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Fuel and Food Poverty in the UK must be addressed before the energy price hike this Spring

By e.schaessens, on 18 January 2022

Written by Rebecca Barlow-Noone, a student on the MSc Population Health programme.

During the pandemic, inequalities in the UK have been brought into sharp relief with a rapid rise in food and fuel poverty, which I documented last year and have seen first-hand as a volunteer for Lambeth Foodbanks. Yet with fuel price caps set to skyrocket in the coming months and no plans to protect those on low incomes, it is likely to push even more people below the poverty line, forcing many to decide whether to ‘heat or eat’.

Foodbanks during the pandemic

Compared to 5 years ago, Trussell Trust food bank demand has increased 128%. Between April 2020 and March 2021, 2.5 million emergency food parcels were delivered in the UK by the Trussell Trust, representing a 33% increase from the previous pre-pandemic year. Furthermore, in December 2020, high levels of child food poverty in London led to additional food parcel distributions by UNICEF. This is despite the £20 per week Universal Credit (UC) uplift introduced in March 2020 in response to the pandemic.

The effect of Universal Credit cuts, energy price hikes, and inflation

As winter approached in late 2021, people on UC saw the tightest squeeze yet. The benefits uplift was cut, leaving recipients £1,040 per year worse off; prepayment energy tariffs saw the highest price increase of £153 to £1309 per year, which is used more by those on low incomes than high incomes; and inflation hit a 10-year high. While a taper rate of UC was implemented shortly after the uplift was cut, this only benefitted claimants who were already in work, and did not apply to people receiving legacy benefits.

I am deeply concerned how rising fuel costs this April will affect those already feeling the effects of the cut and price cap increase. When speaking to clients, I often hear how hard it is to make ends meet. I hear from parents forgoing meals for the sake of their children, and elderly clients unable to pay the higher energy bills through the winter. This is only set to get worse, with Age UK estimating that fuel poverty in the elderly may reach over 150,000 without financial protection this spring. It is unacceptable for people to be treated so poorly in a wealthy society such as the UK, at a time when they need the most support.

As costs of living increase for all, now is the time to increase support for those whose incomes at current UC rates do not allow for basic standards of living. Foodbanks across the UK represent an important lifeline, but this cannot be considered the norm and should not be relied upon by Government. The current rise in food bank reliance and the impending rise in fuel costs demands scrutiny into the social policies that are failing to adequately support those in need, to ensure those at most risk are protected from the increasing fuel price cap.

Health and social care access for people experiencing homelessness and lessons for primary care

By guest blogger, on 3 November 2021

This blog is written by Caroline Shulman and Megan Armstrong. Caroline has worked as a GP for people experiencing homelessness in primary care and as a clinical lead in a hospital homeless team. Caroline is principal investigator (PI) on a range of projects on palliative care, frailty and homelessness. Megan was the senior research fellow on this project and currently is the Programme Manager of PD-Care and the PI of exploring self-management in those experiencing low socioeconomic deprivation. 

Though everyone’s circumstances are different, to support people experiencing homelessness, it helps to understand some of the underlying causes of homelessness. Systemic factors such as austerity, increase in poverty and inequality, regressive changes to welfare systems, increased job insecurity with more zero hours contracts, lack of affordable housing and a hostile environment for migrants have contributed to significant increases over the last decade. However, in addition, there are individual vulnerabilities that increase the likelihood of becoming homeless. It is estimated 90% of people who are homeless have experienced adverse childhood experiences with 54% experiencing four or more (1). Adverse childhood experiences include abuse (emotional, physical, sexual or neglect) and household dysfunction such as living with domestic violence, or with a family member who has an addiction, is suicidal, mentally ill or in prison. Lack of having needs met and being soothed as a child impacts on cognitive, emotional, and social development and unresolved trauma is associated with an overdevelopment of the emotional and reactive parts of the brain (2).

People experiencing homelessness have some of the worst health outcomes of any group in society with the average age of death being in their early 50s  (see here). They have a much higher rate of most long terms conditions, including heart disease, respiratory disease than even populations in the most deprived sectors of society. Conditions usually found in older populations, such as cognitive impairment, incontinence, poor mobility, and frailty are highly prevalent at a young age in this population. Many people, with a history of sleeping on the streets in London, end up on homeless hostels. Homeless hostels are staffed by support workers who have no training in health or social care. In one hostel (for adults aged 35+), where residents average age was 55, frailty scores were equivalent to a population of people in their late 80s. All had multimorbidity with the average number of conditions per person being seven. Older age conditions such as cognitive impairment, falls and poor mobility were highly prevalent, though only 9% had any form of social services package of care (3).

One reason for the young age of death of people experiencing homelessness is the barriers they often face in accessing health and social care. Our study aimed to explore these barriers and potential facilitators from the perspectives of hostel residents and staff (4). We interviewed 18 homeless hostel managers/support staff and 15 people experiencing homelessness from six homeless hostels in London and Kent.

We found there were service barriers to health and social care access due to:

Stigma of both the residents and the hostel staff (often reporting not being believed):

“We have got one of the local GPs around here, they will not accept our residents unless a keyworker is with them, and they have to attend all appointments with them and register with them. They won’t accept them on their own.” Support worker

Lack of communication and information sharing from services with the hostel:

“I was that upset and annoyed that she’s [social worker] not speaking to anyone else that I’m working with [in the hostel]. I said, “It’s not keeping you up to date.” I speak to you once every three weeks, you don’t know what’s happening. So I could be going through a really difficult time and you’re not aware of it….” Resident

A lack of trust from the residents and a struggle to build relationships beyond the hostel staff:

“I’m still finding I’m having to learn to trust people. I don’t always trust people now, and my confidence is not brilliant. Once I know someone [this is different]…., but I’m not very good coming forward at the beginning.” Resident

Incorrect assumptions around capacity and the role of the hostel:

“I think because a lot of people presume because it’s [the hostel] a 24-hour manned project, they’ve got staff. They [external services] don’t really realise that our job isn’t to be carers…It’s not always practical to see everybody every single day. What people see from the outside is 24-hour staff” Support worker

The impact of lack of health and social care support led to staff going beyond their job role, continuous support needed by the residents, and burnout:

“We also have to go and collect people’s medications. We don’t have to but we’re doing that as well and liaising with GPs to put [medication] in dosette boxes and things like that.” Hostel staff

Overall, the hostel staff and residents had a great, trusting relationship. However, due to the lack of external service support, this can become a huge responsibility for the hostel staff. The quote below highlights the trust in the hostel staff.

“I think she [hostel staff member] cares about me. I’ve never actually asked her, does she care? The staff here are alright, I like them. I like the staff here. I ain’t got a bad word to say about them.”

An example of the causes of burnout for hostel staff include the trauma when a resident dies:

“When he was standing along the walls and he was saying, “I’m feeling pain,” and he just slid into the floor. It was during the night, early morning so there were only two staff. Staff were running up and down. It was quite a traumatic experience.”

See our recent paper and blog on palliative care for people experiencing homelessness.

What does this mean for primary care?

  • Everyone needs to be able to register with a GP. Groundswell have developed ‘My Right to Healthcare’ cards that can be posted for free.
  • Training is available for reception staff including a short 6 minute video: resources here
  • Primary Care Networks should consider having an inequalities lead to explore local solutions. They could also undertake a self-assessment to support improved engagement with inclusion health groups (see here).
  • Services should be person-centred, and trauma informed so that people feel safe, welcome, listened to and understood. Here is a video on trauma informed communication skills and an overview of training available here.
  • Services need to recognise the importance of developing trust and trusting relationships, as these are at the heart of healing and recovery. Ideally with the continuity of care with the same provider.
  • Services should  proactively support people with literacy, language, and cognition difficulties.
  • Primary care services should consider how they can take care to people with the highest need to enable trust to be developed. For example, enhanced services undertaking in-reach into hostels can be highly successful in increasing engagement. Reaching out to frontline staff in homeless services, who often feel stigmatised, can be a first step in acknowledging the support they are providing and explore how they can be better supported.

It is our duty to find and care for those in our community who are excluded and marginalised and advocate for their needs. We need to embed inclusive care and assertive advocacy as core to our work.

References

  1. Liu, M., Luong, L., Lachaud, J., Edalati, H., Reeves, A., & Hwang, S. W. (2021). Adverse childhood experiences and related outcomes among adults experiencing homelessness: a systematic review and meta-analysis. The Lancet Public Health.
  2. Bennet, M.S. (2017), ‘Connecting Paradigms: A Trauma-Informed & Neurobiological Framework for Motivational Interviewing Implementation’, Bennett Innovation Group, Denver.
  3. Rogans-Watson, R., Shulman, C., Lewer, D., Armstrong, M., & Hudson, B. (2020). Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. Housing, Care and Support.
  4. Armstrong, M., Shulman, C., Hudson, B., Stone, P., & Hewett, N. (2021). Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels. BMJ open11(10), e053185.

Starting a PhD in the wake of COVID-19: a survival guide for new students

By guest blogger, on 13 September 2021

Claire Grant, first year PhD student at University College London’s Institute of Epidemiology and Health Care, provides tips for starting doctoral studies in unusual times.  

I found out that I’d been awarded an Economic and Social Research Council (ESRC) studentship to complete a PhD in Epidemiology and Public Health in March 2020. In the following months, the situation in the UK and around the world unfolded into what we now describe as “unprecedented” times, and the world has since changed. Completing a PhD in any time is known to be an overwhelming, challenging and sometimes stressful experience – but there are some unique challenges in the wake of COVID-19.

This blog post offers an insight into my personal experience of starting a PhD at UCL in 2020, with the aim of sharing some tips for navigating the specific challenges of home working and remote learning. It goes without saying that this list is by no means exhaustive, and that each student will face unique challenges and opportunities as they embark on their studies. This is simply a reflection of my past year and a message of hope to new starters.

1) Ask questions

Starting anything new can be daunting. Understanding how things work, making sense of departmental norms and university culture is difficult, especially when you are working from home. My advice is to ask questions from the start.

The reality is, there are many questions you will not know the answer to and a lot of these can be easily answered by friendly and knowledgeable staff/students at the university. Knowing who to ask for what will become clearer the more communication you have. Asking peers, supervisors and departmental staff for ‘best contacts’ to deal with concerns will help orientate you and your position in the university.

2) Create a good home working environment

If you are working from home, you will need the appropriate equipment and environment to do so. Funding bodies and even departmental funds might be able to support you to buy the software, equipment, and resources you need to work. I assumed that being a student meant that I wouldn’t be entitled to support – but this was not the case (see point 1 – ask questions).

From the beginning, try to create a working environment that is separate from your home life. This can be challenging, especially if you’re living in a place with limited space. If possible, try to work in a separate room to where you sleep, and if this is not possible, set-up a separate working station within the ro om. As tempting as it is to sit in bed all day, the environment you create to work in will impact on your motivation more than you might think.

That said, I will admit that in an effort to create my ‘ideal working from home environment’ earlier this year, I purchased a cheap computer desk from Facebook marketplace. The questionable instructions (see pictures) and my lack of craftsmanship mean that the unassembled planks of wood are still lying in my kitchen.

3) Network

A PhD is a solo venture, but nobody can complete it alone. In the absence of happen-chance meetings on campus, it is important to remember to opt-in to networking opportunities. Sign up to mailing lists on topics and methods that interest you. Email peers in your cohort and arrange Zoom coffee breaks. Download Twitter and follow accounts that relate to your work. Attend departmental seminars, and if you’re feeling brave, even ask questions! The more virtual rooms you enter – the more people and opportunities you will be exposed to.

Networking doesn’t just have to be PhD related. The Department of Epidemiology and Public Health did a great job at organising informal catch-up sessions for students over the past year, and the conversations were mainly structured around Netflix recommendations and lockdown recipes. The Students’ Union at UCL also have a wide range of clubs and societies for postgraduate students to get involved with. Building a social network of likeminded people with similar interests will help you find your place.

4) Set boundaries

               Your working day

Structure a day that suits your project and working style. Nobody is productive all day, yet we can feel guilty for taking breaks, particularly when working from home. I’ve learnt that a long lunchtime walk listening to a podcast (usually the Guardian’s Today in Focus) makes me feel brighter and more ready for the afternoon than if I eat lunch slumped over my laptop. If you’re required to do a lot of reading on your computer – make an active effort to schedule time away from your screen throughout the day. Your eyes and mind will thank you for the rest.

Being online makes us more accessible than ever. This is exciting as we can attend more events, seminars, and trainings than ever before. However, be realistic and thoughtful about how much you can do. For example, don’t try to complete other work tasks while attending online seminars or training. You wouldn’t do that in person. Allow yourself the same time and energy you would offline. This is much easier said than done.

Your personal life

Set boundaries with ‘PhD life’ and ‘regular life’ as you would any other job. Your research will be more important to you than it is to most people, and it might feel all consuming. It’s also likely that you’ve chosen a topic of particular interest to you, making it difficult to switch off. There’s always more work to do, more papers to read and more ideas to talk through. It can feel as though you should be doing something all the time. At the beginning, I found this difficult to manage.

I also found it strange not having the same sense of completing a task as I did when I submitted course work in previous taught courses. At undergraduate level, I remember the feeling of relief after sitting exams, knowing I’d be enjoying some well-deserved time off before being informed of a definitive result – ‘pass’ or ‘fail’. From my experience, this is not the case in a PhD. Feedback from supervisors usually leads to more work. Good project management will account for the much-needed breaks in this academic marathon. When you do take time off, try to detach completely. Let your supervisors know you won’t be available, turn off email notifications on your phone and wait until you return to reply to messages.

Importantly, life continues as you study. Make sure to carve out room for friends and family. Make time for hobbies and interests. A PhD is only one part of your identity.

5) Trust your abilities

You are probably already doing better than you’re giving yourself credit for. It takes time to get used to this new way of working and the beginning of such a mammoth task can feel daunting. Remember that every project is different, so try not to spend time comparing your progress to your peers. Your supervisors will help guide you and there are various UCL check-ins along the way to make sure you’re on track (such as Thesis Committee reviews).

One of the most common anxieties among new doctoral students is ‘imposter syndrome’ – the overwhelming feeling that you’re a fraud. Take note: you have started on a training programme and that is merited on the basis that you have the abilities required to succeed. Trust the process and know that everyone else is probably thinking the same about themselves.

6) Be flexible with your project

Due to COVID-19 restrictions, your project might have to be adapted or changed completely. You are not alone if this is the case. Over the past year many students have faced dilemmas with methodologies and research topics that are not easily modifiable to the world of online learning. Be open to potential alternatives and listen to the experiences of others in your field. There are many learnings from the past year which will be useful to consider when thinking of alternative approaches to your research.

7) Be kind

To yourself, to your peers, and to staff.

Students and staff at UCL have worked tirelessly to adapt to new ways of learning over the past 18-months. It has been a tough time for everyone, and we have all been impacted in some way. Try to acknowledge this and be compassionate to yourself and others. Remember that staff are also facing some of the same challenges as students and will appreciate your understanding.


Enjoy the journey & best of luck with your studies!

Taking the me out of social media

By guest blogger, on 9 October 2019

Emma Walker, second year BBSRC-ESRC funded Centre for Doctoral Training in Biosocial Research PhD student at University College London’s Institute for Epidemiology and Health Care, describes how getting involved with research on social media helped her to reflect on her own usage. 

It’s 00.23 and I should be in bed. I’ve got lots on tomorrow but I’ve spent the last 45 minutes scrolling. Scrolling through the profiles of Instagram “life style coaches”, yogis, models; each collection of photos perfectly curated to appeal to my desire for millennial aesthetic.

Everything feels so much better than anything I have. And actually, in the world of Instagram, I know that everything is much better than what I have. Number of followers or number of likes on each post has conveniently quantified this for me.

The next evening, as part of my public health PhD work, I’m reading Professor Yvonne Kelly’s paper laying out the effects of social media use on the mental health of girls. I diligently make notes “.. greater social media use related to online harassment, poor sleep, low self-esteem and poor body image .. ” “..girls affected more than boys..” and pause periodically to check my phone.

All my friends are at the pub having a great time, another friend just put up a post where she looks amazing, it already has 50 likes. I get to the methods section of the paper “how many times in the last 2 weeks have you felt miserable or unhappy; found it hard to think properly or concentrate; felt lonely; thought you could never be as good as other kids…”.

Then the penny drops. Why do I think I’m immune? I’m like the lifelong smoker who’s confused by their cancer diagnosis: “I never thought it would happen to me.” The idea starts to filter in: I don’t need this in my life. In fact, I need this to not be a part of my life.

The next day I deactivate my Instagram account. That day I meet a friend for coffee in a hipster café and don’t take a picture of my coffee. That night I get to sleep by 11pm. The next day I work more productively than I’ve worked in weeks.

An opportunity to get involved comes up: the National Literacy Trust are really interested in Yvonne’s work and are keen to put together an event for young people. A great group of undergraduates and I devise a series of activities to find out what young people think about the research.

The first section would involve 4 zones at the front of the Renaissance Learning centre room for Strongly Disagree, Disagree, Agree and Strongly Disagree we put a series of statements on the board and ask the pupils to move to a zone and explain why. We include statements on a range of topics including cyber bullying, sleep deprivation, self-esteem and body image and parents and social media.

On the day, the 50 enthusiastic 11-14 year olds from 3 schools across London jostle about, keen to share their opinions and to hear one another’s. I’m amazed at the diversity of ideas, overall willingness to get involved and the mental health literacy of many of the students.

Some responses are predictable; the boys happy to appear less concerned about body image, many keen to state in front of their teachers that social media does not in any way disrupt their studies. Some are surprising; only a handful of pupils had been on social media before arriving at the event that day (a significantly lower proportion than the adults running it!) Other responses are hard to read; were the gaggle of girls laughing at the very idea of social media posts making you feel left out, honest or desperate to seem not to care?

A clear feeling was the young people’s frustration at their parents use of phones and social media. Many expressed irritation at the rules their parents have established – no phones at the table, in bedrooms, after 8pm – that they, themselves constantly break.

One boy described having to ask the same question 3 times before his dad will look up from his phone. The idea that our event should be run for parents was cheered.

Next we presented them with the evidence base for the possible impact of social media and mental health then asked them to make public health campaign like posters with top tips that could go up in their schools. We were presented with a beautiful collection of posters with thoughtful advice, carefully put together information, clever slogans and eye catching drawings. Audio recordings from the day gave further insights from the young who readily offered tips and advice for younger children.

Overall, I think the event was a success. My main impression was that these young people are actually very well equipped to protect themselves from the potential mental health impact of social media. That in fact it may be people in their 20s, who have grown up in the full glare of social media and its pressures, who are at the greatest risk.

It was a real privilege being able to discuss this topic with young people and the message that stood out the most from them is the opportunity parents have to make a difference by practicing what they preach.  Chances are they’ll benefit from switching off!

As for me, it’s now been 6 months since I deleted Instagram and whilst it hasn’t been plain sailing – I have got this itch for the buzz of an influx of likes –  for the time being I’m happy and I would wholeheartedly recommend it!

I wanna hold your hand: helping young people prepare for happy healthy relationships

By guest blogger, on 11 July 2019

The teenage years are a time for experimenting and for pushing boundaries – particularly when it comes to intimate relationships. Such experimentation is a natural part of growing up. But there are potential risks, too – particularly if these early experiences aren’t positive ones. A new study from Professor Yvonne Kelly from UCL’s Department of Epidemiology and Public  Health  and colleagues, investigates what kinds of intimate behaviour 14 year-olds engage in, and asks how this insight can help to ensure  young people are well prepared for healthy and happy adult relationships.

We know teenagers experiment with intimacy, often moving ‘up’ the scale from hand-holding or kissing to more explicitly sexual activity. But we also know teenage pregnancy numbers have been dropping in recent years. And our new study suggests that fewer young teenagers are actually having sexual intercourse than some might previously have thought.

We’ve all seen the headlines – studies have shown us (links) that 30 per cent of those born in the 1980s and 1990s had sex before the age of 16, and that among those born in the early 1990s a little under one in five had done so by age 15. But our new evidence, based on 14 year-olds born during or just after the year 2000, paints a rather different picture of this latest generation of teenagers.

Our research used data from the Millennium Cohort Study, the most comprehensive survey of adolescent health and development in the UK. It follows children born between September 2000 and January 2002 and has collected information on them at nine months and subsequently at age  three, five, seven, 11, and  14 years. We used information from the most recently available data, when the study’s participants were 14 years old, and were able to look closely at the lives of 11,000 of them.

Intimate activities

Participants were asked about a range of ‘light’, ‘moderate’ and ‘heavy’ intimate activities. Handholding, kissing and cuddling were classed as ‘light,’ touching and fondling under clothes as ‘moderate’ and oral sex or sexual intercourse as ‘heavy.’

As might have been expected, more than half – 58 per cent – had engaged in kissing, cuddling or hand-holding, while 7.5 per cent, or one in 13, had experienced touching or fondling. But in contrast to other studies, (though our sample was younger than those mentioned above) we found only a very small proportion – 3.2 per cent or fewer than one in 30 – had been involved in ‘heavy’ activities in the year before they were interviewed for the study.

And most parents can take comfort from the fact that if their children aren’t participating in other risky activities such as drinking or smoking, they probably aren’t having sex either – there was clear evidence of links between heavier sexual activity and these factors.

We also found those who were most likely to confide worries in a friend rather than a parent, those whose parents didn’t always know where they were and those who stayed out late were more likely than others were to be engaged in heavier forms of sexual activity. Other potential links were found to drug-taking and as well as to symptoms of depression.

Our findings suggest young people who push boundaries may push several at once – that those who drink, smoke or stay out late, for instance, are more likely to engage in early sexual activity.

So, initiatives which aim to minimise risk and promote wellbeing are crucial – and they need to look at intimate activities, health behaviours and social relationships in relation to one another.

A key point is that if young people can learn about intimacy in a positive way at an early stage, then those good experiences can build foundations which will help them throughout their lives.

Most importantly young people need to know how to ensure their intimate experiences are mutually wanted, protected, and pleasurable. The concept of “sexual competence” – used to refer to sexual experiences characterised by autonomy, an equal willingness of partners, being ‘ready’ and (when relevant) protected by contraceptives – is important at all ages, as are close and open relationships with parents.

Better understanding of this interplay between personal relationships and behaviours are key to better support for young people. The right intervention at the right time can ensure a teenager’s intimate life is set on a positive course.

Partnered intimate activities in early adolescence – findings from the UK Millennium Cohort Study, by Yvonne Kelly. Afshin Zilanawala , Clare Tanton, Ruth Lewis and Catherine H Mercer,is published in the Journal of Adolescent Health.

*Afshin Zilanawala is based at the Research Department of Epidemiology and Public Health, University College London, and Oregon State University, United States.

Clare Tanton is based at London School of Hygiene & Tropical Medicine.

Ruth Lewis is based at the University of Glasgow.

Catherine H Merceris based at University College London.

This blog article is courtesy of the Child of our Time blog, which is a blog about the health and happiness of children living in the UK. led by the ESRC International Centre for Lifecourse Studies, University College London,

Anti-social working hours: Are they making women depressed?

By guest blogger, on 12 March 2019

The rise of globalisation and the 24/7 economy are fuelling demands for people to work long hours and weekends.  But what’s the evidence about how these ways of working link with depression? Gill Weston and colleagues from the International Centre for Lifecourse Studies in Society and Health at UCL and Queen Mary University of London found such working conditions are linked to poorer mental health in women.

Across the globe, the effects of overwork are becoming apparent.  In eastern Asian countries the risk of death due to overwork has increased.  In the UK, work-related stress accounts for millions of lost working days every year.

Within the EU, a significant proportion of people have to work unsociable hours – with nearly a quarter working most Saturdays and a third working at least one Sunday a month.  But despite this, there isn’t much clear evidence about the links between work patterns and mental health.

Some studies have found a connection between unsociable work patterns and depression.  But many of the studies only focused on men, some only looked at specific types of worker or workplaces and few took account of work conditions such as whether workers had any control over how fast they worked.

To address these gaps, we set out to look for links between long or irregular hours and depression using a large nationally representative sample of working men and women in the UK.  We particularly wanted to look at whether there were differences between men and women because research has shown that work is organised, experienced and rewarded differently for men and women, and because men and women react differently to overwork and time pressure.

We used data from Understanding Society, which surveys people living in 40,000 households across the UK.  In particular we focused on information about working hours, weekend working and working conditions collected from 11,215 working men and 12,188 working women between 2010 and 2012.  They had completed a questionnaire designed to study levels of psychological distress.

Who works the most?

We found men tended to work longer hours in paid work than women, and having children affected men’s and women’s work patterns in different ways: while mothers tended to work fewer hours than women without children, fathers tended to work more hours than men without children.

Two thirds of all men worked weekends, compared with half of all women.  Those who worked all or most weekends were more likely to be in low skilled work and to be less satisfied with their job and their earnings than those who only worked Monday to Friday or some weekends

Which workers have the most depressive symptoms?

Women, in general, are more likely to be depressed than men, and this was no different in our study.

Independent of their working patterns, we also found that workers with the most depressive symptoms were older, smokers, on lower incomes, in physically demanding jobs, and who were dissatisfied at work.

Are long and irregular hours linked to depression?

Taking these findings and other factors into account, when we looked at the mental health effects of work patterns on men and on women, the results were striking: while there was little or no difference in depressive symptoms between men who worked long hours and those who did not, this was not the case for women.

Those women who worked 55 hours or more per week had a higher risk of depression than women working a standard 35-40 hour week.

Similarly, weekend working showed differences for men and women.  Compared to workers who only worked on weekdays, men who worked weekends also had a greater number of depressive symptoms, but only if they had little control at work or were dissatisfied with work.  Whereas for women,  regardless of their control or satisfaction, working most or all weekends was linked to more depressive symptoms.

Why might women suffer more than men while working these antisocial hours?

There might be a number of reasons why women might be more affected than men:

  • Women who work long hours are in a minority – just four per cent of them in our sample worked 55 hours or more per week. This may place them under additional pressure.
  • Women working longer hours tend to be in male-dominated occupations, and this may also contribute to stress.
  • Women working weekends tend to be concentrated in low-paid service sector jobs, which have been linked to higher levels of depression.
  • Many women face the additional burden of doing a larger share of domestic labour than men, leading to extensive total work hours, added time pressures or overwhelming responsibilities.

What should be done about these risks?

Our findings should encourage employers and policy-makers to think about how to reduce the burdens and increase support for women who work long or irregular hours – without restricting their ability to work when they wish to.  More sympathetic working practices could bring benefits both for workers and for employers – of both sexes.

Long work hours, weekend working and depressive symptoms in men and women: Findings from a UK population-based study by Gill Weston, Afshin Zilanawala, Elizabeth Webb, Livia Carvalho, and Anne McMunn is published in the  Journal of Epidemiology and Community Health, which is published by the BMJ.

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.

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.

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