Social and Environmental Determinants of Mental Health Conference (Picower)
Robert Sege, Tufts
Higher PCEs (7 question survey) in childhood improve adolescent outcomes
4 key types of experiences that children might have:
safe and equitable relationships
social and civic engagmeent
opportunties for emotional growth, childhood play, access to nature
justice
building blocks are vague - on purpose, people have different families, relationships etc.
what these blocks mean to communities will be different depending on the family
HOPE-informed practice:
relationships: parents - who helps you with parenting
environment: recreational opportunities, family check-ins
standard practice is to check for housing stability and quality and intimate partner violence
engagement: standard practice ???
engagement: does the child participate in the family, child-centered play, access to safe playgrounds, screen with asqse (talks about social and emotional health), cultural and spiritual practice
Byungkook Lim, UCSD
Neural circuit mechanisms of ealry life stress-induced maladaptive feeding behaviors
ACE (adverse childhood experience) associated with later mental health illness
aim: underlying brain mechanism is important to treat psychiatric illness
focus on early life stress and adult eating disorder
30 yr follow-up reveals long-term impact of childhood physical abuse on BMI in adulthood.
how does early life stress have on impact on feeding disorders?
case study: kuwaiti children in gulf war: high correlation with binge eating behavior in later life. stress event has long lasting effect on physiological behaviors.
question is: how does this mechanism work?
study: early life stress imposed on baby mouse for one day only (separated from mother and siblings) - intervention: increase high-fat diet, ELT mice (those showed to stress) show vulnerability to obesity after exposure to high fat diet (body weight increases). they perform normally on many behavioral tasks yet they are vulnerable to obesity.
ELT mice show no sig. change in their metabolic rate.
even outside mental health outcomes: leading casues of death in the US is sig. correlated with early childhood adversity (even Alzheimer’s disease)
almost 64% of children in US are exposed to one ACE
supportive environments improve child development (30 million word gap study) - children from high SES tend to hear 30 million more words than those coming from low SES backgrounds
frontal gray matter growth in early life is correlated with SES
positive environments can rescue adversity (bucharest early intervention project)
Rationale: better diagnostic tools to identify vulnerable children, build repetoires of treatment and targeted interventions, inform the political discourse
Understanding the mechanism:
we need animal studies to build and understand the mechanisms
enrichment of mice can model supportive environment
what are the molecular mechanisms underlying enrichment of mice?
epigenetics mechanistically link experience and biology
chemical changes to the genome links to which genes are turned on/off
the environment is a strong mediator of epigenetic changes
chemical modifications to histone proteins determines whether the DNA is open or closed - transcription factors can more readily bind and express gene expression
they found that enrichment increases chromatin openness (DNA) for both males and females.
ROSMAP Patient Cohort: 636 individuals (AD and healthy controls): marry gene expression data with clinical and phenotypic exposures
does enrichment lead to cognitive benefit?
cognitive activity throughout life correlates with end-stage cognition
MEF2 levels correlated with cognition in humans
Annie Belcourt, University of Montana
Indigenous resiliency: developing Ikaakimaat
Ikaakimaat: trying hard, cultural sentiment that is used to describe resiliency.
Dignity-based approach to healthcare, developed by and for native communities
Identity is a really important factor if you want to help with resilience
spirituality is hope, meaning-making
redemptive meaning
critical question: how can we expect systematic changes for scientific equity if we avoid the most difficult questions or topics?
balancing a need for difficulty with a health-based approach
culture as a protective factor: those who participated in blackfeet ceremonies were less likely to have depressive symptoms
Blackfeet Ikaakimaat study:
JPB funded research = 380
developed a new measuere of indigenous environmental exposures to climate and social stressors (2 scales)
examined the relationship to health, mental health, culture, and resiliency
also examined relationships to boimarkers for half of the sample (A1C measures - blood sugar, BMI, hypertension)
Qualitative ethnographic efforts to examine the sources of Ikaakimaat.
Conclusion: culture matters
not been addressed in terms of the science
specifically: learning language (verb based rather than noun based) - shapes how children think about their world
systematic problems require systematic solutions in healthcare
intertwined with culture is storytelling, language, ceremony, housing, education, economies
Marc Weisskopf
Environmental epidemiology:
WWII and the origins of the environmental movement
St. Louis baby teeth survey (my nuclear life podcast): teeth in utero and shortly after after exposed to environemtnal pollutants
strontium-90 levels measured in the teeth of these children - influenced policy signed by JFK about nuclear weapons (above ground storage?)
commmoner’s 4 laws of ecology: evertyhign is connected to everything else, nature knows best, nothing comes from nothing, everything must go somewhere
Nature, the environment, and toxins interact: mercury cycle
Effects of toxicants: many metals interfere with a whole slew of neuronal communication, neurotransmitter release etc. Lead disrupts calcium signaling. BPA endocrine disruping chemicals, many pesticides destroy energy-producing units of cells. There are also general mechanisms that are also deleterious.
Environmental exposures: air pollution - we can combine those measurements with what’s in the air + geographic locations = input into model, and predict what is the likelihood of exposures, this results in maps being developed. Traffic is a major contributor to these pollutants.
Nurses’ health study II - air pollution and autism by pregnancy trimester. higher rate of autism = higher exposure to pollutants during third trimester
Matenral childhood abuse and likelihood of autism in offspring: psychosocial factors are also tremendously important
Pregnancy period: multigenerational exposures - exposure to someone who is pregnant has the ability to effect 3 generations of humans (if fetus is female)
cigarette smoking study: interferes with DNA methylation, is an endocrine disruptor, can cause genetic mutations.
50% odds of developing autism if your grandmother smoked during pregnancy
is it causal? Grandmother smoking - granddaughter autism?
reproductive cells being affected during pregnancy and then affecting the next generation
Importantce of the germline cells:
if you make a mutation in a germline cell, you are going to infect inherited cells.
you can have epigenetic changes in the germline cell, changes can be inherited through cell division.
psychosocial factors are very strong influences on epigenetics
maybe environment is changing epigenetics of a cell?
can we see traces of exposure in the mother showing up in all cells of the child?
Panel discussion:
Protecting the developing child from environmental hazards and promote a healthy environment
our children’s environment - a chemical toxic soup
children are not little adults: more vulnerable to harm from the exposure, organ systems still developing, metabolism and excretion not as efficient, adults may suffer little or no harm but children can have life-long changes if exposed.
mom’s womb is the critical first environment for a child
research links some pesticides and impaired fetal growth and neurodevelopment
approx 1 in 36 children in the US are being diagnosed with ASD
childhood poverty: 1 in 6 children live in low wealth families
prescription for children in nature:
renaturalizing school spaces and promoting greener school enviornments
great variation in methodologies and adjustement for confounding factors
Gregory Bratman, University of Washington
Working at the intersection of psychology, epidemiology, and environment
Natural landscapes are considered as part of the total enviornment
rumination: what can it do to physiology? increases in heartrate, blood pressure, skin conductance, increased respiration - all point to fight or flight activity
nature study: decrease in self-reported rumination in those who spent time outdoors
attention restoration theory: direct attention is overtaxed in urban environments, natural environments provide an opportunity for replenishment of attention
immunological and inflammatory outcomes: measuring ambient terpenes in the forest - measure physiology before and after sitting in the forest
Sarah Milligan-Toffer, CEO of the children and nature network
Children’s outdoor bill of rights
Catherine Jesen Pena, Princeton Neuroscience Institute
Early life stress and translational epigenetics
millions of children experience early life adversity
active shooter drills are likely traumatizing for children
Paul Dworkin, University of Conneticut (Help Me Grow National Center)
“Humans are not ideally set up to understand logic, they are ideally set up to understand stories” - Roger Schank, PhD
The journey to goal-concordant care
family engagement, voice of the family, co-production, goal-concordant care
how do we best transform child health services to promote children’s optimal health, development, and well-being?
developmental and behavioral monitoring:
british favored longitudinal surveillance appraoch eliciting feedback from parents
US: administering developmental screening tools to enable early detection
developmental conditions for which we are screening are not an ideal match for judging conditions
parent’s appraisals - very important indicators of children’s developmental at-risk status. screening tests did not typically encompass parent concerns. Dworkin (british and american recommendations for developmental monitoring. The role of surveillance)
interpret the results of screening tests (not in isolation according to scoring metric) but in the context of the child and all we know about the child’s environment and circumstance
Trainee Talks
Ran Rotem: environmental epidemiology and big data: using EHR to infer environmental contributors to autism
autism prevalence has increased 317% since 2000. Boys: 1 in 25 and girls 1 in 100
the etiology of autism: some genetic risk factors, but many/most cases are sporadic, increasing evidence for transgenerational and gestational risk factors (already present when the child is born)
environmental exposures are hard to ascertain, costly and time consuming to collected
biological effects may be ascertainable using EHR, data are increasingly available, we can directly examine biological pathways, identify culprit environemntal factors by examining downstream effects, infer on interventions downstream of the environmental exposure
can we intervene on the pathway downstream from the environmental exposure?
example: maternal thyroid abnormality and ASD in progeny
thyroid hormones: important metabolic functions, essential for fetal neural migration and differentation, fetus is dependent on maternal supply during 1st half of pregnancy
highly susceptible to exogenous exposures (heavy metals, pesticides, EDCs)
is the thyroid in the mother a mediator of environmental neurodevelopmental risk factors?
can we administer thryoid medications and block the pathway that is contributing to the ASD phenotype?
method:
population: 437,222 births in a large israeli health fund, indications of maternal history of thyroid abnormalities, gestational thyroid hormone levels, outcome: validated ASD diagnosis, covariates: other medical conditions, demographics
result: mothers who had a history of thyroidism had children with a higher risk for ASD
mothers who had been treated for hypothyroidism (i.e. bough the medication) still had an elevated risk of giving birth to a child with ASD
summary: maternal hypothyroidism is associated with increased risk for asd in their children
effect is still there when these women are being medicated during pregnany
actual hormone levels during pregnancy are not associated with autism
other explanation: environmental exposure that causes ASD through another mechanism?
mothers who had hypothyroididsm had other conditions (downstream from maternal thyroid abnormality) that was related to risk factor for ASD
using existing data can get us to think specifically about environmental outcomes of interest (i.e. through electronic health records)
Questions to ponder:
what kind of environmental data is encoded in the BHS?
are there scales/questionnaires that address access to green spaces?
evidence for parental surveillance as optimal relative to developmental screening
what is the right question: how do we best build comprehensive early chlidhood systems to strengthen families to promote children’s optimal health, developmental, and well-being (the solution is through goal-concordant care)
EHR data on pregnant women - look at later ASD diagnosis based on environmental exposures during pregnancy, medications taken during pregnancy, illnesses etc, cerebellar damage at birth etc.