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last updated: Fri, 28 Aug 2015 23:40:01 GMT

 Fri, 28 Aug 2015 11:23:00 GMT Goth teens 'at increased risk of depression and self-harm'

"Goths are three times more likely to be depressed than other teenagers, with 37% admitting to self-harming," the Daily Mail reports. 

A new study looked at mental health outcomes in young people who said they identified with the goth sub-culture. Goths favour black clothes, stark make-up, gloomy music and an interest in the darker side of life.

The study involved 2,000 teens and looked at whether self-identification as a goth at age 15 is linked to depression and self-harm at 18. 

After full adjustment for prior mental health and behavioural problems in the child, the study found goths were around a quarter more likely to have depression by 18 and a third more likely to report self-harming.

The obvious question is, does being a goth make you prone to depression, or are people already prone to depression more likely to identify with goth culture?

It's likely the relationship between mental health and self-identity is a complex one that cannot be boiled down to a simple "X leads to Y" statement.

And it could even be the case that for some teens who would otherwise have remained socially isolated, adopting the goth sub-culture brings a sense of peer solidarity.

Nevertheless, the study still indicates that those who identify with goth culture may be a group with an increased risk of mental health problems. Providing support to these young people could be beneficial.  

Where did the story come from?

The study was carried out by researchers from the University of Oxford and other academic institutions in the UK. 

It was funded by the Wellcome Trust and the Medical Research Council Programme, and was published in the peer-reviewed Lancet Psychiatry on an open access basis, so it can be read for free online.

The UK media's reporting of this well-conducted research is generally accurate. But an exception to this is The Daily Telegraph, which carried the headline: "Chavs are less depressed than goths, Oxford University finds". This is unsupported by the evidence provided by the study. Rates of depression and self-harm in this group are not given in the paper. 

What kind of research was this?

This cohort study aimed to look at the association between teen self-identification as a goth and depression and self-harm.

Previous research observed that deliberate self-harm is associated with goth culture in young people. However, it is unclear whether this is a direct causative association or whether this link is being influenced by other factors – for example, family, peer or life circumstances.

The researchers aimed to try to look at the direction of effect by assessing self-identity at 15 years and then look for the emergence of new mental health problems at 18 years. 

What did the research involve?

This study involved children enrolled into the Avon Longitudinal Study of Parents and Children (ALSPAC). This is an ongoing study that recruited pregnant women in Avon due to have a baby between April 1991 and December 1992. All children in this study have been invited to attend follow-up assessments every year since the age of seven.

This study included those who took a computer-based survey at the assessment at the age of 15, which asked them to self-identify as one of eight different social groups: sporty, populars, skaters, chavs, loners, keeners, bimbos, and goths.

They were asked further questions about how much they identified with these categories. For example, "Is there a group of teens in your school or neighbourhood with the reputation of rebelling against the norm (in clothing or ideas, for example), or in attempting not to conform to social ideals (e.g. goths)?" and "How much do you identify with the goths?" – to which they answered "not at all", "not very much", "somewhat", "more than somewhat", or "very much".

At the same time they also completed the Development and Wellbeing Assessment, which includes questions about symptoms of depression and self-harm.

Then, at the age of 18, depression was assessed using the Clinical Interview Schedule-Revised (CIS-R), where diagnoses are made according to standard diagnostic criteria from the International Classification of Diseases (ICD). 

This scale also assessed self-harm with questions such as, "Have you ever hurt yourself on purpose in any way (e.g. by taking an overdose of pills or by cutting yourself)?". The researchers didn't make a distinction between whether or not self-harm was associated with suicidal intent.

The researchers looked at the association between goth identification and depression or self-harm at 18 years, adjusting for these factors at 15 years to try to better determine a causative direction of effect. 

They further adjusted their analyses for various individual, family and social characteristics, making use of earlier ALSPAC assessments. This included the mother's history of depression, temperament and educational attainment, as well as the child's earlier history of depression, emotional or behavioural problems, or bullying. 

What were the basic results?

Overall, full data on self-identification and mental health at 15 and 18 years was available for 2,351 teens, who formed the sample for this analysis. This represented just under half of the potential ALSPAC cohort who were still participating in the assessments at 15 years.

Those identifying as goths were more likely to be girls, to have mothers with a history of depression, to have reported being bullied as a child, and to have a history of depression or emotional or behavioural problems themselves.

Depression at 18 years was associated with the extent they identified with goth culture. For example, the depression rate among those who did not identify at all was 6%, compared with 9% of those who identified "somewhat" and 18% of those who identified "very much". After adjustment for confounders, people who identified as a goth were 27% more likely to have depression at 18 years (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11 to 1.47). The confounder having the greatest influence was previous depression in the teen/child themselves.

There was also a similar link between goth identification and self-harm, with the greater the extent of identification being associated with the highest risk. 

After adjustment for confounders, goths were a third more likely to report self-harm at 18 years (OR 1.33, 95% CI 1.19 to 1.48). A total of 37% of those who "very much" identified as a goth had self-harmed by 18.

As a comparison, for those who identified "very much" with other groups:

  • skaters – 11% with depression and 25% had self-harmed by 18
  • loners – 9% with depression and 26% had self-harmed by 18
  • sporty – 4% with depression and 6% had self-harmed by 18  

How did the researchers interpret the results?

The researchers concluded that, "Our findings suggest that young people identifying with goth sub-culture might be at an increased risk for depression and self-harm."

They go on to say that, "Working with young people in the goth community to identify those at increased risk of depression and self-harm and provide support might be effective." 

Conclusion

This cohort study has found positive links between self-identification as a goth at 15 years, and subsequent depression and self-harm at 18 years.

The study has many strengths, including the use of a large ongoing cohort study, which has carried out regular annual assessments of the mother and child. This has allowed the researchers to adjust their analyses for prior history of mother and child mental health and behavioural problems.

The study also used recognised assessment scales throughout, which has allowed the researchers to make valid clinical diagnoses of mental health problems.

However, the main point is as the researchers rightly say: "Our observational findings cannot be used to claim that becoming a goth increases risk of self-harm or depression". 

The study has made a valid attempt to explore the possible direction of effect by seeing whether identifying as a goth at 15 precedes depression and self-harm at 18 years.

But this still can't prove cause and effect. You can't say, for example, that if this individual hadn't become immersed in goth culture, they would never have developed depression or self-harm behaviours by 18 years.

It could still be the case that personality characteristics, family or peer relationships, or life circumstances may make the teen more likely to be drawn to the goth culture, but may also separately make them more predisposed to depression or other mental health problems.

The self-identification categories on the survey are also quite vague. Even though the researchers made clear attempts to explore the extent the individual identifies with a particular category, each category is still likely to have captured a wide range of personality characteristics and behaviours.

Self-identification is highly subjective, and two people who identify themselves as a goth "very much" may be quite different. It is possible that teens may not have identified particularly with any of these categories and were just having to opt for the one that seemed to be the best fit.

It is also not known how sincerely teens may have responded – for example, people may have called themselves a "chav" or a "bimbo" only lightheartedly.

And although the research and media attention has focused on goths, the findings suggest other groups, such as "skaters" and "loners", may also be vulnerable young people.

Overall, this research cannot prove direct causation, but it still indicates that those identifying with the goth culture may be a group with an increased risk of mental health problems. As the researchers suggest, providing support to these young people could be beneficial. 

Those who may be well placed to recognise young people who may be having emotional or behavioural difficulties – goths or otherwise – include family members and other peers, schools, and youth groups. 

Depression can potentially affect all teens, whether they are goths, Directioners (especially since the One Direction break-up), chavs or sporties. Read more about the possible signs of depression in young people.

Links To The Headlines

Goths are THREE times more likely to be depressed than other teenagers, with 37% admitting to self-harming. Daily Mail, August 28 2015

Chavs are less depressed than goths, Oxford University finds. The Daily Telegraph, August 28 2015

Goth teenagers at higher risk of depression, study suggests. The Guardian, August 28 2015

Young goths 'at risk of depression'. BBC News, August 28 2015

Goths at risk of depression or self-harming, research says. The Independent, August 28 2015

Links To Science

Bowes L, Carnegie R, Pearson R, et al. Risk of depression and self-harm in teenagers identifying with goth subculture: a longitudinal cohort study. The Lancet Psychiatry. Published online August 27 2015

 Thu, 27 Aug 2015 13:30:00 GMT How having 'senior moments' may be a good thing

"Senior moments? Only worry if you don't notice them," the Daily Mail reports.

"Senior moments" is a term used to describe a sudden memory lapse, such as forgetting your PIN or a relative’s name. While these types of lapses can affect people of all ages, older people are often more concerned when they happen, in case they could be the initial symptoms of dementia.

A new study suggests this may be an unnecessary worry – the real warning sign could be when people "forget that they have forgotten". Being unaware of failing memory could be a warning sign of impending dementia.

The study included more than 2,000 older adults from the US and followed them over a period of 10 years. Participants had memory tests every year and were asked to rate their own memory and whether they experienced any problems. During the study period, around 10% of participants were diagnosed with dementia. They experienced a drop in memory awareness around 2.6 years before the development of dementia.

This study highlights the importance of being memory aware – knowing when your memory has let you down on occasion. The researchers state that loss of memory awareness appeared earlier in younger participants; this may be because older people were more likely to expect their memories to fade as a normal part of ageing. Friends and family members should look out for the warnings signs and ensure medical advice is sought if they are concerned. 

Where did the story come from?

The study was carried out by researchers from Rush Alzheimer’s Disease Center and Department of Neurological Sciences, and was funded by the National Institute on Aging and the Illinois Department of Public Health.

The study was published in the peer-reviewed medical journal Neurology. 

This story has been reported both widely and accurately by the UK media. 

The Independent offers a particularly useful report, with additional advice about ways of reducing risk of dementia and highlighting the role of friends and family in aiding medical professionals in diagnosing the condition.    

 

What kind of research was this?

This study combined people from three prospective cohort studies in the US to investigate the development of memory loss in dementia. The participants were free from dementia at study start; this is the best way to gather information on how a condition develops over time.

 

What did the research involve?

This study included participants from three longitudinal cohort studies to test whether being unaware of memory impairment is an indicator of dementia.

The participants came from:

  • The Religious Orders Study – older Catholic nuns, priests and brothers.
  • The Rush Memory and Aging Project – older individuals from the Chicago area.
  • The Minority Aging Research Study – older black persons from the Chicago area recruited from the community and the clinical core of the Rush Alzheimer’s Disease Core Centre.

All participants were at least 50 years old and had not been diagnosed with dementia. A number of evaluations were carried out each year. These are as follows:

  • Clinical evaluation – including a medical history, neurologic examination, and tests of memory and cognition. Dementia diagnosis was made by a doctor according to standard criteria.  
  • Self-assessment of memory – Participants were asked two questions about their memory; these were "How often do you have trouble remembering things?" and "Compared to 10 years ago, would you say your memory is better or worse?"
  • Performance testing of memory – 19 cognitive tests were carried out to support clinical classification of dementia and measure change in cognitive function. These included tests of episodic memory (e.g. immediate and delayed recall of word lists) and working memory (e.g. numerical tests).

After death, those who had given consent during the study period had an autopsy of their brain.

The temporal course of memory awareness in dementia was investigated for those people who developed dementia before the end of the study and who had completed at least four annual evaluations.

 

What were the basic results?

The study included a total of 2,092 older people who had no memory or cognitive impairment at study start. Around 10% of participants (239 people) developed dementia during follow-up and had four annual assessments available from which to assess the course of their memory awareness.

These people had an average age of 79.2 years at study start and were followed up for 10.8 years. This included 7.5 years before dementia onset and 3.3 years after dementia onset. Memory awareness was stable until 2.6 years before the onset of dementia; after this point there was a rapid decline in memory awareness. Participants who were older at study start tended to have later onset of memory unawareness.

Brain autopsy was carried out in 385 of those who died during the study period. Decline in memory awareness could be linked to brain changes that are associated with dementia – such as protein tangles (characteristic of Alzheimer’s disease) and areas where the brain has been starved of oxygen (characteristic of vascular dementia). Where these changes were not found, decline in memory awareness had not been observed.

 

How did the researchers interpret the results?

The researchers conclude that awareness of memory impairment typically begins to decline about two to three years before dementia onset and is associated with post-mortem evidence of dementia.

 

Conclusion

This study investigated unawareness of memory loss as an indicator of dementia. The 10% of participants diagnosed with dementia during follow-up who had full assessments available experienced a drop in memory awareness around 2.6 years before the development of dementia. It was also noticed that a drop in memory awareness was associated with the characteristic features of dementia at brain autopsy.

Strengths of this study are the large sample size and long follow-up period. However, there are limitations related to the specific US population samples used. For example, one of the cohorts included only nuns, priests and brothers; another included only people of black ethnicity. These people may have distinct health and lifestyle characteristics, meaning they are not representative of everyone.

In practical terms, it may also be difficult to identify a clear cut-off point between the vague concepts of memory "awareness" and "unawareness". The study also has no direct implications in terms of preventing or slowing the development of dementia.

Nevertheless, the findings highlight the role that friends and family members can have in looking out for signs of unawareness of memory loss, and to ensure medical advice is sought if they are concerned.

Early symptoms of dementia can progress very slowly, so they may not be noticed or taken seriously, just thought to be a normal part of ageing. However, symptoms become more severe as the condition progresses. The speed at which symptoms get worse and the way they develop can depend on the cause and overall health of the person. This means that the symptoms and experience of dementia can vary greatly from person to person.

Memory loss is one of the key symptoms of dementia, but others include:

  • increasing difficulty with tasks and activities that require concentration and planning
  • depression
  • changes in personality and mood
  • periods of confusion
  • difficulty finding the right words

There are no certain ways to prevent dementia. However, you may be able to reduce your risk of developing dementia by following normal healthy lifestyle advice – eating a balanced diet, taking regular exercisenot smoking and drinking alcohol in moderation.

Links To The Headlines

Senior moments? Only worry if you DON'T notice them: Becoming oblivious to memory problems is found to be sign of the onset of dementia. Daily Mail, August 27 2015

Dementia sufferers ‘stop noticing memory loss two years before condition develops'. The Guardian, August 27 2015

Dementia sufferers start losing their memory up to three years before disease takes hold. The Independent, August 26 2015

Worrying about senior moments shows mind is still in good shape. The Daily Telegraph, August 26 2015

Do you have 'senior moments'? Research shows that might not be a bad thing. Daily Mirror, August 26 2015

Forgetting your senior moments is sign of dementia. The Times, August 27 2015 (subscription required)

Why senior moments show you haven’t got dementia. Daily Express, August 26 2015

Links To Science

Wilson RS, Boyle PA, Yu L, et al. Temporal course and pathologic basis of unawareness of memory loss in dementia. Neurology. Published online August 26 2015

 Thu, 27 Aug 2015 09:00:00 GMT Low vitamin D levels linked to increased multiple sclerosis risk

"Lack of vitamin D may cause multiple sclerosis, study finds," reports the Guardian. A large study found people genetically programmed to have lower vitamin D levels are at an increased risk of multiple sclerosis (MS).

MS is a condition where the immune system attacks the coating of nerves in the brain and spinal cord, leading to symptoms such as vision loss, fatigue, and difficulties with balance and co-ordination.

Our body makes vitamin D under the skin in reaction to sunlight. We also get small amounts of the vitamin from our diet in foods such as eggs and oily fish.

A link between vitamin D deficiency and an increased risk of MS has long been suspected, as the condition is more common in areas of the world with less sunlight, such as northern Scotland. But it has been difficult to prove cause and effect because other factors may be involved.

This study used a genetic approach believed to be less susceptible to the problem of confounding – where other factors influence the results.

The researchers learned four genetic variants influence vitamin D levels found in the blood. People can have different combinations of these genetic variations. They found people with a combination of the genetic variations giving them lower levels of vitamin D had double the risk of MS.

But what the study does not tell us is whether MS could be prevented in those at higher risk by increasing their vitamin D levels through taking supplements or other methods.

Find out more about the "sunshine vitamin" in our special report on the health claims made about vitamin D.

Where did the story come from?

The study was carried out by researchers from McGill University and the Jewish General Hospital in Canada; the University of Bristol and King's College London in the UK; and Massachusetts General Hospital and Harvard Medical School in the US.

It was funded by the Canadian Institute of Health Research, The Fonds de la Recherche en Santé Québec, the Lady Davis Institute, the Jewish General Hospital, and the Canadian Diabetes Association.

The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it is free to read online.

The UK media reported the story accurately, and many reports included reactions to the research findings from experts such as Professor Danny Altmann, an immunologist at Imperial College London. 

Professor Altmann said: "While it may be too much to expect therapeutic vitamin D to treat or reverse ongoing MS, this paper will add to the weight of argument for routine vitamin D supplementation of foodstuffs as a broad preventative public health measure." 

What kind of research was this?

This genetic study looked at whether there is an association between genetically influenced levels of vitamin D and the risk of MS.

Previous observational studies found an association between lower levels of vitamin D and MS risk. In particular, MS is more common in people living in geographical areas with reduced sunlight – vitamin D levels are increased by exposing the skin to the sun.

But these studies were unable to prove cause and effect. Questions remain, such as whether the low vitamin D caused MS, or whether vitamin D levels go down in people with MS because they have less exposure to the sun as a result of their condition.

Exposure to sunlight is just one way to increase our vitamin D levels. There is also a genetic component that will have a lifetime influence. This study specifically looked for genetic variations linked to vitamin D levels and whether these genetic variations were also associated with MS risk.

This type of study is called a Mendelian randomisation study because these genetic variations are inherited randomly (each parent will have two copies of each, which one we inherit is random). The term is named after Gregor Mendel, a pioneering 19th century scientist, widely regarded as the father of modern genetics.

The study design means confounding by other factors is not a problem.The researchers in the study took additional steps to be sure this was the case. 

What did the research involve?

The researchers identified genetic variations associated with vitamin D levels using data from the SUNLIGHT study. The Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits included blood samples from 33,996 people.

They identified four genetic variations associated with lower vitamin D levels. These were close to four genes that create products that have an effect on the level of vitamin D:

  • a protein that binds to vitamin D and carries it in the blood to target organs
  • an enzyme involved in making vitamin D in the body in response to sunlight
  • an enzyme that activates production of vitamin D
  • an enzyme that inactivates vitamin D

They then used data from the Canadian Multicentre Osteoporosis study (CaMos) of 2,347 people to confirm the effect of these four genetic variants on vitamin D levels.

The researchers used the results to investigate the risk of MS depending on the genetic variations a person carried and their genetically determined lifetime level of vitamin D using data from two studies:

  • the International Multiple Sclerosis Genetics Consortium (IMSGC), which has data from 14,498 people with MS and 24,091 healthy controls, all of European descent
  • the IMSGC/Wellcome Trust Case Control Consortium 2 (IMSGC/WTCCC2) study, which has data from 9,772 people with MS and 6,332 controls

The researchers took the following factors into account when analysing the results:

  • age
  • sex
  • body mass index (BMI)
  • time of year the blood sample was taken
  • ethnicity  

What were the basic results?

The four genetic variants associated with reduced vitamin D levels were also associated with an increased risk of MS, with three showing stronger links than the fourth. Each variant was only associated with a relatively small increase in the odds of MS (odds ratio [OR] of 1.04 to 1.11).

Each genetically determined standard deviation decrease in vitamin D levels doubled the risk of MS (OR 2.0, 95% confidence interval [CI] 1.7 to 2.5).

How did the researchers interpret the results?

The researchers concluded: "Genetically lowered 25OHD [a form of vitamin D in the blood] level is associated with an increase in the risk of MS in people of European descent."

They said that: "These findings provide rationale for further investigating the potential therapeutic benefits of vitamin D supplementation in preventing the onset and progression of MS." 

Conclusion

This study found people with a genetic susceptibility to having lower levels of vitamin D have an increased risk of developing MS.

What the study does not tell us is whether MS could be prevented in those at higher risk by taking steps to increase their vitamin D levels. The results also may not apply to people who are not of European descent.

Studies in healthy children and adults are now underway to explore this area. This study does not show what effect taking supplementary vitamin D would have in people who already have MS.

Previous research into vitamin D being used as a treatment for MS and to prevent relapse has been inconclusive because of small study sizes and poor methodology, so large randomised controlled trials are required.

Nevertheless, this piece of research adds to the growing picture that low levels of vitamin D appear to play some part in the development of MS.

You can usually get enough vitamin D through modest exposure of the skin to sunlight (no suntanning required) and a healthy diet that includes oily fish, eggs and foods fortified with vitamin D.

Some people may require vitamin D supplements, such as people aged 65 and over or those not exposed to much sunlight. The NHS suggests that if you take vitamin D supplements, you should not take more than 25 micrograms (0.025mg) a day as it could be harmful.

Find out more about vitamin D.

Links To The Headlines

Lack of vitamin D may cause multiple sclerosis, study finds. The Guardian, August 25 2015

Low vitamin-D genes linked to MS. BBC News, August 26 2015

Why sunlight could protect against multiple sclerosis. The Daily Telegraph, August 25 2015

Links To Science

Mokry LE, Ross S, Ahmad OS, et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLOS Medicine. Published online August 25 2015


 

 
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