, what we have researched will change policy, improve health & well-being of the population and generally improve the lives of all our brethren?

But I get ahead of myself.

I don’t know whether my findings being relayed in a parliamentary meeting has changed anything (yet).  What I do know is that it didn’t happen by accident.  It wasn’t entirely planned either, but a series of steps and activities that our project, RenEWL (Research on Extending Working Lives), undertook made the outcome much more likely. I share them with you now so that you will hopefully be even more successful than I was.

Emily’s top tips for getting your research mentioned in Parliament:

  1. Start Early – at RenEWL, we set up an impact sub-group from day one. We charted out ideas for impact events, discussed who we wanted to target with our research and mapped out timelines. This is important.  If we had waited until we had had actual research results, we wouldn’t have had the time to plan effective events.

*Note: If you are not a part of a large group, or solo researching, find an impact officer at your institution.  If you don’t have one of those, find a researcher you admire for their impact work and ask them how they plan out their impact.

  1. Build Relationships – One of our first impact events was a launch event we held within the first 6 months of our project. We invited a select group of experts in government, academic and the third-sector who we knew worked in our subject area.  Part of the event was to introduce the project and project plans to the participants.  But what I also think was particularly important, was to build in time to listen to THEM.  We set up group discussions where we asked what they thought of our project aims, but also importantly what topic areas they were interested in that we were missing.
  2. Bring in the experts – One of the initial collaborators on our programme was the International Longevity Centre (ILC-UK). ILC-UK has vast experience with planning events and disseminating results to policy-makers.  Our project commissioned them to help disseminate our findings to policy-makers. I believe it was this collaboration which was instrumental in making our policy maker-focused event ‘Overcoming Inequalities: Addressing barriers to extending working lives’ such a success.  They additionally briefed individual ministers, government units and journalists.
  3. Stay Aware – Find our how Parliament works. To get started, there are simple guides on the Parliament’s website.  Here is the guide for Select Committees. Sign up for the UK parliament newsletter to receive notifications of events and offered trainings.  Find out what topic areas are accepting submissions of evidence here.  We submitted evidence to a number of government consultations, including in person to the Independent Review of the State Pension Age.
  4. Act quickly – Or at least be prepared to act quickly. Don’t wait for a consultation to pop up on your radar to start drafting a document.  Policy-makers act on quick timescales.  You will most likely only have a few hours or days (weeks if lucky) to submit a document.  Don’t get caught out.
  5. Network, network, network – A few of the initial attendees at our launch event agreed to serve on our advisory committee. Other participants later invited us to present findings at their (external) institutions.  From submitting evidence to the Independent Review, John Cridland agreed to be the key-note at our policy-maker event.
  6. Disseminate, disseminate, disseminate – Every person we met through project activities was asked if they wanted be included on our mailing list. We have a project-specific web-site and twitter account.  Every published finding was sent to our mailing list, posted on the web-site and tweeted.  This included our final report, titled ‘Working for Everyone’, that was written in conjunction with ILC-UK and additionally sent to their contact list as well.

Contact Emily Murray via: emily.murray@ucl.ac.uk | @emilytmurray

View Emily Murray’s IRIS profile

Acknowledgements: Professor Jenny Head and Professor Nicola Shelton designed this impact structure.  Professor Head, Dr Nicola Shelton and I planned all impact activities together.  ILC-UK was instrumental in the success of our policy-maker event and report.  The entire RenEWL team was instrumental in the success of our programme. 

Why we need health examination surveys to understand health and health risks

By guest blogger, on 16 November 2018

Would you let a stranger into your home? Would you then answer questions about yourself, your family and your health for an hour or so? Luckily, 10,000 people in England do so every year. Most also allow the interviewer to measure their height and weight. Many agree to a nurse visiting them later. The nurse measures their waist and blood pressure and takes blood, urine or saliva samples.

The Health Survey for England (HSE) is one of the biggest and longest-running health examination surveys in the world. It is organised by NatCen Social Research and UCL. What makes the HSE unique in the UK is that we take these measurements and we ask the general population – anyone living in a private home. We don’t rely only on questions (a ‘health interview survey’). We don’t rely only on information collected by the NHS. We work on three surveys at a time. We are currently: writing the report for the 2017 survey, running the 2018 survey, and preparing for the 2019 survey. We always obtain approval from an NHS Research Ethics Committee for the questions and measurements we plan to include before we start the survey.

Why is this important? Most people report that they are taller than they actually are, and weigh less than they actually do. Relying on self-reported information underestimates how big the obesity problem is in England. People who have undiagnosed diseases cannot tell us about them. By measuring blood pressure, we can find out how many people have high blood pressure (‘hypertension’) but don’t know it. We do the same for diabetes by measuring blood sugar levels. We also collect saliva to measure cotinine. This is made by the body when exposed to nicotine. Smokers have high levels. Non-smokers have measurable cotinine if they spend time in places where other people smoke. Although levels are much lower, it shows they are exposed to the thousands of harmful chemicals in tobacco smoke.

The HSE has been running since 1991. Some information on how health and health risk factors have changed over time has been put onto the HSE website. Obesity in children increased from the early 1990s to the early 2000s. It fell a little but is still too high. We also showed that waist circumference has increased in teenagers even more than general obesity. In adults, too, obesity increased in the 1990s to the mid-2000s. It hasn’t changed much in recent years. However, waist circumference continues to rise. This is more worrying as it is a marker of ‘abdominal obesity’, with fat collecting in the abdomen. This gives people a high risk of developing diseases such as diabetes, heart disease, or some types of cancer.

There is also good news in the health trends. The proportion of adults who smoke cigarettes has fallen from 27% in 1993 to 18% in 2016. Even where parents smoke, the proportion who try to keep their home smoke free has increased.[i] In 2006, two-thirds of non-smoking children had cotinine in their saliva, because of exposure to other people’s smoke. By 2014/15, this had fallen to just over one-third of non-smoking children. The management of high blood pressure is much better than it used to be.[ii] However, it still needs to improve further.

The Health Survey for England 2016 report provided information on many topics. 16% of children, 26% of men and 27% of women were obese. Chronic liver disease was most common in adults aged 55 to 64 years. Almost one in five adults (19%) had probable mental illness. Almost one in four adults (24%) had taken three or more prescribed medicines in the previous seven days. 66% of men and 58% of women met the aerobic physical activity guidelines.

Cases of diabetes are on the rise. Is that because more people are becoming diabetic or because doctors are better at finding those people? HSE data show that both are happening. At one time, for every diagnosed case of diabetes, there were two more people with undiagnosed diabetes. By 2013, 7% of people had diabetes. Four-fifths were diagnosed.[iii] In other words, there were eight people with diagnosed diabetes for every two who didn’t know they had diabetes. A great improvement.

UCL staff are analysing data on adult health; combinations of health risk factors; and circulatory diseases, such as heart attacks and strokes. NatCen staff are analysing data on social care; adult and child obesity; and health of children. Watch out on the UCL, NatCen and NHS Digital websites (listed below) and in the news to see what we find. And if you ever receive a letter inviting you to take part in the HSE, please do!

Professor Jennifer Mindell is a public health doctor who has also worked in general practice and health promotion. She is interested in policies outside the health services that affect health and inequalities. She leads the UCL team dealing with the Health Survey for England and other health examination surveys in the UK; comparative work across Europe (EHES); and a comparison project (ESARU) across the Americas and the UK. Prior to this, she was the Deputy Director of the London Health Observatory. She led health impact assessments (HIAs) of the London Mayor’s Transport and other strategies. She was the chief investigator for a large research project at UCL, Street Mobility. This developed tools to measure the barrier effect of busy roads and the effects on local people. She chairs the UK Faculty of Public Health’s Health Improvement Committee and sits on the FPH Health Policy Committee. She is the health lead for the UCL Transport Institute. She is also Editor-in-chief of the new, award-winning Journal of Transport and Health. She was also very involved nationally in tobacco control for many years. See Jenny Mindell’s IRIS profile web page

For more information about the Health Survey for England, visit the following websites:

———————————————————————————————————————————————————————

[i] Jarvis M, Sims M, Gilmore A, Mindell JS. Impact of smoke-free legislation on children’s exposure to passive smoking: cotinine data from the Health Survey for England. Tobacco Control. 2012;21:18-23. https://tobaccocontrol.bmj.com/content/21/1/18

[ii] Falaschetti E, Mindell JS, Knott C, Poulter N. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet. 2014;383:1912-9. https://linkinghub.elsevier.com/retrieve/pii/S0140673614606887

[iii] Moody A, Cowley G, NgFat L, Mindell JS. Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series. BMJ Open. 2016;6:e010155. https://bmjopen.bmj.com/content/6/2/e010155

Do you not feel clever enough? Some advice to existing and new PhD students about Impostor Syndrome.

By guest blogger, on 4 October 2018

This blog post is written by Alexis Karamanos, who is a very active and engaged PhD student within UCL’s Institute of Epidemiology and Health Care (Research Department of Epidemiology and Public Health). A big thank you to Alex for providing this piece which I’m sure many staff and students will find useful.

Doing a PhD is rewarding, but at times challenging. During my PhD, there are times when I feel I should not be there. While I was indeed struggling to get some results, other very clever students in the IEHC were doing an amazing job; they were publishing to international journals, they were writing and talking to the media about their work, and they were also attending great conferences in the UK and abroad. It was then that I started feeling an outsider in academia; that I maybe sneaked my way in and I was/am about to be found out anytime soon. This is impostor syndrome and (believe it or not) it is very common among PhD students. Paradoxically, impostor syndrome is that intrusive idea that your success is due to mere luck and not your talent or qualifications. Evidence shows that about 70% of people experience it, according to the Journal of Behavioral Science https://www.tci-thaijo.org/index.php/IJBS/article/view/521 . So far, there is no single explanation as to why impostor syndrome occurs. Some experts believe that it has to do with personality traits like anxiety or neuroticism, while others focus on family and behavioural determinants.

Working day-in day-out towards an ultimate goal; a completion of a PhD in this case was never meant to be an easy task. Many people describe PhD time as an emotional ‘’roller coaster‘’ (https://core.ac.uk/download/pdf/11233054.pdf) with many ups and downs along the way, but for some people like me, it looks to be more than that. During one of the first panel meetings with my PhD supervisors, one of them explained to me that ‘’doing a PhD would render me an expert in my topic’’.  While that is true to a certain extent, living up to such an expectation (if taken literally and really did take it literally) can be very difficult. However, the good news is that impostor feelings can be managed to enable you to work to the best of your ability.

One of the first steps to start dealing with impostor feelings is to acknowledge that you have impostor thoughts and put them into perspective. Remind yourself than an impostor thought is just a thought, and not the reality.

Consider your PhD as just a beginners qualification. A PhD is the time during which you develop basic research skills, which you can further develop along the course of your professional career (academic or not). Never say never! Probably in the future you can become a prominent expert in your field, but this certainly takes much more effort and time than a three or four year long PhD.

Something that my PhD topic and experience has taught me so far is that my/your ability is not fixed, but something that can be developed and improved over time with effort and most importantly, patience. What I am always trying to remind myself of is the Socratic paradox; according to which the Greek philosopher Socrates responded to an oracle posed by Pythia, the oracle of Delphi ‘’Socrates is the wisest’’ that ‘’The only thing I know is that I know nothing’’. Truly liberating!

One thing that you can also try is to reframe your thoughts. One way to do so is to learn how to respond to challenges by learning how to value constructive criticism; that it is not a sign of academic incompetence to ask ‘’stupid’’ questions, to ask for help even for something that is considered ‘’easy’’ by others, or remembering that the more you practice a skill, the better you will get at it.

Last but not least, it can be helpful to share your feelings with trusted friends, your partner, mentors or your supervisors. When in doubt, our thoughts may be tricking us to believe in something which may not be true. Therefore, being open about your impostor thoughts may allow other people to critically assess your thoughts together and possibly de-dramatise them. People who have more experience can reassure you that what you’re feeling is normal, and knowing others have been in your position can make it seem less frightening. Nevertheless, if you think that by doing so will not make any difference, it will be wise to seek professional help. UCL’s Students Psychological and Counselling Services  are doing a great job in helping students with challenging feelings such as those related to impostor syndrome, either by providing a number of one to one sessions with a therapist or by providing specialized courses on how to overcome PhD perfectionist thoughts (I have been to one of those great courses and they really do help a lot).

To conclude, if you have impostor thoughts, it is important to remember that most people experience moments of doubt, and that is completely normal and not something to feel bad about it. The main goal should not be for you to not have impostor related moments, but not an impostor life. No matter how much effort and time it takes, the impostor syndrome can effectively be managed and overcome.

Work stress and ill health – what’s the link?

By guest blogger, on 2 October 2018

Lots of studies have suggested stress can be a cause of ill health – and that leads to people ceasing to work before they reach retirement age. But most have offered only a snapshot on the issue. José Ignacio Cuitún Coronado and  Tarani Chandola from the University of Manchester describe a major new study, which has shed new light on how work stress can affect an employee’s health over a longer period.

Many animals have the ability to adapt to environmental changes and pressures so that they’re better prepared the next time they happen. Bears can put on fat as winter approaches, for instance, to help them stave off hunger and stay warm.

And human beings can do this too. Stressful situations trigger chemical responses which can help to give us extra resources when things are tough. Our neuroendocrine systems, for instance, trigger hormonal responses which enhance our physical performance when we need it most.

But these valuable systems can have a down-side. In our research, we wanted to look at how repeated exposure to stressful situations might contribute to health problems, particularly in people nearing the end of their working lives. We call this stress-induced effect ‘Allostatic Load’ – the wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress because of fluctuating hormonal responses.

Given that many governments are looking for ways to extend working lives, there’s particular interest in finding out how stress can affect the health of older workers. We were able to tap into a rich source of information – the English Longitudinal Study of Ageing (ELSA), which has followed a representative sample of almost 10,000 over-50s since 2002.

These participants have been interviewed regularly and one of the things they’ve been asked to report is whether they’ve experienced a sense of imbalance between the effort they put into their jobs and the rewards they get out.

This gave us a sample of 2663 older adults, all over 50 and living in England, who’d reported these feelings at least once and who’d been assessed as having had an adverse reaction to them. We wanted to know whether repeated episodes had a bigger effect than just one, and whether the effect would be just as strong for past episodes as it was for more recent ones.

Health testing

Between 2004-5 and 2014-16 the group were asked about stress at work, but they also underwent physical tests to see how the various systems in their bodies were bearing up.

They were visited by nurses who carried out a battery of tests including taking hair samples to assess levels of the stress-related hormone cortisol, carrying out blood pressure checks to provide information on their cardio-vascular systems, white blood cell counts to assess their immune systems and cholesterol checks on their metabolic systems. Participants also had measurements taken of their waist to height ratios – a good indicator of coronary heart disease risk factors.

Overall, we found the more occasions of work-stress a participant had reported, the greater their ‘Allostatic Load’ index – that is, the greater the amount of biological wear and tear.

Moreover, the evidence suggests that employees who had experienced stress more recently, towards the end of their working lives, had higher levels of health risk when compared to those who had experienced it earlier in their careers.

This suggests there is an association between repeated reports of stress at work and biological stress mechanisms, which in turn could lead to stress-related disorders such as coronary heart disease, type 2 diabetes or depression. This also suggests that previous cross-sectional studies which reported small or inconsistent associations may have suffered because they were only measuring one effect at one time.

Work-related stress is one of the reasons for labour market exit – and our findings would suggest that earlier, snapshot studies may have underestimated the true effect of work-related stress on health over a lifetime.

As this is an observational study, we cannot make any causal claims. There may be other factors that we have not taken into account that may explain the association between stress and disease risk. For example, sleep problems may be relevant – though they may also be part of the journey from stress to ill-health.

But equally it is possible that cumulative exposure to work stress is resulting in damage to employees’ physical health, which is then leading to disability and an early exit from the world of work. So, if we want to extend working lives then reducing work-related stress could be one of the keys to achieving that goal.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career, by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe, is published in the International Journal of Environmental Research and Public Health.

This blog article is courtesy of the Work Life blog, which is a blog about the relationship between work and  health and well-being of people, whether they are preparing for  working life, managing their work / life balance or preparing for retirement and life beyond retirement. Led by the ESRC International Centre for Lifecourse Studies, University College London

Working with a long-term illness – does employment status make a difference?

By guest blogger, on 27 September 2018

Across the developed world, a growing share of the population suffers from chronic disease such as diabetes, arthritis or heart problems – in the EU, around 45 per cent of those aged 55-64 had such a disease in 2015. And that affects their ability to work: just half of those with chronic illnesses are employed, compared to three quarters of those without. But how do the self-employed cope with such conditions, when compared with those in employment? Maria Fleischmann and colleagues from the RenEWL project find these differences in work status can make a major difference.

We know that when people become chronically ill, changes in their working conditions can help them to continue working. And we also know that good working conditions – being able to control how you use your time and how you do your job, whether you make the decisions and whether you feel valued, for instance – can help all of us to stay in paid work for longer.

And of course, if you become ill you’re more likely to feel the need to take time off or maybe to give up work altogether. We wanted to compare how the employed and the self-employed adjust their working conditions when facing a diagnosis of chronic disease.

Existing research tells us that many older people work for employers, and have to ask for their approval when it comes to making adjustments to their working conditions. The self-employed, meanwhile, are much more able to make their own decisions and tend to feel they have more control over their working lives.

We looked at people’s ability to control their work: physical demands, working hours, psychological demands such as how fast they had to work, and social aspects such as whether they felt valued.

And we had a great source of data for this – the English Longitudinal Study of Ageing (ELSA), which has followed a total of almost 9,000 over-50s since 2002.

From that group we were able to find and study 1389 participants who reported no chronic diseases when they were interviewed in 2004-5 – the second wave of interviews – and who were in work.  We were then able to look at what happened to them before the seventh wave of interviews, in 2013-14.

A little over 40 per cent of our sample were in managerial or professional occupations, a quarter in intermediate occupations, and almost 30 per cent in routine and manual occupations.

After diagnosis

At each interview, respondents were asked whether they had been diagnosed by a doctor with lung disease, asthma, arthritis, cancer, high blood pressure, diabetes or high blood sugar, stroke or heart problems.

During the study period 510 of the 1389 sample members were newly diagnosed with one of those conditions. We were able to look at how they fared at work for four years after that, and we found some striking differences between how the employed and the self-employed seemed to have been treated.

The physical demands of our participants’ jobs were pretty similar before their diagnosis, for instance. But afterwards significant numbers of those who were employed said that those demands had actually increased when they were diagnosed. The self-employed, meanwhile, told us the opposite had happened to them – they reported significantly lower physical demands at work immediately after diagnosis. This effect continued for some time, though it grew less pronounced.

How could that be? We think maybe the increase in physical demands among the employed could be due to perception – similar demands might be perceived as more strenuous by the chronically ill. The self-employed, meanwhile, have more freedom to adjust those demands when they feel they need to.

The self-employed reported that their working hours dropped by an average of 2.8 hours per week on diagnosis, while those who were employed did not see a change. This effect was not statistically significant, though.

Employees found that their level of autonomy at work also dropped marginally, while for the self-employed there was no significant change. We did not find any major changes in psychological or social conditions in either group.

So, what did we learn? Essentially, that improvements in working conditions after diagnosis of chronic illness were restricted to the self-employed. So employers may need to ask themselves some hard questions – do they want to hold on to workers who become unwell? If they do, then they should consider the levels of flexibility they offer, and they should think about making adjustments for those workers if they don’t want to lose them.

In an ageing society, older people are expected to work ever longer and therefore to remain at work even when they begin to suffer from health problems. Our findings should also encourage policy-makers and governments to think about how chronically ill older adults are treated at work.

Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA)by Maria Fleischmann, Ewan Carr, Baowen Xue, Paola Zaninotto, Stephen A Stansfeld, Mai Stafford and Jenny Head, is published in the Journal of Epidemiology and Community Health.

This blog article is courtesy of the Work Life blog, which is a blog about the relationship between work and  health and well-being of people, whether they are preparing for  working life, managing their work / life balance or preparing for retirement and life beyond retirement. Led by the ESRC International Centre for Lifecourse Studies, University College London,

Internship insights: how to find and get one as a PhD student.

By guest blogger, on 6 September 2018

Internships are increasingly being seen as a valuable addition to PhD training. In fact a report commissioned by the Government recommended that, “All full‐time PhD students should have an opportunity to experience at least one 8 to 12 week internship during their period of study” (Wilson Review, 2012, p.8). But how do you go about getting one? And how do you convince your supervisors if they’re not so keen? Fran Harkness, PhD student at the MRC Unit of Lifelong Health and Ageing lets us in on her insights.  

I did an internship in the MRC External Affairs team March-June this year. I enjoyed it so much that I’ve since been asked if I’m being paid to persuade other students to go on one by demonic internship overlords? Anyway, as I had to do the hard work of understanding how to get one, I hope that I’ve managed to clarify the process a bit for you. Good luck!

Research it. Think about what you want to get out of this time. I was interested in science policy so it made sense to apply to the Academy of Medical Sciences policy internship scheme. Research councils have links with many organisations. You could intern with the Royal Institution to plan their Christmas lecture. The UKRI scheme sponsors students to get insight into areas as diverse as the civil service, Age UK, and Public Health England. Alternatively you could apply for funding to work in a research unit abroad to pick up new skills and ideas in your own field.

Take time over your application. You need to collate your CV, a statement of interest, and often a fresh piece of work, plus signature from your supervisor. I’d broach the latter first. Don’t do what I did once and stall asking your primary supervisor for so long that it’s now the day of admission and she surprisingly isn’t looking at her emails in Chamonix. That was after I’d spent, I mean wasted, five days writing a government POST note far out of my subject area for the application. On my second application I’d mortifyingly left in a note to myself in blank space after my essay. Proofreading doesn’t take that long.

Convince your supervisors part 1. My stalling behaviour was partly fuelled by anxiety that mine would say no. Your supervisors want to support you to finish on time and may believe that an internship will derail this ambition. Many schemes include a funded extension but their worry is that any absence breaks your flow and delays finish time. Reassuringly, researchers from the University of California found that interns don’t take any longer to graduate, despite halting their programme entirely during the three months. My experience has been that my internship returned me to a mental state helpful for finishing: professional, confident and newly reminded of the point of my research.

Convince your supervisors part 2. Like being asked by my parents to plan how I was going to take the bus into town by myself for the first time, my panel had kindly reservations for me to consider. They requested that I talk to previous interns about the benefits and challenges and how I would overcome the latter. They also asked that I continue to work on my thesis during my internship and that I take it up towards the end of my PhD so that there wasn’t too much write-up hanging over my head. Those last two things didn’t end up happening, but by this time I’m already on the bus into town and nobody minds.

Apply! With your head stuck in a stats problem or down a microscope you may forget that you have time for an internship. Look up and remember that your PhD is a training opportunity for the real world. You can gain new skills, meet contacts, and learn of roles you didn’t realise existed. It can help you get a job afterwards. At the Academy of Medical Sciences every single policy advisor I spoke to had done an internship there during their PhD. I know someone whose internship was so successful she’s now working part time for that organisation whilst finishing her PhD. On top of all this they’re great fun. Go on!

“Why am I doing this?!” A reminder.

By guest blogger, on 6 September 2018

In this post Betsy Jones (UCL Research Department of Primary Care and Population Health) writes about her experience of attending the Alzheimer’s Association International Conference and why we do the work we do. 

I have been assured that asking oneself “Why am I doing this?!” is not an experience unique to any one stage of a research career. The key is having a good answer.

At the height of the British summer heat wave, I travelled to Chicago, to give an oral presentation to the Alzheimer’s Association International Conference (AAIC) on a project I’ve joined, funded by the Dunhill Medical Trust, addressing inequality in primary care of people with dementia among UK ethnic groups.

The first phase of the project has already been published in Clinical Epidemiology and found that dementia diagnosis incidence was significantly higher in Black men and women compared to White men and women, respectively, and was significantly lower in Asian women compared to White women. Tra recently wrote a blog on this below. I presented these results along with new results showing inequality by ethnicity in prescribing of certain drugs among patients with dementia.

The presentation itself went smoothly, and I breathed a sigh of relief as I walked off stage. With the nerves and the bright lights out of the way, I was excited to find that a queue of people were keen to talk with me about the project.

Multiple researchers expressed how grateful they were that someone was looking into this area, highlighting that while the demographics of many developed nations are changing, the research has not often kept up. Others wanted to share personal experiences, speaking of the reluctance of family members to seek a diagnosis or medication even as their condition progressed, especially when cultural factors around memory problems and fear of stigma were at play. These conversations made clear that the need to identify inequalities and break down barriers to good quality care was not a problem unique to the UK, but everyone I spoke with reinforced how important it was to see that we’re working on it.

In the midst of Stata code, funding applications, and reviewer comments, we can lose sight of the goal. As researchers, we have the privilege of generating work that can improve peoples’ lives. We can be reminded of that by our Patient & Public Involvement advisors, our colleagues, or a review of the “Impact” section of our own funding application (and hopefully by this blog post). My conversations with a variety of people after my presentation was a wonderful reminder of the goal and impact of this project. I hope you can take a moment today to remember the goal of your work too, because you’re doing this for a good reason!

Launching the MARCH Network: Social, Cultural and Community Assets for Mental Health

By guest blogger, on 5 September 2018

Mental health is the single largest cause of disability in the UK, and it is estimated that almost a quarter of the country’s population are affected by mental health issues each year. So in September 2018, UK Research and Innovation (UKRI) announced £8 million of funding to bring researchers, charities and other organisations together to address important mental health research questions. One of the grants for £1.25m has been awarded to Dr Daisy Fancourt, Institute of Epidemiology and Health Care at UCL. Here she tells us about her new programme.

I am delighted to be launching the new MARCH Network. While many approaches to mental health focus on a ‘deficit’ approach, identifying and fixing ‘problems’, this new national network takes an ‘asset-based approach’, which gives prominence to the resources (or ‘assets’) that exist within our communities. This network proposes that these Assets for Resilient Communities lie at the centre of Mental Health (M-ARC-H), and can enhance public mental health and wellbeing, help to prevent mental illness and support those living with mental health conditions.

Specifically, we’re focusing on social, cultural and community assets which include the arts, culture, heritage, libraries, parks, community gardens, allotments, care farms, leisure centres, volunteer associations, social clubs and community groups. There are over 1 million of these assets in the UK and over the past decade there has been a surge in cross-disciplinary research into the impact of these assets on mental health. For example, social psychology research has illuminated the impact of these assets on social capital. Sociology and epidemiology research has demonstrated how these assets provide social support and engagement. Psychobiology and behavioural psychology research has identified specific mechanisms underpinning the effects of these activities. And anthropological and historical research has highlighted challenges in maintaining a sense of community for individuals.

However, despite this progress, research in this area is still in its infancy compared to research into other areas of mental health, and there are several challenges facing researchers. For example, much of the work into community assets is happening in silos: silos based on assets (such as research on arts and mental health happening separately from research on volunteering and mental health); and silos based on disciplines. Additionally, there is a recognised social gradient across community participation but precisely what barriers to access are and how they can be overcome remains poorly understood.

So the MARCH network aims to tackle these challenges through two core workstreams. Workstream 1 focuses on cross-disciplinary research and challenges. We will be exploring two core questions:

  1. What evidence is there, from a cross-disciplinary perspective, for how and why community assets impact on public health and wellbeing and the lives of those living with mental illness, and where are the gaps for future research?
  2. How can we use a cross-disciplinary approach to address methodological challenges in researching the impact of community assets on mental health and to provide meaningful data to different stakeholders and users?

Workstream 2 focuses on two research questions relating to engagement with community assets:

  1. Who amongst the UK population, demographically and geographically, currently engages with community assets and specifically how does participation vary dependent on mental health?
  2. What are the current barriers and enablers to engagement at an individual, organisational and policy level and how can we develop innovative approaches to enhance engagement, especially amongst those who are most vulnerable?

To answer these questions, MARCH will:

  • Bring together international leaders in mental health and community assets research and facilitate the development of meaningful partnerships with policy makers, commissioners and third sector organisations.
  • Run a series of planned ‘core’ activities (including roundtables, consultations and focus groups) to address these identified research challenges leading to a series of major new evidence and methodology reports.
  • Distribute £280,000 of ‘plus’ funds for new research projects and activities for identified research gaps.
  • Host a rich portfolio of impact and engagement activities to translate the research findings into policy and practice, and encourage greater public engagement with community assets.
  • Design and deliver a training and support programme to develop cross-disciplinary skills and expertise amongst the next generation of researchers.

This network is extremely topical right now: it fits in with major developments in mental health such as the roll-out of social prescribing through NHS England and sits well alongside biomedical approaches to mental health. So as we imagine the future of mental health, a strong role for community assets appears inevitable. But we need to ensure that we have robust research underpinning this so that practice does not overtake research. Overall the MARCH network has the aim of transforming our understanding of how community assets can be mobilised to encourage more resilient individuals and communities and moving this area of work from the sidelines of mental health research to the mainstream.

If you are interested in receiving updates or becoming involved, you can register with the network at www.surveymonkey.com/r/M-ARC-H

Investigator team:

  • Dr Daisy Fancourt (Principal Investigator, UCL)
  • Prof Kamaldeep Bhui (Queen Mary University of London)
  • Prof Helen Chatterjee (UCL)
  • Prof Paul Crawford (University of Nottingham)
  • Prof Geoffrey Crossick (School of Advanced Study, University of London)
  • Prof Tia DeNora (University of Exeter)
  • Prof Jane South (Leeds Beckett University).

Partners:

Action for Children, Action for Happiness, Age UK, Arts Council England, Arts Council of Wales, Beyond Skin, Coin Street Community Builders, Community Catalysts Ltd, Crafts Council, Creative Scotland, Culture Health and Wellbeing Alliance, Department for Culture, Media and Sport, Department for Environment, Food and Rural Affairs, Greenwich Leisure Ltd, Historic England, Libraries Unlimited, Live Music Now, Local Government Association, Mental Health Foundation, MIND, MindOut, Mosaic Youth, Museums Association, National Trust, Natural England, NCVO, NESTA, NHS Health Scotland, People Dancing, Public Health England, Public Health Wales, Rastafari Movement UK, Royal Horticultural Society, Royal Society for Public Health, Sing Up Foundation, Social Farms and Gardens, Social Prescribing Network, The Children’s Society, The Conservation Volunteers, The Eden Project, The Heritage Lottery Fund, The Listening Place, The Reading Agency, The Wildlife Trusts (UK), Think Local Act Personal, Voluntary Arts, What Works Centre for Wellbeing, Wonder Foundation, Youth Music, Youth Music Theatre UK, UK Theatre.

Dr Daisy Fancourt is a Wellcome Research Fellow in the Department of Behavioural Science and Health at UCL specialising in psychoneuroimmunology and social epidemiology. Her research focuses on the relationships between cultural and community participation and health outcomes across the lifespan.

https://iris.ucl.ac.uk/iris/browse/profile?upi=DFANC73

A comparison of new dementia diagnosis rates across ethnic groups in UK primary care

By guest blogger, on 31 August 2018

In this post Tra Pham (UCL Research Department of Primary Care and Population Health) discusses her recent work with colleagues from the department, Division of Psychiatry and King’s College London on new diagnoses of dementia and the differences among ethnic groups.

Around 46.8 million people worldwide have dementia; this is expected to rise to 131.5 million by 2050. Recent studies have reported stable or declining rates of new dementia cases overtime.

In 2010, members of our department (Rait et al, 2010, BMJ) conducted a primary care database study to investigate survival of people with a diagnosis of dementia, and reported a stable rate of new dementia diagnoses in UK primary care between 1990 and 2007. We know little about the differences in the likelihood of receiving a dementia diagnosis among different ethnic groups. Some evidence has indicated that people from Black and Minor Ethnic (BME) groups present at services (i.e. GP) later in their illness. Therefore, compared with the White British ethnic group, BME dementia patients may have less access to timely diagnosis. This can prevent them from benefiting from early intervention and treatment which may help slow the progression of the disease.

Our recent study reported the overall rate of new dementia diagnoses in UK primary care between 2007 and 2015. In addition, we reported, for the first time, the rate by White, Asian, and Black ethnic groups. Pulling together current best evidence of new dementia cases in the community and the 2015 UK census data, we estimated the proportion of White and Black people developing dementia who received a diagnosis in 2015. Our hypothesis was that there would be a smaller proportion of Black people with dementia who were diagnosed compared with people from the White ethnic group.

We analysed data of 2.5 million older people from The Health Improvement Network (THIN) database. 66,083 new cases of dementia were identified, which corresponded to an increased rate of new dementia diagnoses between 2007 and 2015 (Figure 1).

Figure 1 Rate of new dementia diagnoses per 1,000 person-years at risk (PYAR) by calendar year in The Health Improvement Network (THIN) UK primary care database.

Compared with White women, the dementia diagnosis rate was 18% lower among Asian women and 25% higher among Black women. This rate was 28% higher among Black men and 12% lower in Asian men, relative to White men. Based on diagnosis rates in THIN data and projections of new dementia cases from community cohort studies, we estimated that 42% of Black men developing dementia in 2015 were diagnosed, compared with 53% of White men.

The results thus suggest that the rates of people receiving a diagnosis may be lower than the actual rates of developing dementia in certain groups, particularly among Black men. There are several possible explanations for this. It could indicate that Black men experience barriers to accessing health services or receiving a diagnosis. GPs may be more reluctant to diagnose dementia in BME groups especially if culturally competent tests are unavailable. GPs and families might also be reluctant to name dementia in communities where more stigma is associated with a diagnosis.

Our study emphasises the need for service improvement targeting BME groups who might be facing barriers to accessing health care services and getting a dementia diagnosis. GPs should be equipped with culturally appropriate assessment tools in order to make a timely diagnosis of dementia for BME patients.

Our findings also highlight the importance of raising awareness of the benefits of getting a timely diagnosis of dementia, particularly in people from minority ethnic groups who may be more at risk of dementia. Timely diagnosis of dementia can lead to more targeted support and enable GPs to provide appropriate patient care management. These benefits can be explained to the patients by family and friends, as well as professionals such as nurses and social workers. They can also help the patients to overcome the fears of talking about dementia. Faith and community groups can contribute to ensuring that local dementia services are accessible to all.

This study is conducted in collaboration with King’s College London. This work is supported by The Dunhill Medical Trust [grant number R530/1116]. Our article and relevant references can be found at:

Pham TM, Petersen I, Walters K, Raine R, Manthorpe J, Mukadam N, Cooper C (2018). Trends in dementia diagnosis rates in UK ethnic groups: analysis of UK primary care data. Clinical Epidemiology (10): 949-960. doi: 10.2147/CLEP.S152647.

This article is courtesy of the UCL Research Department of Primary Care and Population Health blog