>>WELCOME, EVERYONE. WE ARE
GOING TO GET STARTED IN JUST A
MOMENT. SORRY FOR THE DELAY. I
HAD SOME TECHNICAL CHALLENGES ON
THIS END BUT WE ARE ABOUT TO GET
IT GOING. ALL RIGHT. TRACY, WE
ARE READY?
>> QUESTION ARE READY, EVERYONE
IS ACCOUNTED FOR AND WE ARE
READY TO GET STARTED.
>> OKAY. THEN I WOULD LIKE TO
WELCOME YOU TO THE 267TH MEETING
OF NATIONAL ADVISORY MENTAL
HEALTH COUNCIL. I'M JOSH GORDON,
DIRECTOR OF NATIONAL INSTITUTE
OF MENTAL HEALTH. THANK YOU FOR
JOINING OUR COUNCIL MEETING.
THANK YOU TO THE MEMBERS COMING
THE NIMH STAFF FOR ALL THEIR
WORK IN PREPARATION, AND
ESPECIALLY THOSE MEMBERS OF THE
DEA STAFF WHO WORK ON THE
COUNCIL AS WELL AS OUR OSPPC
STAFF OFFICE OF SCIENTIFIC
POLICY COMMUNICATION PLANNING
STAFF THAT HELPED PREPARE MY
PRESENTATION FOR THE DAY. OUR
COUNCIL MEETING IS A TIME FOR
EXCHANGE BETWEEN INSTITUTE STAFF
AND COUNCIL MEMBERS. AS WELL AS
AN OPPORTUNITY FOR THE COUNCIL
TO PROVIDE FEEDBACK TO THE
NATIONAL MENTAL HEALTH AND
IMPORTANTLY TODAY'S OPEN SESSION
IS A OPPORTUNITY FOR NIMH AND
COUNCIL MEMBERS TO COMMUNICATE
TO THE VARIOUS CONSTITUENCIES
THAT CONCERN THEMSELVES WITH OUR
GOINGS ON. I'M PLEASED TO SEE
THE FULL PANEL OF COUNCIL
MEMBERS INCLUDING SOME WHO HAVE
BEEN ABLE TO OFFICIALLY JOIN US
TODAY. AS FULL MEMBERS OF THE
COUNCIL VERY EXCITED TO BE ABLE
TO JOIN YOU IN DISCUSSIONS. AND
I LOOK FORWARD TO HEARING FROM
ALL OF YOU ON OUR DISCUSSIONS
TODAY. BEFORE WE MOVE THE
BUSINESS OF THE MEETING I DO
WANT TO REMIND ALL OF US A FEW
LOGISTICAL ITEMS. THE OPEN
SESSION OF COUNCIL IS BEING
VIDEOCAST, BROADLY, THE NIH
COMMUNITY AS WELL AS THE GENERAL
PUBLIC. THAT ALLOWS PEOPLE TO
WATCH AND LISTEN REMOTELY.
MEETING IS ALSO BEING RECORDED
AND THAT WILL ENABLE VIEWING ON
DEMAND IN THE FUTURE. MEETING IS
ALSO BEING TRANSCRIBED FOR THE
RECORD. SO ALL OF THAT MEANS I
WANT TO REMIND YOU ABOUT SOME
ZOOM ETIQUETTE. FIRST WE WANT TO
ENCOURAGE COUNCIL MEMBERS TO
KEEP THEIR VIDEO ON THROUGHOUT
THE MEETING. I WILL ASK NIMH
STAFF AND DIVISION DIRECTORS AND
OTHERS WHO ARE SPEAKING TO US
TODAY TO USE THEIR VIDEO ONLY
WHEN PRESENTING. IN ORDER TO
SPEAK PLEASE UNMUTE YOUR
MICROPHONE AND THEN MUTE IT
AGAIN WHEN YOU ARE DONE. IF
ANYONE IS USING PHONE FOR AUDIO
AND DOESN'T HAVE ACCESS TO MUTE
BUTTON ON COMPUTER IN THE APP
PLEASE PRESS "*" 6 TO MUTE OR
UNMUTED. WE ASK COUNCIL MEMBERS
TO UNMUTE TO MAKE A COMMENT OR
RAISE YOUR HAND TO MAKE A
COMMENT OR ASK A QUESTION.
RATHER THAN USING THE CHAT
FUNCTION. THE CHAT FUNCTION
SHOULD BE USED ONLY TO CONTACT
THE NIMH HOSTS WITH TECHNICAL
ISSUES. I WILL NOTE THAT
ANYTHING YOU DO ENTER IN THE
CHAT BOX IS INCLUDED IN THE
PERMANENT RECORD OF THIS SESSION
AND WILL BE VIEWABLE BY MEMBERS
OF THE PUBLIC. WHEN WE CALL FOR
A VOTED WE WILL ASK COUNCIL
MEMBERS TO USE THE RAISE HAND
FUNCTION AT THE BOTTOM OF THE
OMEN EWE OR IT MAY BE IN YOUR
APP AT THE BOTTOM UNDER THE
REACTIONS MENU. VOTING COUNCIL
MEMBERS ON PHONE SHOULD UNMUTE
BY PRESSING STAR 6 TO CAPTURE
YOUR VOICE. IF YOU EXPERIENCE
CONNECTIVITY ISSUES AND NEED TO
CALL IN, PLEASE REFER TO YOUR
PERSONAL ZOOM ITINERARY FOR THE
OPEN SESSION DETAILS. NEXT WE
HAVE TO -- I WILL ASK FOR
CORRECTIONS OR COMMENTS FROM THE
MINUTES FROM THE WINTER 2022
COUNCIL MEANING. COPIES WERE
PROVIDED TO YOU IN ADVANCE OF
THE MEETING.
ANY QUESTIONS OR COMMENTS ABOUT
THE MINUTES PLEASE RAISE YOUR
HAND OR JUST UNMUTE. TRACY, I
DON'T SEE ANY.
>> GREAT. SO WITH THAT I'M
SEEKING A MOTION FOR APPROVAL OF
THE WINTER 2022 DRAFT MINUTES. A
MOTION AND A SECOND FROM LAURA.
THANK YOU. ALL IN FAVOR OF
APPROVING THE MINUTES AS WRITTEN
PLEASE RAISE YOUR HAND.
EXCELLENT.
OKAY. AND I CAN PUT YOUR HANDS
DOWN, I THINK THEY CAPTURED TH
THAT. ANY OPPOSED TO THE MINUTES
AS WRITTEN? AND ANY ABSTENTIONS
ALL RIGHT. WE HAVE APPROVAL OF
THE MINUTES. THANK YOU VERY
MUCH.
>> GREAT.
EXCELLENT. I'M BACK HOPEFULLY
YOU CAN SEE ME, YE YE YES. MY SN
WENT BLANK A MOMENT. THE NEXT
ITEM ON THE AGENDA IS NIMH
DIRECTOR'S REPORT. WHICH I WILL
PRESENT. TRACY DID YOU RUN MY
OWN SLIDES OR SOMEONE GOING TO
RUN THEM THERE?
>> I BELIEVE ALEX WAS RUNNING
THE SLIDES. BUT IF YOU PREFER --
>> NO, IT'S FINE. ALEX WHY DON'T
YOU GO AHEAD AND DO THAT BECAUSE
I TRIED TO START POWERPOINT AND
THE SCREEN WENT BLANK A MOMENT.
>> LET ME KNOW WHEN YOU ARE ON.
>> I CAN SEE THEM ON MY END.
>> OKAY. I MIGHT HAVE THE WRONG
-- THERE YOU GO. ALL RIGHT.
WELL, AGAIN, WE WILL START OUT
WITH MY DIRECTORS UPDATE FOR
COUNCIL. NEXT SLIDE. THE AGENDA
IS FAIRLY STRAIGHT FORE. WE WILL
START WITH A VERY EXCITING
FOLLOW-UP TO THE PRESIDENT'S
STATEMENT, THEN WE WILL TALK
ABOUT THE UNITY AGENDA WHICH
INCLUDES MENTAL HEALTH POINT AND
WHAT THAT MEANS FOR THE NATIONAL
INSTITUTE OF MENTAL HEALTH. WE
WILL ALSO TALK ABOUT
INTERACTIONS WITH CONGRESS AND
WITH THE WHITE HOUSE AND GIVE AN
UPDATE AS TO OUR APPROPRIATIONS
PROCESS AND THE BUDGET BOTH FOR
THIS YEAR AND OUTLOOK INTO NEXT
YEAR. NEXT WE WILL GO DETAIL
SOME UPDATES FROM HHS AND NIH,
GIVE YOU SOME NEWS FROM NIMH AND
THEN WITH SCIENCE HIGHLIGHTS. IF
YOU HAVE ANY QUESTIONS OR
COMMENTS FEEL FREE TO ENTER THEM
INTO THE CHAT AT ANY POINT. I
MAY INTERRUPT MYSELF TO ANSWER
THEM ALONG THE WAY OR I MAY
HANDLE THEM AT THE END. CAN ALSO
RAISE YOUR HAND IF YOU WOULD
LIKE TO ASK WHEN WE COME ALONG
THE WAY. START WITH THE I
BELIEVE HAPPENED AFTER THE LAST
MEETING MARCH 1, PRESIDENT BIDEN
DELIVERED THE STATE OF THE UNION
ADDRESS WHICH OUTLINED THE
ADMINISTRATION PRIORITIES.
DURING THE ADDRESS WE WERE
PLEASED TO HEAR THE PRESIDENT
ANNOUNCED A BIPARTISAN STRATEGY
TO RESPOND TO NATIONAL MENTAL
HEALTH AND SUBSTANCE USE
DISORDER CRISIS AS PART OF HIS
UNITY AGENDA. THAT WILL
HOPEFULLY BE BIPARTISAN SUPPORT
FOR AN EFFORT TO ADDRESS THE
MENTAL HEALTH CRISIS IN THE
UNITED STATES.
THAT AGENDA INCLUDES THREE
PILLARS. STRENGTHENING SYSTEM
CAPACITY. CONNECTING AMERICANS
TO MENTAL HEALTHCARE. AND
SUPPORTING AMERICANS BY CREATING
HEALTHY ENVIRONMENTS. EACH OF
THESE PLANKS IS OUTLINED BY SO
CALLED FAST FACTS BROCHURE THAT
THE WHITE HOUSE PUT OUT
IMMEDIATELY AFTER THE STATE OF
THE UNION AND RECENTLY UPDATED.
EACH OF THESE IS SUPPORTED BY
EVIDENCE BASED APPROACHES, MANY
OF THEM GREW OUT OF RESEARCH
THAT WAS SUPPORTED BY THE NIMH.
FOR EXAMPLE STRENGTHENING SYSTEM
CAPACITY INCLUDES INCREASING OUR
ABILITY TO GIVE MENTAL
HEALTHCARE AN APPROPRIATE SET,
INCREASING COLLABORATIVE CARE
WHILE INCREASING TELEMENTAL
HEALTH AND INCREASING MENTAL
HEALTHCARE IN SCHOOLS. ALL WHICH
HAS AN EVIDENCE BASE THAT GREW
OUT OF NIMH FUNDING RESEARCH.
THE LATEST VERSION OF THE UNITY
AGENDA, UPDATED JUST A WEEK OR
SO AGO. ESTABLISHES A FEDERAL
RESEARCH ACTION PLAN. THAT
RESEARCH ACTION PLAN WILL BE
SPEARHEADED BY THE WHITE HOUSE
OFFICE OF SCIENCE TECHNOLOGY AND
POLICY BUT WILL INVOLVE NIMH AND
OTHER AGENCIES WHICH HAVE A ROLE
TO PLAY IN RESEARCH RELATED TO
MENTAL HEALTH. I'M PLEASED IN
PARTICULAR TO SEE THE DEPARTMENT
OF EDUCATION, AS WELL AS OTHER
PLAYERS THAT HAVE A ROLE TO PLAY
IN ADDRESSING THE MENTAL HEALTH
CRISIS BUT HERETOFORE HAVE NOT
MADE MAJOR INVESTMENTS IN MENTAL
HEALTH RESEARCH. IN ADDITION TO
THE FEDERAL RESEARCH ACTION PLAN
PROCESS GETTING UNDERWAY EVEN AS
WE SPEAK, THE PRESIDENT'S BUDGET
REQUEST FOR NIMH INCLUDES
RESEARCH FUNDING FOR AREAS THAT
WERE NOTED IN THE UNITY AGENDA
NEEDING ADDITIONAL DATA. THIS
INCLUDES $5 MILLION PROPOSED FOR
RESEARCH FOR INNOVATIVE
TREATMENT MODELS THAT WE WILL
USE TO CONTINUE OUR INVESTMENTS
AND ENLARGE OUR INVESTMENTS AND
IMPLEMENTATION SCIENCE AND
SERVICES RESEARCH AS WELL AS
ADDITIONAL $5 MILLION PROPOSED
TO FUND RESEARCH ON MENTAL
HEALTH IMPACT OF SOCIAL MEDIA.
NIMH IS GEARING UP TO BE ABLE TO
ENSURE THAT WE USE THAT MONEY
WISELY, SHOULD IT BE ALLOCATED
BY CONGRESS. AND IMPORTANTLY,
INVESTING IN THESE AREAS EVEN
WHILE WAITING FOR ADDITIONAL
RESOURCES TO BE ABLE TO DEVOTE
TO THEM. NEXT SLIDE. LET'S TALK
ABOUT INTERACTIONS WITH CONGRESS
AND WHITE HOUSE. ON FEBRUARY
16TH, 2022 RIGHT THROUGH APRIL
5, 2022, SO RIGHT AROUND THE
TIME OF OUR LAST MEETING AND
CONTINUING RIGHT UP UNTIL
RECENTLY, NIMH STAFF HAS BEEN
ENGAGING WITH NUMBER OF
DIFFERENT REPRESENTATIVES FROM
CONGRESS INCLUDING HERE YOU CAN
SEE STAFF SENATOR ROY BLOUNT'S
OFFICE FROM REPRESENTATIVE
KIRKPATRICK'S OFFICE, I MYSELF
SPOKE WITH THE FRIENDS OF
NATIONAL INSTITUTE OF MENTAL
HEALTH AND CONGRESSIONAL MENTAL
HEALTH CAUCUS IN MARCH, NIMH
ADVANCES AND PROGRAMS EARLY
PSYCHOSIS RESEARCH AND IN APRIL
I REPRESENTED DON BEYER ON
SUICIDE PREVENTION RESEARCH. AS
YOU CAN SEE FROM THE LIST THERE
IS INTEREST IN MENTAL HEALTH IN
CONGRESS AND THAT INTEREST IS
DECIDEDLY BIPARTISAN AND WE ARE
HOPING THAT THIS WILL MEAN
INCREASE ATTENTION AND INCREASE
RESOURCES FOR RESEARCH AND CARE
FOR MENTAL HEALTH IN THE UNITED
STATES. NEXT SLIDE. CONTINUING
THROUGH APRIL AND MAY, I MET
WITH REPRESENTATIVE DAVID TRONE
TO PARTICIPANT VIEW UPDATES ON
SUICIDE PREVENTION COVID-19
RESEARCH. PRINT 29,
APPROPRIATIONS PROCESS I MET
WITH THE APPROPRIATION CLERKS TO
DISCUSS NIMH RESEARCH AND THE
BUDGET REQUEST FOR THE INSTITUTE
AND IN MAY ALONG WITH DR. NORA
VOLKOW NIMH STAFF MET WITH
HEALTH LABOR AND PENSIONS AND
SENATOR CHRIS MURPHY'S STAFF TO
DISCUSS LEGISLATIVE PROPOSALS.
FINALLY I TESTIFIED TWICE SINCE
OUR LAST MEETING BEFORE SENATE
COMMITTEES, SENATE COMMITTEE ON
HEALTH EDUCATION LABOR AND
PENSIONS HAD AUTHORIZATION
COMMITTEE TO LOOK INTO
AUTHORIZING AND REAUTHORIZING
LEGISLATION THAT THERE
STRENGTHEN FEDERAL MENTAL HEALTH
AND SUBSTANCE USE PROGRAMS AND
REQUEST I BE WILL TO PROVIDE
COMMENTARY ON EVIDENCE BRACED
APPROACHES TO DOING SO. ON MAY
17 REMOTELY I TESTIFIED BEFORE
THE SENATE APPROPRIATION
SUBCOMMITTEE ON LABOR HEALTH AND
HUMAN SERVICES EDUCATION RELATED
AGENCIES ON THE PROPOSED FISCAL
YEAR 2023 BUDGET FOR NIH. LET ME
SAY IN BOTH HEARINGS THERE WAS A
LOT OF INTEREST IN UNDERSTANDING
THE MENTAL HEALTH IMPACT OF
COVID AND THERE WAS ALSO
INTEREST IN PARTICULAR AROUND
MENTAL HEALTH IN YOUTH. LOOKING
FOR EVIDENCE BASED APPROACHES
AND SUPPORT RESEARCH INTO
EXPANDING AVAILABILITY OF
EVIDENCE BASED APPROACHES. WE
HAVE ALSO BEEN ENGAGING WITH THE
WHITE HOUSE OFFICE OF SCIENCE
AND TECHNOLOGY POLICY WHICH AS I
SAID BEFORE LISTEN RESPONSIBLE
FOR GUIDING THE FEDERAL RESEARCH
PLAN. ON MAY 19 NIMH DEPUTY
DIRECTOR SHELLEY AVENEVOLI
PARTICIPATED IN A FIRE SIDE CHAT
TO DISCUSS ADOLESCENT BRAIN
DEVELOPMENT ESPECIALLY STRESS
AND COVID-19 PANDEMIC AND SOCIAL
MEDIA. SHE WAS JOINED THERE BY
DEPUTY DIRECTOR OF NIDA, DR.
WILSON CONGRESS LY COKE LYNN. LK
ABOUT APPROPRIATIONS AND
BUDGETS. MARCH 15, AS MOST OF
YOU KNOW PRESIDENT BIDEN SIGNED
THE CONSOLIDATED APPROPRIATIONS
ACT OF 2022, WHICH GAVE US OUR
2022 FISCAL YEAR 2022 BUDGET.
THAT INCLUDED $2.2 BILLION
BUDGET FOR NIMH, WHICH
REPRESENTS HEALTHY INCREASE OVER
LAST YEAR. INCLUDED IN THAT
2.2 BILLION WAS $20 MILLION
EXTRA INCREASE ABOVE AND BEYOND
WHAT OTHERWISE WOULD HAVE GOTTEN
FROM THE GENERAL INCREASE IN THE
NIH BUDGET. IN ORDER TO EXPAND
RESEARCH ON THE IMPACT OF COVID
THE COVID-19 PANDEMIC ON MENTAL
HEALTH YOU HAVE ALREADY SEEN A
NUMBER OF COVID-19 RELATED
MENTAL HEALTH GRANTS IN PRIOR
COUNCIL ROUNDS AS WELL AS
SEVERAL WE ARE APPROVING THIS
COUNCIL ROUND BUT ALSO AN
EMERGENCY RFA TO RECRUIT MORE
RESEARCH IN THAT AREA. THAT RFA
WILL BE APPLICATION FROM THAT
RFA WILL BE REVIEWED IN THE NEXT
FEW WEEKS. AND WE WILL BE
PRESENTING IT BY -- FOR
DISCUSSION IN OUR AUGUST VIRTUAL
COUNCIL MEETING. ALSO INCLUDES
$1 BILLION TO LAUNCH ADVANCE
RESEARCH PROJECTS AGENCY FOR
HEALTH AT NIH, SOMETHING WE
DISCUSSED HERE WITH YOU IN THE
PAST. THIS IS A SEPARATE AGENCY
LOCATED AT THE NIH BUT REPORT
DIRECTLY TO THE SECRETARY. AND
WE EXPECT AND HOPE THAT ARPA H
WILL COLLABORATE WITH NUMBER OF
NIH INSTITUTES INCLUDING NIMH IN
ORDER TO ADVANCE PROJECTS IN
WAYS THAT WE CAN'T DO IT ON OUR
OWN HERE AS AN INSTITUTE BUT
THAT CAN INCREASE THE RAPIDITY
WHICH REACH PUBLIC HEALTH
IMPACT. NEXT SLIDE. THIS THEN
IS THE CURVE OF THE BUDGET
APPROPRIATIONS FOR 2010 THROUGH
2022. YOU CAN SO E WE CONTINUE
TO HAVE STEADY INCREASE IN OUR
BUDGET STARTED IN 2016. WE HAVE
PUT FOR YEARS 2018 THROUGH 2022
A LITTLE PURPLE SMUDGE AT THE
END OF THAT LINE, THAT
REPRESENTS THE APPROPRIATIONS
THAT ARE OUTSIDE OF THE NORMAL
APPROPRIATION PROCESS BY GIVING
TO NIMH AS PART OF THE 21ST
CENTURY CURES ACT WHICH PASSED
AT THE END OF 2016 AND WHICH
SUPPLIES DOLLARS FOR THE BRAIN
INITIATIVE, THAT IS NOT ALL THE
DOLLARS THE BRAIN INITIATIVE
BUDGET HAS, THERE IS ADDITIONAL
APPROXIMATELY $100 MILLION OR SO
OF BASE NIMH BUDGET WHICH GOES
TO BRAIN AT DIRECTION OF
CONGRESS. AS A RESULT OF THESE
BUDGET INCREASES WE HAVE BEEN
ABLE TO MAINTAIN A RELATIVELY
MODEST SUCCESS RATE, THIS YEAR
THAT SUCCESS RATE WITH OUR
INCREASE IN 2022 IS ESTIMATED TO
GO UP TO APPROXIMATELY 24%. WE
RECEIVED ESTIMATED WE WILL
RECEIVE 2834 APPLICATIONS, A
SLIGHT DECREASE FROM 2021 WE SEE
A LOT OF APPLICATIONS POSSIBLY
RESULTING FROM THE FACT THAT
MANY INDIVIDUALS WERE OUTSIDE OF
THEIR LABS WORKING REMOTESLY
WRITING GRANTS TO NIH DURING THE
COVID PANDEMIC AND THAT HAS
RESULTED IN A SLIGHT DECREASE
FOR 2022. BUT BECAUSE OF OUR
BUDGET WE ARE ABLE TO INCREASE
THE NUMBER OF GRANTS THAT WE
ANTICIPATE AWARDING THIS FISCAL
YEAR TO CLOSE TO 700 TOTAL
GRANTS TO INCLUDE THE CURES
AWARD. NOTE FOR THOSE OF YOU IN
THE AUDIENCE WHO SAY MY GRANT
GOT 16 PERCENTILE AND NOT
GETTING FUNDED. FOR MANY REASONS
THE SUCCESS RATE DOES NOT EQUAL
THE PERCENTILE RATE WE REACH.
FIRST AND FOREMOST NIMH GRANTS
DO EXCEPTIONALLY WELL IN
COMPETITION WITH GRANTS AND
OTHER AGENCIES SO WE FIND THAT
TYPICALLY WELL MORE THAN 10% OF
GRANTS ARE SCORED IN THE TOP 10
PERCENTILE OVERALL. SECONDLY,
THE 24% FIGURE INCLUDES BRAIN
GRANTS, INCLUDES NUMBER OF OTHER
GRANTS FOR EXAMPLE THROUGH
RFAs AND CLINICAL TRIALS
RFAs AS WELL AS DEDICATED RFAS
IN GAP AREAS, WHICH HAVE HIGHER
SUCCESS RATE. SO THAT IS OUR
BUDGET APPROPRIATIONS. LET'S
MOVE ON TO NEWS FROM HHS AND
NIH. MARCH 2, 2022, THE HEALTHY
HUMAN -- HEALTH AND HUMAN
SERVICES SECRETARY JAVIER
BECERRA ANNOUNCE AD NATIONAL
TOUR TO STRENGTHEN MENTAL HEALTH
AS PART OF HHS RESPONSE TO THE
MENTAL HEALTH CRISIS. SECRETARY
BECERRA VISITED A NUMBER OF
LOCATIONS THROUGHOUT THE COUNTRY
VISITING PLACES WHERE MENTAL
HEALTH IS DELIVERED INCLUDING
SCHOOLS AND INCLUDING CLINICS.
AND EMPHASIZING THE NEED TO
FOCUS ON MENTAL HEALTH AS WE
MOVE FORWARD AS A NATION AFTER
THE PANDEMIC. HHS ALSO AS I
MENTIONED FORMALLY ESTABLISHED
ARPA H AND WE RECENTLY RECRUITED
TO NIH ADAM RUSSELL WHO HAS BEEN
APPOINTED TO SERVE AS AGENCY
ACTING DEPUTY DIRECTOR. DR.
RUSSELL AS WELL AS OTHER MEMBERS
OF THE NIH OFFICE OF THE
DIRECTOR HAVE BEEN BUSY
ESTABLISHING THE ADMINISTRATIVE
STRUCTURE NECESSARY TO SUPPORT
THE ARPA H ENDEAVOR WHILE WE
AWAIT APPOINTMENT OF A DIRECTOR
OF ARPA H AND THAT APPOINTMENT
WILL BE -- THAT IS A
PRESIDENTIAL APPOINTMENT SO WE
AWAIT WORD FROM THE WHITE HOUSE
WHO THAT MIGHT BE.
AT NIH, BITTERSWEET NEWS AS DR.
NED SHARPLESS, WHO HAS BEEN A
STRONG PARTNER OF NIMH HELPING
ENSURE SUCCESS OF THE CLINICAL
CENTER, AND IN OTHER TRANS-NIH
INITIATIVE, NED STEPPED DOWN
FROM HIS ROLE AS DIRECTOR OF THE
NATIONAL CANCER INSTITUTE AND
ANOTHER FRIEND OF NIMH DOUG LOWY
WHO PREVIOUSLY ON SEVERAL
OCCASIONS SERVED AS THE ACTING
NCI DIRECTOR HAS BEEN NAMED AS
ACTING DIRECTOR AGAIN WHILE WE
WAIT A PRESIDENTSIAL APPOINTMENT
TO REPLACE DR. SHARPLESS.
FINALLY I WANT TO NOTE FROM NIH
WIDE PERSPECTIVE I WANT TO NOTE
NIH WIDE DIVERSITY EQUITY
INCLUSION AND ACCESSIBILITY
CONTINUE. FEBRUARY 1ST NIH
RELEASED A DRAFT NIH WIDE DEIA
STRATEGIC PLAN FOR PUBLIC
COMMENT AND MARCH 17TH NIH
ISSUED ITS NEW TRIBAL
CONSULTATION POLICY WHICH
DICTATES THE FORM AND CONTENT OF
CONSULTATIONS WE DO WITH NATIVE
AMERICAN AND ALASKA NATIVE
TRIBES AS WHEN RESEARCH WAS
SIGNIFICANT COMPONENTS AND
TRIBAL LANDS USING TRIBAL
CITIZENS, WE NEED TO FOLLOW TO
ENSURE THAT THAT WORK IS DONE IN
AN ETHICAL WAY WITH ACCEPTANCE
OF TRIBAL LEADERSHIP. NEXT
SLIDE. ONE MORE PIECE OF NIH
WIDE NEWS. THE NIH CLIMATE
CHANGE AND HEALTH INITIATIVE
STRATEGIC FRAMEWORK WAS PUB
ACCOMPLISHED FEBRUARY 7 --
PUBLISHED FEBRUARY 7. NIH
PARTICIPATE IN NIH WIDE PROGRAM
FOCUSED ON CLIMATE CHANGE AND
HEALTH LED BY NIEHS BUT ATTEMPTS
TO UNDERSTAND THE HEALTH IMPACT
OF CL CLIMATE CHANGE AND DEVELOP
APPROACHES TO MODERATE THOSE
IMPACTS. NEXT SLIDE. NEWS IN
THE HEAL INITIATIVE HELPING TO
END ADDICTION LONG TERM
INITIATIVE, CONGRESSIONALLY
FUNDED, PROGRAM TO TRY TO REDUCE
IMPACT OF THE OPIOID EPIDEMIC
HELD AN INVESTIGATOR MEETING,
THE THIRD INVESTIGATOR MEETING
ON MAY 11 AND 12TH WHICH NOTED
PROGRESS ACHIEVED THE PAST YEAR
INCLUDING TECHNOLOGY BASED
THERAPIES FOR PAIN MANAGEMENT
AND DISCUSSED FUTURE DIRECTIONS
FOR THE INITIATIVE. ANOTHER
EFFORT IMPORTANT FOR THE NIMH,
MASH 17TH ALL OF US RELEASED ITS
FIRST GENOMIC DATA SET, NEARLY
100,000 GENOME SEQUENCE
INDIVIDUALS PARTICIPATING IN THE
PROGRAM. ABOUT 50% OF THAT DATA
ARE FROM INDIVIDUALS WHO
IDENTIFY WITH RACIAL OR ETHNIC
GROUPS THAT HAVE BEEN
HISTORICALLY UNDER-REPRESENTED
IN BIOMEDICAL RESEARCH SO IT
REPRESENTS A TREMENDOUS
OPPORTUNITY TO ENSURE THAT OUR
GENETIC INFORMATION THAT WE HAVE
BEEN GETTING, GENETIC DATA CAN
BE USEFUL FOR FRANKLY ALL OF US.
THE ALL OF US PROGRAM CONTINUES
TO RELEASE DATA AND CONTINUES TO
IMPROVE USER INTERFACES THAT
ALLOW INVESTIGATORS TO QUERY
THAT DATA AND ENCOURAGE THOSE OF
YOU WITH INTEREST IN DATA
SCIENCE TO EXPLORE THE
OPPORTUNITIES THEY HAVE WITH
THEIR DATA SETS. IN THE BRAIN
INITIATIVE ALSO MOVING FULL BORE
FEBRUARY 22ND NIH LAUNCHED THE
BRAIN INITIATIVE CONNECTIVITY
ACROSS SCALES PROJECT. THIS IS A
TRANSFORMATIVE PROJECT AIMED TO
MAP NEUROCIRCUITS IN MICE HUMANS
AND HUMAN PRIMATES WITH MULTIPLE
FUNDING OPPORTUNITIES WITH
RECEIPT DATES IN JULY. AND
BEYOND. THE BRAIN INITIATIVE
WILL HOST THEIR 8TH ANNUAL
INVESTIGATOR MEETING ON JUNE 21
AND 22, A VIRTUAL MEETING.
ANYONE INTERESTED SHOULD GO
AHEAD AND REGISTER FOR THAT
MEETING, IT WILL BE EXCITING
OPPORTUNITY TO SEE THE NEW
DEVELOPMENTS THAT AROSE FROM THE
BRAIN INITIATIVE PROGRAMS. NEXT
SLIDE. NOW MOVING TO THE NIMH.
THE NIMH NEWS I WILL TALK ABOUT
BRIEFLY ABOUT A STRATEGIC PLAN.
GIVE YOU AN UPDATE ON THE
BALANCE OF THE NIMH PORTFOLIO
WHICH I PROMISE TO DO
PERIODICALLY. TALK ABOUT NIMH
DIVERSITY EQUITY INCLUSION AND
ACCESSIBILITY INITIATIVES. GIVE
UPDATE ON THE INTERAGENCY AUTISM
COORDINATING COMMITTEE, TALK
ABOUT OUR PLANS FOR OUR 75TH
ANNIVERSARY, IT WILL SOON BE 75
YEARS SINCE FOUNDING OF NIMH AND
COVER SOME STAFF NEWS. AS YOU
ALL LIKELY KNOW, THE NIMH
STRATEGIC PLAN HAS FOR THE LAST
SEVERAL YEARS BEEN A LIVING
BREATHING DOCUMENT ON THE WEB.
AND WE DO FORMAL YEARLY UPDATES
WHICH WE JUST COMPLETED AND
WHICH ARE NOW ACCESSIBLE ON NIMH
WEBSITE. THE UPDATES FOR 2022
INCLUDE EXPANDED INFORMATION ON
DEIA EFFORTS, LINKS TO NIMH
APPROACH TO MENTAL HEALTH
DISPARITIES RESEARCH CLIMATE
CHANGE AND HEALTH INITIATIVE.
REORGANIZE STRATEGIES TO MAP
INTEREST AREAS ON TO THE
PIPELINE OF NEURAL DEVELOPMENT,
AND TWO NEW INTEREST AREAS THAT
FOCUS ON ECONOMIC FACTORS OF
RELEVANCE TO MENTAL HEALTH. THE
STRATEGIC PLAN IS ACCOMPANIED BY
A 2021 STRATEGIC PLAN PROGRESS
REPORT THAT HAS SPOTLIGHTS
ADVANCES MADE IN THE PAST YEAR.
THAT HIGHLIGHT DIFFERENT AREAS
OF THE GOALS OF THE PLAN AS WELL
AS FAST FACTS FIGURES AT A
GLANCE FOR 2021 INCLUDING FOR
EXAMPLE SNAP SHOTS OF DIGITAL
MEDIA, AND FOR EXAMPLE FUNDING
OF NEXT GENERATION RESEARCHERS.
I HAVE BEEN ATTEMPTING OVER THE
YEARS TO BE AS TRANSPARENT AS
POSSIBLE ABOUT THE BALANCE OF
THE NIMH PORTFOLIO. IN 2017, MAY
HAVE BEEN EARLY 2018 I WROTE MY
FIRST MESSAGE ON THE BALANCE OF
THE PORTFOLIO DESCRIBING TO IF
COMMUNITY AT LARGE THE BALANCE
OF INVESTMENTS THAT NIMH MAKE.
AND I REPORTED OUT TO YOU I
BELIEVE IN SEPTEMBER THE CURRENT
BALANCE IN MARCH OF 2022 I
PUBLISHED ANOTHER DIRECTOR
MESSAGE UPDATING GENERAL
COMMUNITY ON THAT PORTFOLIO
BALANCE AND I WILL REITERATE
THOSE DATA HERE AGAIN IF WE LOOK
AT SHORT MEDIUM AND LONG-TERM
INVESTMENT IN MENTAL HEALTH
RETHESE ARE INVESTMENTS IN
RESEARCH THAT HAVE THE POTENTIAL
TO AFFECT HEALTHCARE DELIVERY IN
SHORT MEDIUM AND/OR LONG TERM.
ROUGHLY SPEAKING, APPROXIMATELY
JUST LESS THAN 20% OF OUR
RESEARCH FUNDS ARE EXPENDED ON
FUNDAMENTAL BASIC RESEARCH.
SOMETHING AROUND 35% DISEASE
RELATED BAYING IS RESEARCH.
SOMETHING AROUND 45, 50%
THERAPEUTICS DEVELOPMENT AND
SERVICES. THAT'S 2020 DATA YOU
CAN SEE THE TRAJECTORIES OVER
TIME, THERE'S BEEN SOME EXCHANGE
OF EMPHASIS IN OUR PORTFOLIO
INITIALLY IN 2010 THROUGH 2013 I
EXPLAINED IN THE 2018 MESSAGE AS
WELL AS AGAIN THE LAST SEVERAL
YEARS SWITCH BACK TO FOCUS ON
THERAPEUTICS DEVELOPMENT
SERVICES. HAPPY TO TALK ABOUT
REASONS WHY THIS MIGHT BE
HAPPENING. ONE OF THOSE THINGS
IS OUR EMPHASIS FROM 2016 TO
2018 ON IMPORTANCE OF
INTERVENTION RESEARCH AND
PARTICULARLY IN THE PSYCHOSOCIAL
REALM WHERE WE MADE SOME CHANGES
TO OUR CLINICAL TRIALS
ANNOUNCEMENTS TO MAKE IT CLEAR
WHAT WE MEAN BY TARGETEDDED
ENGAGEMENT IN THAT CONTEXT THAT
LED TO INCREASE IN RESEARCH
AREA. AS WELL AS RESURGENCE OF
DIVISION OF SERVICES
INTERVENTION RESEARCH
PARTICULARLY WITH A FOCUS ON
NOVEL IMPLEMENTATION STRATEGIES
AND THE APPLICATIONS DING TALL
TECHNOLOGIES. -- DIGITAL
TECHNOLOGIES. YOU ALSO NOTICE
OVER THE LAST SEVERAL YEARS A
GRADUAL SHIFT IN BASIC RESEARCH
PORTFOLIO FROM THE MEDIUM TERM
DISEASE RELATED BASIC RESEARCH
TO WHAT MIGHT BE SLIGHTLY LONGER
TERM FUNDAMENTAL BASIC RESEARCH.
I WANT TO POINT OUT THAT AMONG
THE MANY REASONS WHY THAT MIGHT
BE OCCURRING, WE HAVE ATTEMPTED
OVER THE LAST SEVERAL YEARS TO
INSIST THAT OUR ANIMAL
RESEARCHERS AND RESEARCHERS
USING OTHER MODELS SUCH AS HUMAN
CELL MODELS APPROPRIATELY
CHARACTERIZE THE HYPOTHESES THEY
ARE TESTING AND NOT SIMPLY TRY
TO SAY WE ARE MODELING
SCHIZOPHRENIA IN AMEBA BUT ASK
BASIC SCIENCE QUESTIONS WHEN
APPROPRIATE AND ASK DISEASE
RELATED QUESTIONS WHEN THEY ARE
APPROPRIATE. AND WE THINK THIS
ACCOUNTS FOR SOME OF THAT CHANGE
THAT WE ARE SEEING OVER THE LAST
SEVERAL YEARS. NEXT SLIDE. I'M
OFTEN ASKED WHETHER THE BALANCE
WE ARE STRIKING IS APPROPRIATE.
I DON'T KNOW NECESSARILY HOW TO
ANSWER THAT. I THINK EVERYONE
HAS THEIR OWN INDIVIDUAL OPINION
ABOUT HOW MUCH SHOULD BE SPENT
ON SHORT MEDIUM OR LONG TERM
RESEARCH AND INDEED MANY PEOPLE
HAVE THEIR OWN OPINIONS ABOUT
WHAT CONSTITUTES SHORT MEDIUM OR
LONG TERM RESEARCH. HARD TO
CATEGORIZE RESEARCH WE DO MUCH
LESS OTHER INSTITUTES DO INTO
THOSE FUNDAMENTAL BASIC DISEASE
RELATED BASIC AND THERAPEUTICS
DEVELOPMENT CANS. SO INSTEAD OF
COMPARING THOSE WE CHOSE A
CATEGORY ACROSS CLINICAL TRIALS
RESEARCH WHICH HAS ITS OWN NIH
WIDE SO CALLED RCDC CATEGORY
WHICH IS AN NIH WIDE METHOD OF
CATEGORIZING RESEARCH INTO
SPECIFIC BUCKETS. IF YOU LOOK
COMPARE THE NIMH AND NIH SUPPORT
FOR CLINICAL TRIALS RESEARCH AS
A PERCENT OF OUR TOTAL FUNDING,
YOU CAN SEE THAT THEY MATCH
QUITE NICELY. SO I DON'T KNOW IF
IN 2020, 16% OF THE NIMH BUDGETS
IS BEING SPENT OWN CLINICAL
TRIALS RESEARCH IS THE RIGHT
AMOUNT OF DOLLARS SPENT ON IT
BUT WHAT I CAN SAY IS IT IS
PRETTY MUCH WHAT THE NIH DOES AS
A WHOLE. IF THAT IS A MARKER OF
POTENTIAL SUCCESS I'M PLEASED
WITH IT. OTHER NEWS BEYOND
BUDGETARY BALANCE I WANT TO NOTE
THAT WE CONTINUE WITH DEIA
EFFORTS, ONE COMPONENT OF THAT
ORGANIZED AT THE NIH LEVEL IS
EACH INSTITUTE HAS TO FORMULATE
RACIAL AND ETHNIC EQUITY PLAN OR
REPLAN THE NIH REPLAN WAS
FINALIZED IN MARCH, WAITING FROM
FEEDBACK FROM NIH AND MAY MAKE
ADJUSTMENTS ONCE WE RECEIVED
THAT FEEDBACK. THREE MAIN GOALS
OF THE REAP PLAN TO APPLY THE
RACIAL EQUITY LENS FRAMEWORK TO
THE IC WORK FORCE STRUCTURES
SYSTEMS TO IDENTIFY DISMANTLE
RACIAL AND ETHNIC DISPARITIES IN
OUR WORK FORCE AND ENHANCE
DIVERSITY OF OUR WORK FORCE.
SUPPORTING THOSE GOALS FROM OUR
PLAN WE HAVE IMPLEMENTED ALREADY
SEVERAL MEASURES THAT ATTEMPT TO
ADDRESS ISSUES OF ENVIRONMENT
HERE AT NIMH AND ENHANCE
DIVERSITY INCLUSIVENESS OF OUR
WORKPLACE. WE INSTITUTED NIMH
WIDE GROUND WATER TRAINING WITH
CONTRACTING GROUND WATER TUT.
THAT HELPS ALL NIMHERS
UNDERSTAND THE ROLE OF SOCIAL
DETERMINANTS AND HISTORY IN
ESTABLISHING THE PLAYING FIELD
WE ARE ALL IN RIGHT NOW.
EMPHASIZING THE NEED TO ADDRESS
THAT PLAYING FIELD THROUGH
MEASURES THAT ENHANCE RACIAL
EQUITY. NIMH LEADERSHIP TEAM
AND SUPERVISORS PARTICIPATED IN
THIS AND THE RECORDING IS
AVAILABLE TO ALL STAFF TO ENSURE
WE ALL KNOW WHERE WE ARE AT.
NIMH IS ALSO LED STAFF TRAININGS
ON MICROAGGRESSIONS IN CREATING
A NEURODIVERSE INCLUSIVE
WORKPLACE AS STRATEGIES TO
INFORM CULTURE CHANGE HERE AT
NIMH. WE ALSO CONTRACTED WITH
THE ID PLANNING GROUP TO
FACILITATE LISTENING SESSIONS
WITH NIMH STAFF. THOSE 20
SESSIONS WERE COMPLETED APRIL OF
2022, WE AWAIT FINAL REPORT
COMING ANY DAY NOW. SUMMARIZES
THE COMMON THEMES THAT OUR STAFF
RAISED. THIS REPORT FINDINGS
SHARED WIDELY WITHIN NIMH AS
WELL AS NIMH ANTI-RACIST TASK
FORCE WHICH RECOMMENDED
LISTENING SESSIONS IN THE FIRST
PLACE TO INFORM RECOMMENDATIONS
TO NIMH LEADERSHIP THAT WILL
ADDITIONALLY IMPROVE OUR
ENVIRONMENT. THAT IS A SUMMARY
OF SOME OF THE ACTIVITIES WE
ENGAGED IN AROUND DIVERSITY
EQUITY INCLUSION AND
ACCESSIBILITY. NOW I WILL TURN
TO ANOTHER RESPONSE NIMH TO
OVERSEE THE INTERAGENCY AUTISM
COORDINATING COMMITTEE. UNDER
THE THE AUSPICES OF DR. SUSAN
DANIELS THE IACC EXPECT
SECRETARY AND DIRECTOR OF AUTISM
RESEARCH COORDINATION. ON APRIL
13 AND 14 THE IACC HELD THE
THIRD MEETING FROM THIS
INCARNATION OF IACC WHICH WAS A
VIRTUAL MEETING, DISCUSSED
HOUSING AND COMMUNICATIONS
RESEARCH. THE IACC CONTINUES TO
DEVELOP 2021, 2022 STRATEGIC
PLAN FOR AUTISM RESEARCH
SERVICES AND POLICY AND IN JUNE,
THIS MONTH THE IACC HAS OR WILL
NOT SURE IF IT CAME OUT TODAY OR
NOT, PUBLISH THE 2020 SUMMARY OF
ADVANCES IN AUTISM SPECTRUM
DISORDER THAT IS AN ACCOUNTING
OF MAJOR ADVANCES
IN THAT WAY HE WILL CONTINUE A
ROLE AT NIMH THAT HE HAS DONE
WITH OUTSTANDING RESULTS.
TRYING TO ENSURE RESEARCH
FINDINGS INSTITUTE DEVELOPS
INFLUENCE POLICY AT THE FEDERAL
LEVEL HAS AGREED TO SERVE AS
INTERIM ACTING DIRECTOR
EFFECTIVE JULY 3RD. I KNOW IT'S
REALLY HARD TO DO VIRTUALLY BUT
I ALSO KNOW MANY OF YOU HAVE
KNOWN AND RECOGNIZED BOB'S
EXCELLENCE OVER THE YEARS, SO
I'M GOING TO ASK FOR A ROUND OF
APPLAUSE. AND FOR HIS SERVICE
OVER MANY, MANY YEARS TO NIMH AS
DIRECTOR. I KNOW YOU CAN'T
REALLY HEAR THE STUFF OVER ZOOM
BUT I KNOW YOU ARE LISTENING AND
YOU APPRECIATE HOW MANY PEEP IN
THIS ROOM THINK SO HIGHLY OF
YOUR EFFORTS. YOU WILL BE MISS
IN THE ROLE YOU ARE LEAVING AND
GREATLY VALUED IN THE ROLE THAT
YOU ARE ABOUT TO ASSUME.
IN ADDITION IN ADDITION TO
RECRUITING NEW DIRECTOR OF
SERVICES INTERVENTION RESEARCH
WE ARE ALSO RECRUITING FOR A
DEPUTY DIRECTOR OF OFFICE OF
CLINICAL RESEARCH, RECRUITMENTS
TO COME THAT I CAN'T ANNOUNCE
YET BUT HOPEFULLY ANNOUNCED SOON
SO PAY ATTENTION TO THOSE OF YOU
INTERESTED IN JOINING. REALLY A
WONDERFUL PLACE TO WORK AND HAVE
MAXIMUM IMPACT ON MENTAL HEALTH
RESEARCH THROUGHOUT THE COUNTRY
AND AROUND THE WORLD. SO PLEASE
LOOK FOR THESE JOB OPPORTUNITIES
NIMH CAREERS WEBSITE IN THE USA
JOBS. NEXT SLIDE. IN OTHER
NEWS, DR. JOYCE CHUNG, DEPUTY
CLINICAL DIRECTOR OF NIMH
CLINICAL RESEARCH PROGRAM AND
DIRECTOR OF TRAINING
OPPORTUNITIES IS SERVING AS THE
NIH CLINICAL CENTER DESIGNATED
INSTITUTIONAL OFFICER AND
EXECUTIVE DIRECTOR OF GRADUATE
MEDICAL EDUCATION OVERSEEING
MANY OF THE GME ACREDITSED
RESIDENCY AND FELLOWSHIP
PROGRAMS THAT NIH OFFERS. REALLY
WONDERFUL OPPORTUNITIES FOR
JOYCE AND SHE WILL BE MISSED AT
NIH WE ARE GLAD SHE WILL
CONTINUE TO SERVE THE MISSION OF
THE CLINICAL CENTER AROUND
EDUCATION. OTHER HAPPY NEWS IN
THE INTRAMURAL RESEARCH PROGRAM,
DR. SUSAN AMARA DIRECTOR OF IRP
AND MARILYN POWELL CLINICAL
DEPUTY DIRECTOR HAVE BEEN HARD
AT WORK. THE TWO NEW MEMBERS ARE
JAMES BOURNE AND ANGELA LANGDON.
THEY COME TO THE IRP AS
INVESTIGATORS CHIEF OF SECTIONS
AND UNITS. DR. BOURNE COME AS
SENIOR INVESTIGATOR, DR. LANGDON
AS TENURE TRACK INVESTIGATOR. WE
ARE EXCITED ABOUT THE
CONTRIBUTIONS TO MAKE TO OUR
YOUR COMMUNITY AND THE RESEARCH
COMMUNITY AT LARGE. FINALLY DR.
HOLLY LISANBY DIVISION OF
TRANSLATION RESEARCH IS
EVENTUALLY UNDUCTED AS A
DISTINGUISHED LIFE FELLOW OF THE
AMERICAN PSYCHIATRIC
ASSOCIATION, CONGRATULATIONS,
HOLLY. NEXT SLIDE. AND OUR OWN
DR. VICTORIA ARANGO WHO IS A
PROGRAM OFFICER IN DIVISION OF
TRANSLATIONAL RESEARCH WHO WAS
RECENTLY ELECTED PRESIDENT
SOCIETY OF BIOLOGICAL
PSYCHIATRY. THOSE FOLLOWING THE
ANNOUNCEMENTS KNOW THAT MANY
NIMHS THAT SERVE IN LEADERSHIP
ROLES THE AMERICAN COLLEGE OF
NEUROPSYCHOPHARMACOLOGY
SOLIDIFYING IMPACT ON BIOLOGICAL
PSYCHIATRY AT LARGE.
FINALLY, I WILL TAKE THE LAST
FEW MINUTES TO TALK ABOUT
SCIENCE HIGHLIGHTS.
THOSE OF YOU FOLLOWING
PSYCHIATRIC GENETICS, ARE MOST
LIKELY LIKE ME, QUITE PLEASE
WITH THE PROGRESS THAT WE HAVE
BEEN MAKING OVER THE YEARS IN
TERMS OF IDENTIFYING THE NUMBER
OF DIFFERENT GENES, PLACES IN
THE GENOME, THAT LEAD TO
SCHIZOPHRENIA BUT ALSO
FRUSTRATED AND BEWILDERED BY THE
SHEER NUMBER. AND AT TIMES
DISPAIRING FOR CLINICAL --
CHANGING THE LINKAGES INTO
BIOLOGIC KNOWLEDGE ABOUT OUR SEW
I WANT TO UPDATE YOU TWO
SIMULTANEOUSLY PUBLISHED PAPERS
THAT MOVE US FORWARD FROM SIMPLY
LISTS OF GENES TO BIOLOGICAL
PATHWAYS. BOTH OF THEM ARE
RESULT OF NIMH AND OTHER FUNDING
AGENCIES THAT HAVE SUPPORTED
THIS KIND OF RESEARCH. THE FIRST
PAPER LOOKS AT COMMON GENE
VARIANTS AND TRIES TO UNDERSTAND
WHETHER WE CAN GET TO BIOLOGY
THROUGH THEM IN THE AREA OF
SCHIZOPHRENIA. SO IN THIS LATEST
UPDATE, THE NUMBER OF PLACES IN
THE GENOME THAT HAVE NOW BEEN
STATISTICALLY SIGNIFICANTLY LEAD
TO SCHIZOPHRENIA HAS INCREASED
YET AGAIN TO WELL OVER 250
PLACES IN THE GENOME. EACH ONE
OF THEM HERE REPRESENTED BY
THOSE GREEN TRIANGLES SCATTERED
THROUGHOUT THE GENOME. AND THIS
REPRESENTS THE MAIN
ACCOMPLISHMENT OF GENOME WIDE
ASSOCIATION
STUDIES.
GWAS STUDIES HAVE IDENTIFIED
MANY, MANY PLACES AND ALSO THEN
HOW WE TAKE THESE PLACES IN THE
GENOME AND TRANSFER THEM INTO
BIOLOGY. SYSTEMS BIOLOGY HAS
COME TO THE RESCUE. ONE CAN
USING A RANGE OF DIFFERENT
TECHNIQUES, TRY TO IDENTIFY FOR
THOSE PLACES IN THE GENOME THE
MOST LIKELY GENES THAT ARE
RESPONSIBLE FOR THE LINKAGE TO
SCHIZOPHRENIA. AND THEN ASK WHAT
KIND OF GENES THOSE ARE. AND
WHEN ONE DOES THAT, USING THE
APPROPRIATE STATISTICAL
TECHNIQUINGS, YOU CAN GET A
SENSE OF WHAT BIOLOGICAL
PATHWAYS AND/OR ANATOMICAL
LOCALIZATIONS ARE
OVERREPRESENTED IN THE GENE CELL
THAT IS LIKELY RESPONSIBLE FOR
COMMON VARIANT RISK ASSOCIATED
WITH SCHIZOPHRENIA. WHEN YOU DO
THAT, ONE ANSWER COMES OUT AS
PARTICULARLY STATISTICALLY
ROBUST. THAT IS A VERY LARGE
NUMBER OF THESE LIKELY GENES ARE
ASSOCIATED WITH THE SYNAPSE. IN
PARTICULAR THAT INCLUDES SIZE OF
THE SYNAPSE, PRE-SYNAPSE AND
POST SYNAPSE AND MULTIPLE
DIFFERENT COMPONENTS OF THOSE
SYNAPTIC LOCATIONS, WHETHER IT
BE POST SYNAPTIC DENSITY OR POST
SYNAPTIC MEMBRANE, ACTIVE ZONE
ON THE PRE-SYNAPTIC SIDE,
SYNAPTIC VESICALES, PRE-SYNAPTIC
MEMBRANE OR ZONE WHERE SYNAPTIC
VESICALES ARE DOCKED WITH THE
MEMBRANE. EACH OF THOSE PLACES
IS REPRESENTED OR I SHOULD SAY
OVERREPRESENTED EACH OF THE
MOLECULAR COMPONENTS OF THOSE
PLACES ARE OVERREPRESENTED ON
THE RISK -- LIST OF RISK GENES
FOR SCHIZOPHRENIA. SUGGESTING
INDEED THAT WE SHOULD BE PAYING
ATTENTION TO TO SYNAPTIC BIOLOGY
IF WE WANT TO UNDERSTAND GENETIC
RISK FOR SCHIZOPHRENIA. THIS
NEXT PAPER PUBLISHED
SIMULTANEOUSLY IN NATURE LOOKED
INSTEAD OF RARE -- THE COMMON
VARIANTS THAT ACCOUNT FOR EACH
SMALL AMOUNTS OF RISK LOOK FOR
OPPORTUNITIES TO IDENTIFY RARE
CODING VARIANTS THAT ENCODE
LARGE AMOUNTS OF RISK FOR
SCHIZOPHRENIA. IN THIS PAPER
IDENTIFIED APPROXIMATELY 10
GENES WHICH MEET A VERY, VERY
STRINGENT STATISTICAL CRITERIA
FOR BEING LINKED TO
SCHIZOPHRENIA, THEY ARE LISTED
HERE, AS WELL AS SOMETHING ON
THE ORDER OF ANOTHER 20 GENES OR
SO, HERE IN YELLOW. WHICH ARE
LIKELY ASSOCIATED WITH
SCHIZOPHRENIA BUT DON'T MEET THE
SAME STRINGENT STATISTICAL
CRITERIA WITH THE CURRENT DATA
SET. I WILL POINT OUT, IF YOU
CAN ADVANCE ONE MORE, GO BACK,
SORRY, THOUGHT THERE WAS A
CIRCLE, POINT OUT SEVERAL OF
THESE SUCH AS GRIN 2A, CACNAC
AND GIA 13 REPRESENT GENES
EXPRESSED IN SYNAPSES. AND SO IN
THE CASE OF RARE VARIATION THAT
CONFERS LARGE AMOUNTS OF RISK,
SOME OF THESE HARD TO ESTIMATE
RISK BECAUSE THEY ARE SO RARE
BUT FOR EXAMPLE GRIN 2A, THESE
ARE MANY TENS OF MULTIPLES OF
RISK HIGHER, HIGHER RISK OF
GETTING SCHIZOPHRENIA IF YOU
HAVE THE GENE VARIANT IN THE
GENES THAT STOPS THE FUNCTION OF
THE GENE. ANY CASE, BPO STIPES
OF GENETIC RISK SYNAPSE BIOLOGY
IS COMING UP AS SOMETHING THAT
WE NEED TO PAY ATTENTION TO IF
YOU WANT TO UNDERSTAND
SCHIZOPHRENIA. SO MOVING AWAY
FROM GENETIC DISCOVERY, UP THE
TRANSLATIONAL PIPELINE, I WANT
TO TELL YOU ABOUT ANOTHER PAPER
THAT'S BEEN PUBLISHED EARLY THIS
YEAR, LOOKING AT TRYING TO
UNDERSTAND THE BIOLOGY OF
ANXIETY. AND IN PARTICULAR ITS
INTERSECTION WITH AUTONOMIC
NERVOUS SYSTEM. SO ONE OF THE
THEORIES OF ANXIETY IS WE HAVE
AN OVERACTIVE RESPONSE TO
AUTONOMIC STIMULI. AND SO CALLED
AUTONOMIC HYPERSENSITIVITY.
REGULATING AUTONOMIC SENSITIVITY
IS THE JOB WE THINK OF THE
VENTROMEDIAL PREFRONTAL CORTEX,
VARIOUS METHODS ARE USED TO SHOW
AUTONOMIC, ONE TO USE ADRENERGIC
STIMULATION AS A PROBE, YOU CAN
SHOW INDIVIDUALS WITH GENERALIZE
ANXIETY DISORDER ARE MORE
SENSITIVE TO MORE PERIPHERAL
ADRENERGIC STIMULATION. THIS
PAPER ATTEMPTED TO UNDERSTAND
WHETHER THERE'S DIFFERENCES IN
THE BRAINS OF GAD THAT ACCOUNT
FOR THEIR AUTONOMIC
HYPERSENSITIVISENSITIVITY. THISH
SHOWED THAT PATIENTS WITH
GENERALIZED ANXIETY DISORDER
HAVE DEFICITS IN THEIR VENTRO
MEDIAL PREFRONTAL CORTEX
RESPONSE TO STIMULATION WITH
ADRENERGIC ACTIVITY, THEY HAVE A
BLUNTED RESPONSE TO THE
ADRENERGIC STIMULATION
SUGGESTING PERHAPS THAT THE
VMPFC IS UNABLE TO ACCOMPLISH
ITS ROLE. AND THEY ALSO HAVE
DIFFERENCES IN MANY THE VENTRO
MEDIAL PREFRONTAL CORTEX IN THE
INSULA AS WELL, SORRY DIFFERENT
PART OF THE CORTEX, WHERE THE
PATIENT WITH GAD HAVE AN
INCREASE IN THE ACTIVITY WITHIN
THE INSULA. WHAT DOES THAT MEAN
IT MAY BE A WAY TO IDENTIFY
INDIVIDUALS WITH GAD WHO HAVE A
PARTICULAR TYPE OF GAD,
AUTONOMIC HYPERSENSITIVITY. AND
TARGET TREATMENTS THAT MIGHT
UPREGULATE ACTIVITY IN THESE
BRAIN REGIONS THAT ARE
INAPPROPRIATELY DOWN REGULATED
OR VICE VERSA, IN ORDER TO
ATTEMPT TO REDUCE ANXIETY.
IMPORTANTLY WHETHER OR NOT THAT
WORKS AS TREATMENT IT CAN WORK
AS WAY TO TEST THE THEORY
ITSELF. REMEMBER THE THEORY IS
THAT AUTONOMIC HYPERSENSITIVITY,
HYPERSENSITIVITY TO YOUR OWN
BODILY SIGNAL COULD IN AND OF
ITSELF CAUSE ANXIETY SYMPTOMS
AND WE CAN NOW TEST THAT THEORY
BY TRYING TO REGULATE THE
RESPONSE TO AUTONOMICS USING
THESE BRAIN REGIONS THAT ARE
RESPONSIBLE TO TRY TO DAMPEN IT
TO SEE IF THAT IN AND OF ITSELF
WILL REDUCE ANXIETY SYMPTOMS OR
WHETHER IT IS SIMPLY A MARKER OF
INDIVIDUALS WITH ANXIETY.
MOVING FURTHER UP THE
TRANSLATIONAL PIPELINE LET'S
TALK RESEARCH THAT HAS THE
POTENTIAL TO MAKE A DIFFERENCE
IN THE NEAR TERM. THIS IS
RESEARCH OUT OF OUR DIVISION OF
SERVICES INTERVENTION RESEARCH,
LOOKING AT WAYS TO REDUCE
DURATION OF UNTREATED PSYCHOSIS
IN REAL WORLD SETTINGS. MANY
KNOW DATA FROM NUMBER OF
DIFFERENT STUDIES, MUCH OF IT
SUPPORTED BY NIMH SHOWSNA THE
SOONER YOU GET PEOPLE WITH
PSYCHOSIS INTO TREATMENT DURING
VERY FIRST EPISODE, THE BETTER
THEY WILL DO IN THE LONG RUN. SO
A MAJOR POLICY GOAL IS TO REDUCE
THE TIME IT TAKES FOR SOMEONE
WITH A FIRST EPISODES OF
PSYCHOSIS TO BE RECOGNIZED AS
HAVING THAT PSYCHOSIS AND TO BE
REFERRED AND ACTUALLY GO INTO
TREATMENT. THIS PROGRAM USED A
COMBINATION OF A NUMBER OF
DIFFERENT INTERVENTIONS. MOST
NOTABLY IN AN EFFORT TO ENSURE
THAT THE HAND OFF FROM TREATMENT
IS FACILITATED. THE -- TO TEST
WHETHER THE COMBINATION OF
INTERVENTIONS CALLED STEP MIGHT
REDUCE THE TIME IT TAKES TO GET
PEOPLE INTO TREATMENT, WHAT YOU
CAN SEE FROM THESE GRAPHS, SORRY
THE DESIGN OF THIS WAS A SO
CALLED CLUSTER RANDOMIZED TRIAL
AND WHERE YOU ARE -- PUTTING
INTERVENTION INTO SOME SITES AND
NOT USING ITS IN OTHER SITES
SITES YOU CHOOSE FOR
INTERVENTION VERSUS NOT
RANDOMIZED. THIS ALLOWS YOU TO
CONDUCT RESEARCH IN COMMUNITY
BASED SETTINGS AND COMPARE THE
EFFECT OF THE INTERVENTION TO
CHANGE IN THE INTERVENTION. YOU
CAN SEE ACROSS A RANGE OF
DIFFERENT -- DIFFERENT
PRESENTING LEVELS THAT THE
DURATION OF UNTREATED PSYCHOSIS
WAS REDUCED IN THE INTERVENTION
SITES COMPARED TO THE CONTROL
SITES. NEXT SLIDES SLIDE. FINALE
MORE TREATMENT RELATED STUDY I
WANTED TO SHARE WITH YOU GIVEN
WE DO HAVE JUST A COUPLE OF
MINUTES TO DO IT. MAINTENANCE
OF WELLNESS IN PATIENTS WITH
OBSESSIVE COMPULSIVE DISORDER
HAS BEEN A REAL PROBLEM. IN THAT
MANY INDIVIDUALS WITH OCD MAY OR
MAY NOT STAY ON THEIR MEDICINE,
MANY RELAPSE AND ONE OF THE MAIN
STAYS OF TREATMENT FOR OCD IS IN
THE EXPOSURE RESPONSE PREVENTION
WHICH IS AN EVIDENCE BASED
PSYCHOTHERAPY, IN FACT SEVERAL
STUDIES DEMONSTRATED THAT
EXPOSURE RESPONSE PREVENTION CAN
BE MORE EFFECTIVE THAN
MEDICATION AT LEAST OVER THE
SHORT TERM. SO OF PRACTICAL
INTEREST TO PRACTICERS IS
WHETHER YOU CAN SUCCESSFULLY
DISCONTINUE MEDICATION IN
INDIVIDUALS WITH OCD WHO HAVE
BEEN TREATED WITH EXPOSURE
RESPONSE PREVENTION. SO THIS
TRIAL ATTEMPTED TO ANSWER THAT
QUESTION. NEXT SLIDE. THE
RESULTS WERE, WELL, DECIDEDLY
MIXED. TO SAY THE LEAST. ONE
HAND WHAT YOU CAN SEE FROM THE
DATA HERE IS THAT IN BOTH
GROUPS, THOSE WHO TAPERED
MEDICINE AND THOSE WHO CONTINUED
ON MEDICINE, THERE WAS A GRADUAL
INCREASE IN SCORE SYMPTOM SCORES
Y BOX, PRINCIPLE OUTCOME IN
OBSESSIVE COMPULSIVE SYMPTOMS
OVER 24 WEEKS OF THE STUDY. OF
NOTE THOSE WHO CONTINUE THEIR
MEDICATIONS MAINTAINED SLIGHTLY
BETTER QUALITY OF LIFE AND
SATISFACTION SCORES. AND
SLIGHTLY BETTER DEPRESSION
RELATED SCORES. SO ALTOGETHER
THESE DATA SUGGEST THAT THE
MEDICATION CONTINUES TO PLAY A
ROLE IN MAINTENANCE OF WELLNESS
AFTER EXPOSURE RESPONSE
PREVENTION. THE ADVANTAGE IS
MODEST SO NOT A HARD RULE TO
EXPECT PATIENTS TO STAY ON
MEDICATION BUT AT LEAST WE CAN
RELIABLY WARN THEM THERE IS
STILL A ROLE FOR CONTINUING
MEDICATION AFTER EXPOSURE
RESPONSE PREVENTION BASED UPON
THIS DATA. SO THAT IS THE END OF
MY UPDATE FOR YOU, HOPEFULLY YOU
GOT A SENSE WHERE WE ARE IN
TERMS OF INTERACTIONS WITH
POLICY MAKERS, APPROPRIATIONS
AND BUDGET, NEWS FROM HHS, NIH
AND NIMH AND SOME IDEA OF THE
KIND OF WORK WE SUPPORTED OVER
THE PAST SEVERAL YEARS AND THE
RESULTS WHICH HAVE FROM VARIOUS
DATA THAT I SHOWED YOU FOR LONG
TERM MEDIUM TERM AND SHORT TERM
TIME FRAMES FOR IMPACT UPON
PUBLIC HEALTH. WITH THAT I WILL
OPEN UP FOR SOME QUESTIONS. YOU
CAN CUT OUT THE SLIDES. SO WE
HAVE PLENTY OF TIME FOR
QUESTIONS AND DISCUSSION.
>> GO AHEAD TED.
>> THEY JOSH HOW ARE YOU. THERE
WAS BLURRINESS. I HAD A QUESTION
WHEN YOU LOOK AT THE GRAPH WITH
LOOK AT FUNDAMENTAL RESEARCH AND
CLINICAL RESEARCH AND DIFFERENT
PARTS OF THE PORTFOLIO AT NIMH.
FIRSTLY I LIKE THE WORD
FUNDAMENTAL IN TERMS OF RESEARCH
MORE THAN BASIC PREFERENCE,
DOESN'T MATTER. ONE QUESTION I
HAD, THAT DOESN'T TAKE INTO
ACCOUNT BRAIN FUNDED WORK I
ASSUME. THAT IS I WOULD IMAGINE
GOING TO FALL LARGELY IN THE ONE
CATEGORY NIMH SEEMED LIKE WAS
DROPPING WHICH WAS THE MORE
FUNDAMENTAL BASIC RESEARCH SIDE.
SO WONDER IF YOU COULD COMMENT
ON BRAIN FUNDING AND IS THAT
CLEARLY HAS A INFLUENCE ON THE
BROADER FUNDENING THE AREA OF
MENTAL HEALTH AND IT IS NOT
TAKEN INTO ACCOUNT IN THAT
GRAPH. SO FIRST I WANTED A SMALL
CORRECTION. THE FUNDAMENTAL
BASIC RESEARCH, THE RESEARCH
THAT DOESN'T LOOK SPECIFICALLY
AT DISEASE PROCESSES OR DISEASE
MODELS IS ACTUALLY INCREASING
SLOWLY OVER THE LAST --
>> I'M SORRY, I GUESS --
>> NOT DECREASING.
IT WAS THE DISEASE FOCUS BASIC
RESEARCH, THOSE ARE STUDIES THAT
LOOK AT DISEASE MODELS WHETHER
ANIMAL MODEL OR TISSUE MODEL OR
THAT ARE SPECIFIC LOOKING AT
PATHOPHYSIOLOGICAL HYPOTHESES.
THAT'S SLIGHTLY DECREASING OVER
THE LAST THREE TO FOUR YEARS
AFTER INCREASE PREVIOUS TO THAT.
BUT WHAT ABOUT BRAIN? YOU ARE
RIGHT THE DATA THAT I SHOWED YOU
WAS NON-BRAIN FUNDING. AND MOST
OF THE BRAIN DOLLARS WOULD
PROBABLY FIT INTO MOST BRAIN
DOLLARS OF RELEVANCE WILL
PROBABLY FIT INTO BASIC
RESEARCH. THERE ARE NUMBER OF
BRAIN PROJECTS THAT ARE DISEASE
FOCUSED INCLUDING SOME THAT ARE
REALLY IN THE TREATMENT
DEVELOPMENT SPACE. FOR EXAM IT
WILL BRAIN FUNDED SEVERAL
PROJECTS ON EFFECTS ON BOTH
INVASIVE AND NON-INVASIVE
INTERVENTIONS THAT BRAIN
STIMULATION THERAPIES, FOR
DEPRESSION OCD AND OTHER MENTAL
ILLNESS DIAGNOSES. SO THERE'S
SOME DISEASE FOCUSED WORK BOTH
ON THE CLINICAL SIDE AND BASIC
SIDE IN BRAIN BUT MOST IS IN
BASIC SCIENCE. SO IF YOU WOULD
LOOK AT THOSE EXPENDITURES,
PROPORTIONALLY, THAT WOULD
FURTHER SUPPORT RESEARCH IN THE
BASIC CATEGORY BE IT FUNDAMENTAL
OR DISEASE FOCUSED.
>> SEEMS LIKE I GUESS THEN IF
YOU LOOK OVERALL, THE
FUNDAMENTAL CLINICAL RESEARCH IS
REALLY DROPPING. WAS THAT A FAIR
ASSUMPTION?
>> YEAH. IF WE CAN -- I DON'T
KNOW ALEX WE CAN GET THAT SLIDE
BACK UP.
>> I THINK IT WAS 80, IF I WROTE
DOWN A SLIDE NUMBER.
>> WHAT YOU WILL SEE AS THAT
COMES UP IS THAT THERE WAS A --
THAT CATEGORY OF RESEARCH
INCREASED IN THE FIRST HALF OF
THE DECADE OR SO THAT IN THE
PAST. AND THEN DECREASED AGAIN
IN THE SECOND HALF. RECEIVE THIS
IS THE GREEN LINE DISEASE
RELATED BASIC RESEARCH, SO
INCREASE IN 2010 TO 2014 I DON'T
KNOW EXACTLY WHY. THAT INCREASE
OCCURRED. THEN THERE WAS
DECREASE. I WANT TO POINT OUT
THAT EVEN THOUGH THESE NUMBERS
LOOK LIKE DECREASES OR INCREASES
AS PERCENT OF TOTAL FUND, EVERY
SINGLE -- EACH OF THESE THREE
CATEGORIES HAVE BEEN INCREASING
IN EXPENDITURES AS THE NIMH
BUDGET HAS GONE UP. SO IF YOU
PUT THIS IN REAL DOLLARS THERE
IS NO DECREASE IN INVESTMENTS IN
ANY OF THESE THREE AREAS FROM
2016 TO 2020, ALL INCREASING IN
THE NUMBER OF DOLLARS THAT ARE
BEING SPENT.
>> I GUESS I WOULD ASK A
FOLLOW-UP QUESTION WHICH IS THAT
IF DISEASE RELATED BASIC FUNDING
IS DROPPING, I HEAR WHAT YOU SAY
ABOUT THE -- EVERYTHING IS
RISING. BUT RELATIVELY, IT IS
DROPPING. HOW WILL THAT IMPACT
OUR ABILITY TO UNDERSTAND
THERAPIES WHEN WE HAVE THEM? IT
WOULD SEEMS TO ME WE NEED
DISEASE RELATED BASIC STUDIES TO
KNOW THE THERAPIES WE ARE USING
ARE EFFICACIOUS.
>> THE ANSWER DEPENDS ON THE
CAUSE. AND I DON'T THINK WE
FULLY UNDERSTAND IT YET. BUT LET
ME STOP YOU AND SAY YEAH IT IS
DROPPING BUT STILL REMAINS A
SIGNIFICANT CHUNK OF INVESTMENT,
EVEN IF YOU LOOK SOLELY BASE OF
THE CATEGORY THE MAJORITY OF
FUNDS GOING TOWARDS BASIC
RESEARCH ARE DISEASE FOCUSED
AREAS. SO THEY ARE TRYING TO
LOOK AT ANXIETY, TRYING TO LOOK
AT MOOD, TRYING TO LOOK AT
UNDERSTAND COGNITIVE PROCESSES
THAT GO AWRY IN ILLNESS. SO THAT
IS FALLENING THE GREEN LINE SO
IF IT IS DROPPING IT REMAINS A
SIGNIFICANT CHUNK OF
EXPENDITURES. SECONDLY, AGAIN AS
I ARGUED BEFORE WE HAVE REALLY
BEEN PUSHING AWAY FROM
INAPPROPRIATELY LABELING BASIC
STUDIES THAT ARE REALLY SHOULD
BE FOCUSED ON BASIC HYPOTHESES
AND NOT CALLING THEM A MODEL OF
SCHIZOPHRENIA OR MODEL OF AUTISM
WHERE IT IS INAPPROPRIATE. SO
SOME OF THAT DROP IS LIKELY DUE
TO NOT TO CHANGE THE EMPHASIS OF
SCIENCE BUT CORRECT
CATEGORIZATION THE LANGUAGE THE
SCIENCE IS USING. FINALLY THE
OTHER THING WE ARE DOING IS
PUSHING PEOPLE TO DO DISEASE
RELATED RESEARCH IN HUMANS. AND
THAT HAS SOME PITFALLS WE WILL
TALK ABOUT WHEN WE GET A LITTLE
LATER IN THE OPEN PROGRAM WE
WILL TALK ABOUT PROPOSED WORK
GROUPS IN HIGH DIMENSIONAL DATA
SETS BUT WE RECOGNIZE IF WE WANT
TO UNDERSTAND SCHIZOPHRENIA AND
AUTISM AND MAJOR DEPRESSIVE
DISORDER WE NEED A SENSE OF
NEUROBIOLOGY IN HUMANS AND AS
OUR TECHNOLOGIES IMPROVE WE CAN
ANSWER A LOT OF THOSE QUESTIONS
SO FOR EXAMPLE, FOR WELL OVER
FIVE YEARS WE HAVE BEEN
DISCOURAGING GENETIC RESEARCH
FORWARD GENETIC RESEARCH IN
RODENTS THAT SEEKS TO TRY TO
UNDERSTAND THE GENETICS OFFER
MOOD FOR EXAMPLE, BECAUSE WE CAN
PERFECTLY WELL DO GENETIC
STUDIES IN HUMAN BEINGS AND NOT
JUST TRY TO STUDY SOME ANIMAL
CORRELATE OF MOOD BUT ACTUALLY
STUDY DEPRESSION. SO THOSE
KINDS OF THINGS ARE DELIBERATE
PUSH FROM A POLICY PERSPECTIVE
TO TRY TO MOVE SOME OF THE
DISEASE FOCUS RESEARCH INTO
HUMAN MODELS.
>> IT IS WORTH SAYING THAT THE
KETAMINE CAME FROM PUTTING DRUGS
ON BRAIN SLICES SO IN USUALLY AT
LEAST AND IT IS OBVIOUSLY THEN
WAS APPLIED IN CLINIC THE TERM
OF TARGET. SOMETHING TO THINK
ABOUT AND ONE THING THAT MIGHT
HELP IS TO GRAPH THIS AT SOME
POINT WITH THE ORANGE AND GREEN
COMBINED BECAUSE I LIKE YOUR
POINT, JOSH, I THINK THE POINT
ABOUT THE FACT THAT SOME OF THE
DISEASE RELATED BASIC WORK THAT
FIVE YEARS AGO MIGHT BE COUNTED
AS DISEASE RELATED BASIC IS NOW
IN FUNDAMENTAL BASIC CATEGORY
THAT HELPS UNDERSTAND THE
CHANGES A LITTLE BIT BETTER.
>> RIGHT. AND IF YOU DO THAT
AGAIN WHAT YOU ARE LOOKING AT IS
INVERSE OF THE BLUE CURVE, YOU
ARE LOOKING ANYWHERE BETWEEN 50
AND 60% OF EXPENDITURE IT IS
LAST DECADE ON THE BASIC SCIENCE
SIDE. BRIAN.
>> THANKS. ONE MORE COMMENT. I'M
GLAD YOU ARE PUSHING IN THIS
AREA BECAUSE TOO OFTEN THE ONLY
VOICES AT THE TABLE TALKING
PORTFOLIO ARE ARGUING WE NEED TO
BE SPENDING MORE ON CLINICAL
REALM. IT IS IMPORTANT FOR US TO
REMEMBER THINGS LIKE THE FACT
THAT KETAMINE CAME FROM THROWING
DRUGS ON TO BRAIN SLICES, AND
THE BASIC RESEARCH IS PLAYING A
ROLE IN MANY DEVELOPMENTS THAT
HAVE LED TO NOVEL THERAPIES,
INCLUDING PSYCHOSOCIAL
INTERVENTION AS WELL AS DRUG AND
DEVICE BASED THERAPIES.
>> THAT PAPER I DON'T REMEMBER
EXACTLY WHERE IT WAS PUBLISHED
BUT IT WAS NOW PUBLISHED IN
NATURE SCIENCE -- NOT PUBLISHED
IN NATURE SCIENCE OR CELL.
>> NO IT WAS NOT.
>> YOU CAN PROBABLY ADD
(INAUDIBLE) SILL SIGH BEAN TO
THAT LIST AS WELL. ONE THING I
WAS STRUCK BY AND GLAD YOU
PLEASED THAT YOU HIGHLIGHTED IT.
IS THE CONVERGING EVIDENCE NOW
OVER MANY YEARS PSILOCYBIN THAT
AMONG MANY CAUSES OF
SCHIZOPHRENIA, SYNAPTIC BIOLOGY
SORT OF FUNDAMENTAL SYNAPTIC
PROCESSES APPEAR TO BE
DISREGULATED IN A WAY THAT I
WOULD SAY IS NOT UNDERSTOOD AT
ALL BUT CLEARLY IS A CORE
FEATURE OF THE ILLNESS AND WE
ARE GETTING -- THERE WAS
RECENTLY A PAPER PUBLISHED IN
NATURE SUGGESTING THAT
INHIBITORY AND EXCITATORY
NEUROTRANSMISSION IS ALSO
FUNDAMENTALLY ALTERED IN AUTISM
FOR YEARS, DECADES, OTHER
INSTITUTES HAVE BEEN LEADING THE
CHARGE ON UNDERSTANDING SYNAPTIC
BIOLOGY. I WONDER IF THIS IS AN
APPROPRIATE TIME TO STEP BACK
BECAUSE THERE REALLY -- YOU KNOW
IT REALLY IS AN AREA THAT IS
UNDERSTUDY NOW, THERE ARE MANY
NEW TECHNOLOGIESNA HAVE COME TO
THE FLOOR SINCE THEN, TARGETED
PROTEOMICS AND THINGS LIKE THAT
WHICH CAN GIVE INSIGHTS THAT
PREVIOUSLY WERE UNATTAINABLE
WHETHER WHETHER THIS MIGHT BE
THE TIME TO THINK ABOUT NEW
INITIATIVES TO FOSTER
APPLICATIONS. WE GET A
TREMENDOUS -- AS YOU KNOW A
TREMENDOUS NUMBER OF
APPLICATIONS RELATED TO
CIRCUITRY BASED STUDIES WHICH
ARE AWESOME, THEY ARE GREAT, I
LOVE THE THEM. BUT IT IS SUGGESG
THAT IT IS AT A FINER LEVEL OF
CIRCUIT NOW THAT WE NEED TO
FOCUS IN ON HERE. AND WILL
REALLY ISN'T THE COHORT OF
INVESTIGATORS THAT WAS AVAILABLE
SAY 20 YEARS AGO FOR THIS AREA.
SO WHAT ARE YOUR THOUGHTS ON
THAT?
>> BRIAN, I THINK YOU RAISE A
REALLY IMPORTANT POINT. YOU ARE
RIGHT, MUCH OF OUR BASIC
PORTFOLIO, DISEASE FOCUS OR
FUNDAMENTAL,, HAS MOVED WITH THE
STAGIEST IN NEUROSCIENCE TO
FOCUS ON THE ROLE OF
NEUROSCIENCE AND THAT IS
INCREDIBLY IMPORTANT WORK, WE
NEED TO UNDERSTAND THE CIRCUITS
THAT GOVERN MANY OF OUR
BEHAVIORS. I THINK THAT CIRCUIT
WORK IS GOING TO BE REALLY
IMPORTANT IN ORDER TO KNOW WHERE
IN THE BRAIN TO LOOK FOR HOW OUR
DISEASES MANIFESTED. BUT THE
LOCUST OF DYSFUNCTION OR ONE
LOCUST OF DYSFUNCTION IN
SCHIZOPHRENIA QUITE LIKELY AS
YOU POINTED OUT, OTHERS AS WELL
IS INDEED IS SYNAPSE. I THINK A
FOCUS ON REINRIG RATING RESEARCH
IN SYNAPTIC BIOLOGY WITHIN THE
CONTEXT OF MENTAL ILLNESS WILL
BE IMPORTANT TO DO. I WOULD ADD
TO THAT EXPERTISE, IT WAS
IMPLICIT WHAT YOU SAID BUT NOT
EXPLICIT, THAT WE NEED GREATER
EMPHASIS ON BIOCHEMISTRY, ON THE
MOLECULAR COMPONENTRY THAT MAKE
UP OUR CIRCUITS WHETHER AT THE
SYNAPSE OR OTHER PLACES MANY THE
CELL. AND I ASSURE YOU OUR
DIVISION -- STAFF AND DIVISION
OF NEUROSCIENCE BASIC BEHAVIORAL
SCIENCES IS LISTENING TO THIS
AND WILL TAKE THAT INTO ACCOUNT
AS THEY THINK ABOUT PRIORITIES
FOR THE COMING YEARS.
>> THANK YOU, THANKS FOR THE
OVERVIEW. INTERESTING. EXCITING
TO SEE THE PRESIDENT STATION
UNITY AGENDA, CALLING OUT THE
CRISIS IN MENTAL HEALTHCARE
ACROSS THE COUNTRY. CAN YOU TELL
US A BIT MORE ABOUT HOW NIMH
WILL WORK WITH OTHER AGENCIES
GIVE US A SENSE OF WHAT THIS
MEANS? CURIOUS TO KNOW WHAT THIS
MEANS FOR IMPLEMENTATION SCIENCE
IN THE NIMH PORTFOLIO FOR
ENSURING WHAT WE KNOW WORKS
ACTUALLY MOVES TO THE NEXT STAGE
OF SCALE UP AND IMPLEMENTATION?
ANY OTHER INSIGHTS?
>> LET ME START WITH A LITTLE
BIT OF HISTORY TO THIS. NIMH HAS
BEEN CONSULT WIDE THE WHITE
HOUSE AS EARLY AS DECEMBER AS
THEY WORKED TO PUT TOGETHER
THEIR UNITY AGENDA AS PARTS OF
THEIR CONSULTATION PROCESS WITH
HHS. AS I MENTION MANY OF THE
ACTION ITEMS IN THE WHITE HOUSE
IMPLEMENTATION PLAN WERE ITEMS
THAT WE SUGGESTED OR OTHER
AGENCIES SUGGESTED BUT THAT
BUILD ON EVIDENCE BASE PRACTICES
THAT Y'ALL ALL THE SCIENTISTS
OUTS THERE LISTENING HAVE
PIONEERED OVER THE COURSE OF THE
LAST COUPLE OF DECADES. SO
THAT'S BEEN GOOD NEWS AND IT'S
BEEN WONDERFUL WATCHING THAT
PROCESS HAPPEN. AS WE MOVE FROM
THE FACT SHEET TO ACTUALLY
IMPLEMENTING IT, NIMH IS PART OF
AN HHS-WIDE TEAM THAT IS BEING
OVERSEEN BY THE WHITE HOUSE TO
PUT MANY OF THOSE PLANKS INTO
ACTION TO FIGURE OUT HOW WE DO
-- HOW WE EXPAND ACCESS TO
MENTAL HEALTH AS MUCH ASS IN
SCHOOLS, HOW DO WE INCREASE THE
NUMBER OF MENTAL HEALTH
PRACTICERS AROUND/OR EFFICIENCY
WHICH THEY CAN RESPOND TO
CRISES, ET CETERA. SO WE SERVE
IN THAT WAY MUCH AS ADVISORS.
AND TRYING TO POINT THE WAY THE
RESEARCH STUDIES HAVE BEEN
ALREADY ACCOMPLISHED. THE
RESEARCH COMPONENT OF THIS PLAN
HAS BEEN MORE SLOW TO DEVELOP.
IN THE INITIAL RELEASE THAT WAS
OUT IN JANUARY, THE ONLY
RESEARCH COMPONENT WAS THE CALL
FOR MORE RESEARCH INTO THE
MENTAL HEALTH IMPACT OF SOCIAL
MEDIA. BUT THE OFFICE OF SCIENCE
AND TECHNOLOGY POLICY AS WELL AS
HHS, HAVE BEEN TRYING TO GUILTY
GUSH OUT WHAT RESEARCH IS NEEDED
TO BE ABLE TO ENSURE THAT --
FIGURE OUT WHAT RESEARCH IS
NEEDED TO BE ABLE TO ENSURE THAT
THESE PLANKS CAN BE FOLLOWED AND
THERE'S BEEN SOME BACK AND FORTH
SO FAR WITH NIMH AND AS I
MENTIONED LAST WEEK, THE
INCLUSION IN THAT PLAN WAS
ADDED, THE PLAN WAS A PLANK OF
THE PLAN WAS ADDED TO FORMULATE
A RESEARCH AGENDA. SO THAT WILL
BE A COLLABORATIVE PROCESS WHERE
WE TALK WHAT EQUITIES WE HAVE
WHAT EVIDENCE WE HAVE AND WHAT
WE SEE AS GAPS AND OTHER
AGENCIES TALK ABOUT WHAT THEY
SEE AS GAPS IN P OUR RESEARCH
PORTFOLIO. AND WE HOPE THAT
ALONG WITH THAT AGENDA WILL COME
ADDITIONAL RESOURCES TO ENSURE
WE ACCOMPLISHED THAT. AS I
MENTIONED ALSO I'M PLEASED THAT
BOB WILL BE MOVING TO OFFICE OF
DIRECTOR AT NIMH TO SERVE AS ONE
OUR CHIEF LIAISONS WITH THESE
AGENCIES TO ENGAGE IN THIS KIND
OF BACK AND FORTH DISCUSSION
ABOUT WHAT WE HAVE TO OFFER AND
THE WAYS WE NEED TO THINK ABOUT
FOCUSING OUR SERVICES AND
INTERVENTION RESEARCH PORTFOLIO
TO ENSURE WE ANSWER QUESTIONS OF
USE TO THOSE WHO ARE OUTS THERE
TRYING TO IMPLEMENT THESE
PRACTICES. SO I DON'T -- THAT
MIGHT HAVE BEEN VAGUE. I DON'T
KNOW IF I HAVE SPECIFIC ANSWERS
YET TO YOUR QUESTIONS BUT WHAT
WE CAN ANTICIPATE IS THAT THIS
IS GOING TO BE AN EXCITING YEAR
AND YEAR TO COME AND THERE WILL
BE DEVELOPMENTS IN SPECIFICALLY
IN THE AREA OF SERVICES
INTERVENTION RESEARCH THOUGH
THERE IS INTEREST REALLY ACROSS
OUR PORTFOLIO.
>> THANK YOU.
>> AKNEE THAT, SPEAKING OF ONE
OF THOSE AGENCIES WE WORK IN A
BIDIRECTIONAL WAY.
>> I KNOW YOU ARE WARE BUT TO
PROGRAM'S QUESTION ABOUT
IMPLEMENTATION SCIENCE, IT IS A
SMALL PORTFOLIO BUT WE HAVE BEEN
WORKING WITH NIMH CLOSELY WHERE
WE CAN AND EXAMPLE OF THAT IS
PARTNERING AND IMPLEMENTATION
SCIENCE RESEARCHERS TOGETHER
WITH THE CCBHC PROJECT WE HAVE
LOOKING AT DIFFERENT
INTERVENTIONS, EVIDENCE BASED
INTERVENTIONS AND WHAT ARE THE
BEST PATHWAYS TO ADOPT EVIDENCE
BASED MEDICINE IN THOSE LARGE
CLINIC SETTINGS.
>> ONE OF THE BIGGEST PROGRAMS
RIGHT NOW IN IMPLEMENTATION SIDE
IS LEARNING HEALTHCARE SYSTEM
EPINET LOOK AT FIRST PSYCHOSIS
AND WE ARE TRYING TO EXPLORE
WITH ANITA AND OTHERS AT SAMSA,
OTHER WAYS OF MENTAL HEALTH AS
WELL. TED.
>> I WANTED TO COMMENT ON THAT,
THANKS FOR THE DISCUSSION ABOUT
THIS, REALLY EXCITING TO HEAR
ABOUT THE PLANS. THE OTHER THING
I HAD IS A PIECE OF THIS IS THE
ARPA, HEALTH ARPA TO ADVANCE
RESEARCH PROJECT HEALTH AGENCY.
MAYBE TOTALLY MISPRONOUNCING.
SORRY. BUT THERE WAS A
ANNOUNCEMENT WENT AROUND I SAW
IN ONE OF THE THINGS I SAW ABOUT
THE MAYBE THE LIST FOR DIRECTOR.
OR ANNOUNCEMENTS ABOUT IT
PHYSICAL ESTABLISHMENT, I WAS
SURPRISED TO NOT SEMEN TALL
HEALTH THERE. AND THAT WAS
INTERESTING TO ME AS IT FLEW BY,
I COULD UNDERSTAND FIND THE
EXACT READINGS BUT SOMEONE
COMMENTED AUTISM WASN'T THERE TO
ME SPECIFICALLY FOR CENTER FOR
DISABILITY DEVELOPMENT AND I
REALIZE GENERALLY MENTAL HEALTH
WASN'T SO THAT SOMETHING I THINK
WHERE DO YOU SEE THEM IN MENTAL
HEALTH CRISIS, IN CONNECTING TO
NIMH?
>> FIRST THE MORE GENERAL THEN
MORE SPECIFIC. ARPA H WAS A
PRIORITY OF THE PRESIDENT,
GARNERED SUPPORT FROM CONGRESS,
THE PRESIDENT HAS A SET OF
HEALTH TALKING POINTS WITH ARPA
H WHICH INCLUDE DIABETES AND
CANCER BUT DID NOT INCLUDE
MENTAL HEALTH. SO IN A LOT OF
MATERIALS AND ANNOUNCEMENTS AND
THINGS LIKE THAT, THE INITIALLY
IDENTIFIED POTENTIAL AREAS OF
EMPHASIS INCLUDED THE ONES THAT
THE PRESIDENT IDENTIFIED AND NOT
MENTAL HEALTH. HOWEVER WE HAVE
BEEN ASSURED OVER AND OVER ARPA
H WON'T BE RESTRICTED IN ITS
FOCUS TO THESE AREAS OF
PRIORITY. BUT WILL LOOK BROADLY
ACROSS THE BIOMEDICAL RESEARCH
PORTFOLIO TO LOOK FOR
OPPORTUNITIES TO BRING WHAT THEY
HAVE TO BARE TO ADDRESS ISSUES.
THAT INCLUDES MENTAL ILLNESS.
ALL THE NIH INSTITUTES ABOUT A
YEAR AND A HALF AGO WERE INVITED
TO SUBMIT IDEAS FOR PROJECTS
THAT WE FELT WERE ARPA HABLE,
THAT SOMETHING THAT IS A WORD
NOW. AND NIMH SUBMITTED THREE
POTENTIAL IDEAS THERE. ONE
RELATED TO BIOMARKERS, ONE
RELATED TO LEARNING HEALTHCARE
AND ANOTHER ONE RELATED TO GENES
TO BIOLOGY TRYING TO MAKE THIS
HIGH THROUGH PUT PROCESS TO
UNDERSTAND THE BIOLOGICAL
PATHWAYS IMPLICATED BY GENETIC
RISK. THERE ARE LOTS OF OTHER
AREAS WHERE WE MIGHT ENVISION
ARPA H PLAYING AN IMPORTANT
ROLE. WE DON'T MOW WHICH WILL BE
PURSUED BY THE NEW DIRECTOR. THE
WHOLE POINT OF OF ARPA H IS
EMPOWER DIRECTOR TO PURSUE OUT
OF THE BOX IDEAS. IT IS NOT TO
BE BUSINESS AS USUAL BUT WE HOPE
AND EXPECT CNS IN GENERAL AND
MENTAL ILLNESS IN PARTICULAR
WILL BE AMONG PRIORITIES. WILL
THEY PLAY A ROLE IN THE FOR
EXAMPLE THE RESEARCH STRATEGIC
PLAN THAT I JUST MENTIONED OSTP
IS LEADING AND NIH IS
PARTICIPATING IN, THEY MAY WELL,
THEY ARE NOT YET BECAUSE THEY
DON'T HAVE ANY STAFF TO DO IT.
BUT ONE CAN IMAGINE GIVEN HIGH
PRIORITY THE WHITE HOUSE PUT ON
MENTAL HEALTH THEY WILL ASK ARPA
H TO PLAY A ROLE. WE WILL WAIT
AND SEE. ISH ALSO MENTION A LOT
OF CONSTITUENCIES PARTICULARLY
SELF-ADVOCATES ARE WARE OF THE
GLARING MISS THERE. AND IN THE
INCLUDING MENTAL HEALTH AMONG
INITIALLY IDENTIFIED PRIORITIES
FOR ARPA H AND MAKING THEIR
VOICES HEARD I'M SURE THEY WON'T
BE IGNORE. OTHER COMMENTS OR
QUESTIONS? WE HAVE A FEW MINUTES
LEFT HERE OPT SCHEDULE OR WE CAN
GO TO OUR BREAK EARLY. OKAY. I
THINK THAT WILL DO IT. SORRY.
>> JUST ONE LAST QUESTION. ALSO
GOOD TO HEAR ABOUT CONTINUING
EFFORTS AT NIMH ON DIVERSITY
EQUITY INCLUSION AND I CAN'T
REMEMBER WHAT THE A --
>> ACCESSIBILITY.
>> ACCESSIBILITY. AND THE NIMH
RACIAL ETHNIC EQUITY PLAN, IS
THERE A EVALUATION FRAMEWORK FOR
THIS, HOW WILL YOU KNOW WHEN YOU
ACHIEVED WHAT YOU ARE HOPING TO
ACHIEVE?
>> WE HAD TO INCLUDE IN THERE A
EVALUATION PROCESS. I DON'T
REMEMBER THE DETAILS OF WHAT WE
PROPOSE THERE. BUT ONCE OF THE
MAIN PLAININGS OF EVALUATIONS IS
DATA AND TRANSPARENCY. JUST AS I
HAVE BEEN TRANSPARENT TO Y'ALL
AND PUBLIC WITH REGARD TO FOR
EXAMPLE SUCCESS RATES BY RACE
AND ETHNICITY, AND WE ARE
LOOKING FOR IMPROVEMENT IN THOSE
IN REDUCTION IN THE GAPS,
BETWEEN DIFFERENT GROUPS, WE ARE
ATTEMPTING TO DEVELOP ABILITY TO
MONITOR THAT IN TERMS OF THE
DIVERSITY OF OUR WORK FORCE, IN
TERMS OF FAIRNESS OF LEADERSHIP
OPPORTUNITIES, OF TRANS-NIH
ENGAGEMENT AND INVOLVEMENT OF
AWARDS, ET CETERA. SO THAT IS
THE -- AMONG THE KINDS OF THINGS
WE ARE DOING TO LOOK AT THAT. IN
ADDITION THE FEVS HAS BEEN
INTRODUCING NEW ITEMS, THAT'S
THE -- I DON'T REMEMBER WHAT IT
STANDS FOR BUT THE ANNUAL SURVEY
GIVEN TO ALL FEDERAL EMPLOYEES
THAT MEASURES THEIR SATISFACTION
WITH THE WORKPLACE IN A NUMBER
OF DIFFERENT AREAS. AND WE ARE
NOW THE FEDERAL GOVERNMENT IS
INTRODUCE MORE AND MORE
QUESTIONS IN THERE THAT MONITOR
ISSUES OF FAIRNESS. ALSO GIVEN
US THE ABILITY TO LOOK INTO
RATINGS OF SATISFACTION IN THESE
DIFFERENT AREAS AS FUNCTION OF
INDIVIDUAL RACE AND ETHNICITY.
SO THAT IS ONE MEASURE OF THE
INCLUSIVENESS OF THE ATMOSPHERE
OF THE CULTURE AT NIMH THAT WE
WILL BE FOLLOWING OVER TIME AS
WELL. AGAIN WE WILL BE
TRANSPARENT WITH WHAT WE SHOWED
THE BASELINE DATA FROM 2020 TO
OUR EMPLOYEES AT AND ALL HANDS
MEETING. DID WE DO ALL HANDS? I
CAN'T REMEMBER BUT WE ARE
SPREADING THAT INFORMATION
AROUND AS SORT OF BASELINE
FEDERAL EMPLOYEE VIEWPOINT
SURVEY, THANK YOU, SHELLEY AS
BASELINE MEASURE. SO WE ARE
ESTABLISHING NUMBER OF DIFFERENT
WAYS TO EVALUATE THE IMPROVEMENT
AND CULTURE BOTH FROM A
QUANTITATIVE DATA PERSPECTIVE
BUT ALSO FROM A SUBJECT
EXPERIENCE STANDPOINT. SHELLEY,
IF YOU HAVE ANYTHING TO ADD,
WORK ON WHAT THEY ARE DOING IN
TERMS OF NIH WIDE?
>> I THINK IT IS A WORK IN
PROGRESS. THIS IS A FIRST STEP
AND IT IS ITERATIVE. SO WE ARE
NOT JUST LEARN OURSELVES HOW TO
DO A BETTER JOB OF SETTING
ANGLES AND EVALUATING THEM BUT
LEARNING FROM OTHER ICs SINCE
THIS IS A TRANS-NIH EFFO TRANS-.
>> MAKING THE MILESTONES
IMPORTANT MAYBE AN IMPORTANT
ASPECT OF TRANSPARENCY.
>> WE WILL DO THAT AS WE MOVE
ALONG. RIGHT NOW WE HAVEN'T
GOTTEN THE MACHINERY YET TO BE
ABLE TO DO IT INTERNALLY THOUGH
FEVS -- I DON'T KNOW IF WE CAN
RELEASE FEVS DATA OR IF WE DO IT
NORMALLY, WE DO IT ON INTRAMURAL
SITES BUT GOOD SUGGESTION,
PAMELA, THANK YOU. OKAY. IF
THERE ARE NO FURTHER QUESTIONS
OR COMMENTS WE ARE SCHEDULED TO
TAKE A BREAK UNTIL 2:15 WHICH
POINT I'M EXCITED TO NOTE WE
WILL HAVE A GUEST SPEAKER DR.
KATIE MCLAUGHLIN FROM HARVARD
TALKING STRESS PATHOLOGY IN
CHILDREN THAT, IS A PARTICULARLY
TIMELY TOPIC FOR CONSIDERATION.
WE THOUGHT WE WOULD BRING THIS
WORK TO YOUR ATTENTION SO LOOK
FORWARD TO SEEING YOU AT 2:15 IN
JUST ABOUT 20 MINUTES. WE WILL
START PROMPTLY THEN. IN THE
MEANTIME FEEL FREE TO TURN OFF
YOUR VIDEOS AND MUTE YOURSELVES,
PLEASE STAY CONNECTED JUST SO
MISHAPS LIKE THE ONE THAT
HAPPENED TO ME AT THE BEGINNING
OF THE SESSION DON'T HAPPEN TO
YOU AS YOU TRY TO REJOIN. SEE
YOU SOON.
>>IT IS MY PLEASURE
TO WELCOME DR. KATIE MCLAUGHLIN
TO OUR COUNCIL MEETING.
PROFESSOR OF PSYCHOLOGY HARVARD
UNIVERSITY AND SHE JOINED US
TODAY TO PRESENT ON HER WORK AS
I MENTIONED EARLIER IS QUITE
RELEVANT TIMING. I THOUGHT IT
WOULD BE NICE TO HAVE A MOMENT
FOR YOU TO HEAR DIRECTLY FROM
THE SCIENTISTS INSTEAD OF JUST
FROM MY SCIENCE HIGHLIGHTS THAT
I PRODUCE EVERY NOW AND THEN.
AND SO WE CHOSE TO INVITE DR.
MCLAUGHLIN AS WELL BECAUSE OF
THE TOO MANICALLINESS OF THE
TOPIC -- TIMELINESS OF THE TOPIC
AS WE CONTINUE TO DEAL WITH THE
PANDEMIC ITSELF AND THE MENTAL
HEALTH CONSEQUENCES THEREOF,
THERE IS INCREASING INTEREST ON
THE PART OF POLICY MAKERS AS
WELL AS SCIENTISTS AND CARE
PROVIDERS IN UNDERSTANDING THE
MENTAL HEALTH IMPACTS OF THE
PANDEMIC AND THE GENERAL
POPULATION AND ESPECIALLY IN
CHILDREN AND ALSO IN
UNDERSTANDING HOW WE MIGHT BUILD
RESILIENCE AND COMBAT RISK. SO I
THOUGHT IT WOULD BE GREAT TO
HAVE DR. MCLAUGHLIN PRESENT TO
US TODAY ON STRESS RELATED
PSYCHOPATHOLOGY IN CHILDREN AND
ADOLESCENTS DURING COVID-19
PANDEMIC MECHANISMS OF RISK AND
RESILIENCE. AND WITH NO FURTHER
ADIEU, I WILL TURN IT OVER TO
DR. MCLAUGHLIN, AGAIN AS YOUR --
AS YOU LISTEN TO THE TALK AND
QUESTIONS OR COMMENTS TO MAKE
ARISE YOU WANT TO PUT THEM INTO
CHAT WE'LL GO WITH THAT. AND
OTHERWISE WE WILL HAVE -- TAKE
QUESTIONS OLE
>> GREAT. THANKS FOR THE
INVITATION TO BE HERE. I'M HAPPY
TO FIELD QUESTIONS ALONG THE WAY
IF FOLKS WANT TO JUST JUMP IN,
THE VIEW THAT I HAVE RIGHT NOW I
DON'T THINK I CAN SEE THE CHAT
AS IT COMES UP SO PLEASE FEEL
FREE TO INTERRUPT ME IF YOU HAVE
QUESTIONS. AS JOSH SAID I'M
GOING TO SPEAK ABOUT THE ROLE
THAT STRESS HAS PLAYED AND
CONTRIBUTING TO THE INCREASES IN
MENTAL HEALTH PROBLEMS THAT WE
HAVE OBSERVED DURING THE
PANDEMIC AMONG CHILDREN AND
ADOLESCENTS AND THINK A A LITTLE
BIT ABOUT WHAT THAT'S WE CAN DO
PLENTIFULLY ABOUT THIS INCREASE
IN MENTAL HEALTH PROBLEMS. SO IN
TERMS OF A BRIEF ROAD MAP AROUND
MENTAL HEALTH, I WILL TALK ABOUT
INCREASES IN STRESS THAT HAVE
HAPPENED DURING THE PANDEMIC
THROUGH THE LENS OF LEADING
MODELS THAT CAN HELP US TO
UNDERSTAND IDENTIFY WHICH KIDS
MIGHT BE MOST VULNERABLE TO
EXPERIENCING MENTAL HEALTH
RELATED PROBLEMS AS THE PANDEMIC
CONTINUES. I'M GOING TO TALK
ABOUT EMERGING RESEARCH OVER THE
PAST FEW YEARS, FOCUSED ON
UNDERSTANDING THE MECHANISMS OF
RISK AND RESILIENCE TO THE
STRESS RELATED MENTAL HEALTH
PROBLEMS WE HAVE SEEN IN
CHILDREN AND ADOLESCENTS. AND
I'M GOING TO ADD END BY TALKING
CLINICAL STRATEGIES WE CAN THINK
ABOUT IN TERMS OF HOW TO
INTERVENE TO IMPROVE MENTAL
HEALTH FOR CHILDREN AND
ADOLESCENT WHOSE HAVE BEEN MOST
IMPACTED DURING THE PANDEMIC. SO
BEFORE I DIVE INTO THE ROLE OF
STRESS, I WILL BRIEFLY COMMENT
ON WHAT WE KNOW ABOUT THE
INCREASES IN MENTAL HEALTH
PROBLEMS THAT HAVE HAPPENED FOR
KIDS AND ADOLESCENTS OVER THE
PAST COUPLE OF YEARS. I'M SURE
THIS IS NOT GOING TO BE A
SURPRISE TO ANYONE HERE. I'M
BRIEFLY TO GOING TO SHOW DATA
FROM A RECENT META ANALYSIS THAT
INCLUDED ALMOST 100,000 CHILDREN
AND ADOLESCENTS. THESE ARE ALL
SAMPLES THAT WERE COLLECTED
DURING THE PANDEMIC. WHAT YOU
CAN SEE HERE IS ACROSS, HOPE YOU
CAN SEE MY MOUSE, ACROSS THE
MANY STUDIES CONDUCTED, THE
ESTIMATE WAS ABOUT 25% OF
CHILDREN AD LESSENS WERE
EXPERIENCING CLINICALLY
SIGNIFICANT DEPRESSION,
DEPRESSION IN MODERATE TO VEER
RANGE DURING THE PANDEMIC THESE
CLINICALLY SIGNIFICANT
DEPRESSION SYMPTOMS INCREASED AS
THE PANDEMIC WORE SON SO GOT
WORSE WITH TIME. AND AS EXPECTED
HIRING FEMALES HIRING TEENAGERS
AND CHILDREN. THIS ESTIMATE IS
ABOUT TWICE WHAT WE SAW BEFORE
THE PANDEMIC STARTED. WE SEE THE
SAME PATTERN AND ESTIMATES OF
CLINICALLY SIGNIFICANT ANXIETY.
SO HERE THE FULL ESTIMATE IS
ABOUT 21% OF KIDS AND
ADOLESCENTS EXPERIENCING
MODERATE TO SEVERE ANXIETY
SYMPTOM DURING THE PANDEMIC THE
CLINICALLY SIGNIFICANT SYMPTOMS
INCREASE Z AS THE PANDEMIC WORE
ON, THAT IS IN CONTRAST FROM
DATA FROM ADULTS WHICH SUGGEST
IN ADULTS ELEVATIONS AND
SYMPTOMS WE SAW EARLY ON IN THE
PANDEMIC HAVE STARTED TO
DECLINE. AT LEAST THUS FAR IN
THIS ANALYSIS, WE DON'T SEE THAT
PATTERN HAPPENING YET WITH
CHILDREN. I WANT TO MENTION
THESE INCREASES IN INTERNALIZING
SYMPTOMS COME AGAINST THE
BACKDROP OF ALREADY RISING
LEVELS OF DEPRESSION ANXIETY AND
SUICIDAL BEHAVIOR IN KIDS AND
ADOLESCENTS SO THIS IS ONE
EXAMPLE OF A VERY LARGE TRACKING
SURVEY THAT'S CONDUCTED ANNUALLY
FOR MANY YEARS. WHAT YOU SEE IS
SORT OF RATES OF PAST YEAR
DEPRESSION BEGINNING TO RISE
AROUND 2010, ABOUT A 30%
INCREASE IN THE PREVALENCE OF
DEPRESSION IN AD LESSENS PRIOR
TO PANDEMIC SO INCREASE IN
PSYCHOPATHOLOGY WE SEE DURING
THE PANDEMIC COME AGAINST A
BACKDROP OF ALREADY INCREASING
MENTAL HEALTH PROBLEMS FOR YOUTH
WHICH I KNOW IS NOT A SURPRISE
TO ANYONE HERE. TODAY I WILL
TALK ABOUT THE ROLE THE EXPOSURE
TO STRESSORS PLAYED IN MENTAL
HEALTH PROBLEMS AMONG KIDS
DURING THE PANDEMIC. IT GOES
WITHOUT SAYING ONE PRIMARY
EXPERIENCES WE HAVE ALL SHARED
OVER THE PAST TWO YEARS IS
INCREASE IN THE AMOUNT OF
STRESSORS WE HAVE HAD TO
CONFRONT IN OUR DAILY LIVES SO
I'M GOING TO TALK ABOUT WHAT I
MEAN BY STRESS. BEFORE I START
TALKING ABOUT SOME OF THE RECENT
DATA. SO STRESSORS INVOLVE
CHANGES IN ENVIRONMENT, THAT
REQUIRE US TO ADAPT AND STRESS
IS TYPICALLY PERCEIVED WHEN THE
DEMAND FOR SITUATION OUTWEIGH
OUR ABILITY TO COPE EFFECTIVELY
WITH THOSE DEMANDS. SO CERTAIN
TYPES OF ENVIRONMENTAL
EXPERIENCES ARE PARTICULARLY
LIKELY TO BE PERCEIVED AS
STRESSFUL. UNFORTUNATELY THESE
KINDS OF EXPERIENCES HAVE BEEN
PARTICULARLY COMMON OVER THE
PAST COUPLE OF YEARS INCLUDING
FOR KIDS AND ADOLESCENTS. SO
FIRST EXPERIENCES IN -- THAT
INVOLVE THREAT DANGER OR
POTENTIAL HARMS YOU CAN THINK
ABOUT THE RISK FOR SERIOUS
ILLNESS, ONE'S SELF OR LOVED
ONES FROM THE CORONA VIRUS,
EXPERIENCES THAT INVOLVE LOTS
OBVIOUSLY OF LOVED ONES WITH
NEARLY A MILLION AMERICANS LOST
OVER THE PAST TWO YEARS, BUT
ALSO LAWS O OF INCOME STATUS
EMPLOYMENT CONNECTION TO SCHOOL
AND SO ON. SITUATION THAT
INVOLVE UNPREDICTABILITY AND
UNCONTROLLABILITY WHICH PROBABLY
DEFINES OUR COLLECTIVE
EXPERIENCE OVER THE PAST TWO
YEARS WITH CHANGING HEALTH
GUIDANCE, MANY PEOPLE
EXPERIENCING INSECURE ACCESS TO
FOOD, CHILD CARE, ABILITY TO
WORK, TO GO TO SCHOOL,
INTRODUCTION OF VARIANTS AND SO
ON. UNFAIR TREATMENT RELATED TO
STIGMA AND DISCRIMINATION WHICH
WE KNOW HAS INCREASED
PARTICULARLY FOR ASIAN AND BLACK
AMERICANS OVER THE PAST TWO
YEARS DURING THE PANDEMIC. AS
WELL AS SOCIAL ISOLATION. THESE
ARE ALL EXPERIENCES THAT ARE
PARTICULARLY LIKELY TO BE
PERCEIVED AS STRESSFUL AND
POWERFUL PREDICTORS OF EMERGENCE
OF PSYCHOPATHOLOGY SO WHAT I
WILL TALK ABOUT IS HOW INCREASES
IN THESE TYPES OF STRESSORS HAS
BEEN ONE OF THE KEY DRIVERS OF
THE INCREASES IN PSYCHOPATHOLOGY
THAT WE HAVE SEEN DURING THE
PANDEMIC. SO THIS SORT OF
WIDESPREAD EXPOSURE TO PANDEMIC
RELATED STRESSORS ALONG WITH
INCREASE IN MENTAL HEALTH
PROBLEMS WE HAVE SEEN THE PAST
TWO YEARS HIGHLIGHTS THE URGENT
NEED FOR NEW APPROACHES TO
INTERVENTION, TO PREVENT STRESS
RELATED PSYCHOPATHOLOGY. SO
THESE EFFORTS IN MY VIEW SHOULD
BE GUIDED BY SUBSTANTIAL
EXISTING THEORY AND RESEARCH ON
THE LINKS BETWEEN STRESS AND
PSYCHOPATHOLOGY SO FOR THE
REMAINDER OF THE TALK I WILL
WALK THROUGH SEVERAL LEADING
CONCEPTUAL OR THEORETICAL MODELS
ABOUT THE RELATIONSHIP BETWEEN
STRESS AND PSYCHOPATHOLOGY WE
CAN LEVERAGE, TO UNDERSTAND
WHICH CHILDREN ARE MOST
VULNERABLE TO STRESS RELATED
PSYCHOPATHOLOGY DURING THE
PANDEMIC, AS WELL AS PRESENT
SOME EMERGING DATA OVER THE PAST
COUPLE OF YEARS ABOUT HOW THESE
FRAME WORKS ARE RELEVANT TO THE
EXPERIENCES OF KIDS AND AD LESS
SEPTEMBERS OVER THE PAST SEVERAL
YEARS -- ADOLESCENTS OVER THE
PAST SEVERAL YEARS. I WILL
START BY TALKING ABOUT MODELS
THAT FOCUS PRIMARILY ON THE
ENVIRONMENTAL ASPECT OF STRESS.
SO IN OTHER WORDS, THE
CHARACTERISTICS OF STRESSFUL
EXPERIENCES THEMSELVES. AND
THESE MODELS I WILL ARGUE ARE
RELEVANT TO UNDERSTANDING WHO
MIGHT BE MOST VULNERABLE OR MOST
IN NEED OF INTERVENTION AS A
FUNCTION OF THE EXPERIENCE THEY
HAVE HAD DURING THE PANDEMIC. SO
THESE INCLUDE CUMULATIVE RISK
MODELS MODELS FOCUS ON SPECIFIC
TYPE OF STRESSES AND STRESS
SENSATION MODELS. I WILL WALK
THROUGH EACH SEPARATELY AND SHOW
YOU RELEVANT DATA FROM P THE
PANDEMIC. SO I WILL START
TALKING CUMULATIVE RISK. SURE
CUMULATIVE RISK MODELS ARE
FAMILIAR TO EVERYONE HER HERE. E
APPROACHES EMERGE FROM EARLY
WORK IN DEVELOPMENTAL
PSYCHOPATHOLOGY SHOWING KIDS WHO
EXPERIENCE MULTIPLE TYPES OF
STRESS OR ADVERSITY MUCH HIGHER
RISK FOR DEVELOPING
PSYCHOPATHOLOGY PERHAPS
UNSURPRISINGLY KIDS WHO
EXPERIENCE A SMALLER NUMBER OF
STRESSORS. THE BASIC IDEA IS AS
YOUR EXPOSURE TO STRESS
INCREASES, SO DOES LIKELIHOOD OF
PSYCHOPATHOLOGY, THE IDEA IN
THESE MODELS IS AN ADDITIVE
AFFECT THAT AS STRESS
ACCUMULATES SO DOES THE
VULNERABILITY TO DEVELOPING
PSYCHOPATHOLOGY. I WILL SHOW
YOU DATA FROM MY LAB THOUGH
EVIDENCE FOR CUMULATIVE IMPACT
OF PANDEMIC RELATED STRESSORS ON
MENTAL HEALTH DOCUMENTED IN KIDS
AND ADULTS DURING THE PANDEMIC.
SO I WILL TALK LONGITUDINAL
QUESTION WHERE WE OBSERVE IN
CHILDREN AN ADOLESCENTS AND
DESIGNS FOR ME TO REFERENCE
STUDY NUMBER OF TIMES THROUGHOUT
THE TALK. WE ARE IN THE MIDST OF
CONDUCTING SEVERAL LONGITUDINAL
STUDIES OF MENTAL HEALTH IN
CHILDREN AND AD LESSENS WHERE WE
HAD RICH DATA, ON HOW THESE
CHILDREN WERE FUNCTIONING PRIOR
TO THE PANDEMIC. PRETTY CLOSE IN
TIME TO WHEN THE PANDEMIC
STARTED. WE WERE ABLE TO FOLLOW
THESE CHILDREN AND THEIR
FAMILIES, AT TWO POINTS IN THE
EARLY PHASE OF THE PANDEMIC AND
THE FIRST IN THE INITIAL PHASE
DURING THE PERIOD OF TIME MOST
WERE IN LOCK DOWN AND APRIL
2020, SO IN ADDITION TO LOOKING
AT MENTAL HEALTH WE ASSESSED
PANDEMIC RELATED STRESSORS IN A
RANGE OF RISK OF PROTECTIVE
FACTORS AND WE DID THE SAME
AGAIN IN WHAT I'M CALLING WHAT
WILL HOPEFULLY BE MID PANDEMIC,
HARD TO NOTICE POINT BUT THIS
WAS FALL 2020, NOVEMBER AROUND
THE TIME OF THE ELECTION. SO
BECAUSE EXISTING MEASURE OF
PANDEMIC RELATED STRESS DIP
EXIST WE CREATED ONE. THAT
INCLUDED ITEMS RELEVANT TO
EXPERIENCES THAT FAMILIES WERE
FACING DURING THE EARLY PHASE OF
THE PANDEMIC. THIS IS A COMMON
PRACTICE IN THE FIELD WHEN
UNIQUE STRESSORS LIKE DISASTER
OR TERRORIST ATTACK HAPPEN WHERE
THERE ARE EXPERIENCES UNIQUE TO
THAT PARTICULAR EVENT LIKE
HAVING TO SLEEP IN THE SUPERDOME
DURING HURRICANE KATRINA, SO
WHEN OUR STRESSOR ASSESSMENT WE
INCLUDED HEALTH RELATED
STRESSORS THINGS LIKE HAVING A
FAMILY MEMBER OR LOVED ONE
CONTRACT COVID OR DIE OF COVID,
SOCIAL STRESSORS, BEING ISOLATED
EXPERIENCING DISCRIMINATION OR
HAVING CONFLICT WITH SOMEONE WHO
WAS IN YOUR HOME, FINANCIAL
STRESSORS LIKE HAVING PARENT
LOSE JOB OR INCOME OR
EXPERIENCING FOOD INSECURITY,
CHALLENGES WITH SCHOOL. SO KIDS
HAD DIFFICULTY ENGAGING OR
PARTICIPATING IN REMOTE
SCHOOLDAYS BECAUSE THEY DIDN'T
HAVE A QUIET PLACE TO WORK AND
ASPECT OF THE PHYSICAL
ENVIRONMENT LIKE BEING IN A
CROWDED HOUSE. SO PERHAPS
UNSURPRISINGLY WE BEFORE I TALK
ABOUT THESE FIGURE IS WILL SAY
THAT IN OUR DATA, VERY SIMILAR
TO THE META ANALYSIS I SHOWED
YOU WE SAW A DOUBLING OF
SYMPTOMS INTERNALIZING AND
EXTERNALIZING PROBLEMS IN THESE
KIDS DURING PANDEMIC RELATIVE TO
HOW THEY WERE DOING BEFORE THE
PANDEMIC STARTED. OF ALL OF THE
RISK FACTORS THAT WE ASSESSED IN
OUR SURVEY BY FAR THE FACTOR
MOST STRONGLY PREDICTED WHETHER
KIDS DEVELOPED INCREASING
SYMPTOMS OF PSYCHOPATHOLOGY WAS
THE DEGREE OF THEIR EXPOSURE TO
THESE PANDEMIC RELATED
STRESSORS. YOU CAN SEE THAT
CLEARLY IN THESE FIGURES AS
PANDEMIC RELATED STRESSORS
INCREASED, SO DID THE LIKELIHOOD
OF DEVELOPING INTERNALIZING
SYMPTOMS IN THE EARLY PHASE OF
THE PANDEMIC RELATIVE TO HOW YOU
-- HOW MANY SYMPTOMS YOU HAD
PRIOR TO PANDEMIC, AS WELL AS
YOUR SYMPTOMS LATER ON IN THE
PANDEMIC. RELATIVE TO WHERE YOU
WERE WHEN THE PANDEMIC FIRST
STARTED, WE SEE THE EXACT SAME
PATTERN LOOKING AT EXTERNALIZING
SYMPTOMS. SO SORT OF THE BUILD
RESPONSE RELATIONSHIP BETWEEN
PANDEMIC RELATED STRESS AND
SYMPTOMS OF PSYCHOPATHOLOGY. I
WILL SAY THAT THESE RESULTS HAVE
BEEN REPLICATED IN MANY CONTACTS
LONGITUDINAL SAMPLES OF KIDS
ADOLESCENTS AND ADULTS ACROSS
MANY CULTURAL CONTACTS, CHILDREN
FROM CHINA, ROMANIA, OTHER PARTS
OF EUROPE DURING THE PANDEMIC SO
THESE ARE ROBUST APPROXIMATE
REPLICABLE EFFECTS. SO SECOND
SET OF MODELS FOCUSES ON HOW
SPECIFIC TYPES OF STRESSORS
MIGHT BE PARTICULARLY LIKELY TO
CONTRIBUTE TO PSYCHOPATHOLOGY.
SO ACTUALLY RATHER THAN JUST
TALKING AT YOU FOR THE NEXT 30
MINUTES I LOVE TO GET A LITTLE
AUDIENCE PARTICIPATION JUST ON
THIS ONE SO YOU CAN LIKE USE THE
CHAT, NOT SURE I WILL SEE IT,
JUST SHOUT OUT, CURIOUS IF YOU
WERE GOING TO GUESS THE KIND OF
STRESSOR EXPERIENCED OVER THE
PAST YEAR LIKE HEALTH STRESSOR,
ECONOMIC STRESSOR, STRESSORS OF
DAILY LIFE LOSS, WHATTED YOU
GUESS THE KIND OF STRESS THAT
MIGHT -- MOST STRONGLY PREDICTED
PSYCHOPATHOLOGY IN EITHER ADULTS
OR KIDS? CURIOUS WHAT FOLKS
THINK BEFORE I TELL YOU.
>> SCHOOL CLOSURES.
>> OKAY.
>> ABUSE.
>> YES.
>> YES, EXPOSURE TO VIOLENCE.
>> DAYSLY DISRUPTION.
>> MR. DAILY DISRUPTION. .
>> WHAT IS INTERESTING BEFORE I
SHOW YOU THE DATA FROM THE
PANDEMIC I WILL SHOW YOU LATE
DATA FROM ADULTS AND KIDS, WHEN
THESE KINDS OF STRESSES HAPPEN
LIKE NATURAL DISASTERS,
TERRORIST ATTACKS, PEOPLE OFTEN
FOCUS ON THE THREAT TO ONE
PHYSICAL SAFETY THAT HAPPENS IN
THESE KINDS OF EVENTS AND ASSUME
THESE ARE THE KINDS OF STRESSORS
THAT HAVE BIGGEST IMPACT ON
PSYCHOPATHOLOGY, WHAT IS
INTERESTING IN PRIOR STUDIES IS
THAT WHAT FOLKS TEND TO SEE IS
THAT ACTUALLY THE SORT OF MORE
CHRONIC OR DISRUPT DAILY
DISRUPTIONS TO LIFE WHETHER
SCHOOL CLOSURE NOT GOING TO
SCHOOL OR INTERACT WITH YOUR
PEERS, THAT HAVE STRONGEST
IMPACT ON PSYCHOPATHOLOGY AND
YOU SEE THAT MIRED IN DATA
COLLECTED IN ADULTS, YOUNG
ADULTS AT THE BEGINNING OF
PANDEMIC. I WILL SHOW YOU DATA
ON KIDS NEXT. YOU CAN'T SEE THE
FULL SCALE, I WILL REVEAL FROM A
MOMENT BUT WHAT IS PLOTTED HERE
EFFECT SIZES THE BLACK LINE IS
0, ANYTHING TO THE RIGHT IS AN
EFFECT SIZE THAT'S LARGER THAN
0, AND WHAT YOU CAN SEE IS THAT
THIS IS COHORT OF YOUNG ADULTS
20 BEFORE THE PANDEMIC AND 22
WHEN THIS ASSESSMENT WAS
PERFORMED AT THE BEGINNING OF
THE PANDEMIC. THESE ARE HEALTH
RELATED RISKS. SO THINGS LIKE
RISK TO YOUR OWN HEALTH RISK TO
THE HEALTH OF YOUR LOVED ONES
AND YOU CAN SEE THERE'S
CONSISTENT FAIRLY SMALL EFFECTS
ON PERCEPTIONS OF STRESS AND
SYMPTOM TOMS OF ANXIETY AND
DEPRESSION FOR THESE STRESSORS
BUT THEY ARE DWARFED BY THE
EFFECTS FOR LIFESTYLE
DISRUPTIONS, NOT GOING TO WORK
OR SCHOOL, ECONOMIC STRESSOR,
THINGS LIKE LOSS OF JOB OR
EDUCATION, FINANCIAL ADVERSITY,
AND SO ON. SO THESE KINDS OF
DISRUPTIONS TO DAILY LIFE SEEM
TO BE HAVING A BIGGER IMPACT ON
PSYCHOPATHOLOGY DURING THE
PANDEMIC. THAN EVEN RISK OF
ONE'S SAFETY OR HEALTH. WHAT WE
SEE IN KIDS IS REALLY
INTERESTING SO WE USED A
SLIGHTLY DIFFERENT SET OF
MEASURES HERE IN THE STUDY I
SHOWED YO YOU. BUT FAR AND AWAY,
THE TYPES OF STRESSORS IN OUR
DATA THAT HAVE BIGGEST IMPACT ON
INCREASES IN PSYCHOPATHOLOGY
DURING THE PANDEMIC WERE SOCIAL
STRESSORS. THINGS LIKE BEING
ISOLATED, NOT BEING ABLE TO
INTERACT WITH PEERS, HAVING
ONGOING CONFLICT WITH SOMEONE IN
YOUR HOUSE, WE SEE FOR BOTH
INTERNALIZING AND EXTERNALIZING
SYMPTOMS THESE STRESSORS HAD A
DISPROPORTIONATE AFFECT SO
SOMEBODY I DON'T RECOGNIZE THE
VOICE BUT SOMEBODY SAID NOT
BEING ABLE TO GO TO SCHOOL,
SCHOOL RELATED STRESSOR, THAT
WAS THE SECOND CATEGORY THAT HAD
A PARTICULAR LARGE EFFECT AND
FOR EXTERNALIZING PROBLEMS THIS
EFFECT IS VIRTUALLY THE SAME AS
IMPACT OF SOCIAL STRESSORS SO AT
LEAST IN OUR DATA FOR KIDS,
THESE SOCIAL SCHOOL RELATED
STRESSORS ARE THE SPECIFIC TYPES
OF STRESS THAT ARE DRIVING
INCREASES IN PSYCHOPATHOLOGY
MORE THAN OTHERS. SO A FINAL
MODEL FOCUSES ON THE
ENVIRONMENTAL COMPONENT OF
STRESS, STRESS SENSITIZATION.
THE IDEA IS THIS LINK BETWEEN
STRESS AND PSYCHOPATHOLOGY IS
MAGNIFIED OR STRONGER IN PEOPLE
WHO HAVE A HISTORY OF EARLY LIFE
ADVERSITY OR EARLY LIFE TRAUMA,
TO SHOW YOU EXAMPLE OF THIS IN
DATA REFLECTED BEFORE THE
PANDEMIC THIS IS REALLY WELL
REPLICATED EFFECT, THIS IS AN
EXAMPLE FROM ADULTS, WHAT YOU
SEE ON THE X AXIS IS NUMBER OF
PAST YEAR MAJOR STRESSFUL LIFE
EVENTS, LOSING A JOB, GETTING A
DIVORCE, THE Y AXIS IS THE
LIKELIHOOD YOU HAD DEPRESSION IN
THE PAST YEAR, AND THEN WHAT YOU
SEE EACH OF THESE LINES REFLECT
GROUPS OF PEOPLE WITH DIFFERENT
LEVELS OF EXPOSURE TO EARLY LIFE
ADVERSITY. THE BASIC IDEA HERE
IS THAT THE MAGNITUDE OF THIS
RELATIONSHIP BETWEEN RECENT
STRESS AND THE ONSET OF
PSYCHOPATHOLOGY IS MUCH
STRONGER, THIS LINE STEEPER IF
YOU HAVE EXPERIENCED A LOT OF
ADVERSITY AS A CHILD. STEEPEST
FOR FOLKS WHO HAD THREE O MORE
ADVERSITY, A LITTLE LESS STEEP
FOR FOLKS WITH TWO AND THE SORT
OF MOST SHALLOW FOR FOLKS WHO
HAVE NOT ENCOUNTERED ADVERSITY.
SO DURING THE PANDEMIC THERE'S
BEEN NOT MUCH DATA PUBLISHED YET
WHETHER THE SAME PATTERN OF
SENSITIZATION IS TRUE. THIS IS
DATA FROM (INAUDIBLE) LAB NOT
SHOWING EXACTLY WHAT I DESCRIBE
BUD THEY HAVE SHOWN
UNSURPRISINGLY THAT PEOPLE WHO
HAD EARLY LIFE ADVERSITY IN
GENERAL ARE EXPERIENCING HIGHER
LEVELS OF PERCEIVED STRESS, AND
HIGHER DEPRESSION SYMPTOMS
DURING THE PANDEMIC. SOME DATA
WE HAVEN'T PUBLISHED YET FROM MY
LAB, I WILL GIVE YOU A PREVIEW,
SOMEBODY SHOUTED ABUSE, WHAT YOU
SEE REFLECTED HERE IS THAT, THAT
THE IMPACT OF THE DAILY PANDEMIC
RELATED STRESSORS I TALKED ABOUT
A FEW MINUTES AGO ON SYMPTOMS OF
INTERNALIZING PROBLEMS, THEY
HAVE A BIGGER IMPACT FOR KIDS
WHO HAVE A HISTORY OF EXPOSURE
TO TRAUMA. OR OTHER KINDS OF
VIOLENCE. SO THE RELATIONSHIP
BETWEEN STRESS AND
PSYCHOPATHOLOGY GETS
PROGRESSIVELY STEEPER AS
EXPOSURE TO TRAUMA INCREASES.
SUCH THAT THE KIDS WERE MOST
VULNERABLE TO DEVELOPING STRESS
RELATED PSYCHOPATHOLOGY ARE KIDS
WHO HAD PRIOR EXPOSURE TO
TRAUMA, PARTICULARLY IF THAT
TRAUMA WAS REPEATED OR SEVERE.
SO I WILL SHIFT NOW FROM THESE
ENVIRONMENTAL STRESS MODELS WITH
RELEVANCE FOR THINKING WHO MIGHT
BE IN NEED OF INTERVENTION TO
TALKING A LITTLE BIT ABOUT HOW
MODELS OF RISK AND RESILIENCE
HELP THINK ABOUT HOW WE MIGHT
INTERVENE FOR KIDS WHO ARE
EXPERIENCING STRESS RELATED
PSYCHOPATHOLOGY. THERE IS KIND
OF THREE MODELS I'M GOING TO
DISCUSS HERE. AS WELL. MODELS
THAT FOCUS ON STRESS APPRAISAL,
STRESS BUFFERS, PROTECTIVE
FACTORS THEN STRESS MECHANISMS.
SO GOING TO TALK FIRST ABOUT
STRESS APPRAISAL. STRESS PAY
PRAISAL MODELS FOCUS NOT JUST ON
THE ROLE OF WHAT HAPPENS IN YOUR
ENVIRONMENT BUT WAY THESE EVANS
ARE INTERPRETED, AND APPRAISED
AND SHAPING HOW YOU RESPOND TO
THAT STRESSOR. INFLUENTIAL
MODELS ARGUE THAT WE FEEL STRESS
AND PERCEIVE DEMANDS OF
SITUATION TO OUTWEIGH ABILITY TO
COPE WITH THOSE DEMANDS
EFFECTIVELY. SO ONE WAY OF
ASSESSING APPRAISALS IS ASKING
PEOPLE ABOUT THE DEGREE WHICH
THEY FEEL EVENTS IN THEIR LIFE
OVERWHELMING OR OUT OF CONTROL
IN A GLOBAL WAY. EVEN WHEN A
SITUATION IS PERCEIVED STRESSFUL
THERE IS ONGOING APPRAISAL
PROCESS THAT HAPPENS. WE
FREQUENTLY REFER TO THIS AS
COGNITIVE APPRAISAL WHICH ALTERS
INTERPRETATION OF A SITUATION
MEANING OVER TIME AND WE KNOW
THAT ENGAGING IN REAPPRAISAL CAN
MODULATE CARDIOVASCULAR
SUBJECTIVE NEURAL AND MENTAL
HEALTH RESPONSES TO STRESSORS IN
ADAPTIVE WAYS. SO THE IDEA IS
PEOPLE WHO ENGAGE IN HIGHER
LEVEL WAS OF REAPPRAISAL MIGHT
BE LESS LIKELY IMPACTED IN TERMS
OF INCREASING MENTAL HEALTH
PROBLEMS IN RELATION TO PANDEMIC
RELATED STRESSORS. SO WHAT
EVIDENCE DO WE HAVE OF THIS
DURING PANDEMIC? I WILL SHOW YOU
THE SAME STUDY IAN GOTLIB. IN
MANY STUDIES WE SEE THE STRESS
APPRAISALS THAT DEGREE WHICH YOU
FEEL THINGS ARE OVERWHELMING AND
YOU DON'T HAVE CONTROL OVER WHAT
IS GOING ON IN YOUR ENVIRONMENT
HAS A STRONG RELATIONSHIP TWO
SYMPTOMS OF PSYCHOPATHOLOGY IN
THIS STUDY THEY WERE LOOKING AT
DEPRESSION SYMPTOMS. HERE THEY
EVEN SHOW THIS HEIGHTEN
PERCEPTION OF STRESS HELPS TO
EXPLAIN THE LINK BETWEEN EARLY
LIFE STRESS AND INCREASING
SYMPTOMS OF DEPRESSION THAT I
SHOW YOU A FEW SLIDES BACK. BUT
THE IDEA THAT SORT OF REAL
QUESTION IS CAN YOU ALTER THIS
PROCESS THROUGH THINGS LIKE
COGNITIVE REAPPRAISAL? THERE IS
NOT A LOT OF DATA ON THIS IN
CHILDREN ADOLESCENTS YET DURING
THE PANDEMIC THERE'S A FEW
STUDIES BUT IN ADULTS RELATIVELY
LARGE SAMPLE, YOU CAN SEE LINK
BETWEEN PERCEPTIONS OF STRESS
AND SYMPTOMS OF ANXIETY DURING
EARLY DAYS OF PANDEMIC IS WEAKER
AND PEOPLE WHO ROUTINELY ENGAGE
IN COGNITIVE REAPPRAISAL SO IF
YOU ARE USING THE REAPPRAISAL
STRATEGY MORE EVEN IF
EXPERIENCING A LOT OF STRESS IT
IS LESS LIKELY TO LEAD TO
SYMPTOMS OF ANXIETY. SO I HAVE
BEEN TALKING HOW EXPOSURE TO
STRESS IS A POWERFUL PREDICTOR
OF PSYCHOPATHOLOGY BUT WE KNOW
THAT NOT EVERYONE EXPERIENCE
EVEN HIGH LEVELS OF STRESS IS
GOING TO DEVELOPMENTAL HEALTH
PROBLEM. THIS IS TRUE EVEN AFTER
SERIOUS TRAUMATIC EVENTS LOSS OF
LOVED ONES NATURAL DISASTERS AND
ALSO TRUE IN CONTEXT OF THE
PANDEMIC. PROTECTIVE FACTORS
THAT BUFFER AGAINST EMERGENCE OF
PSYCHOPATHOLOGY FOLLOWING STRESS
AN ADVERSITY HAVE BEEN STUDIED
EXTENSIVELY, I WILL TALK ABOUT
WHAT WE HAVE SEEN ABOUT TYPES OF
STRESS BUFFERS DURING PANDEMIC.
THE IDEA IS THIS LINK BETWEEN
STRESS AN PSYCHOPATHOLOGY IS
WEAKER OR BUFFERED SMALLER, IN
PEOPLE WHO HAVE THE PRESENCE OF
SOME KIND OF PROTECTIVE FACTOR.
WHAT I WILL SAY HERE IS ACTUALLY
I THINK THE POSITIVE MESSENGER,
GOOD NEWS ABOUT MENTAL HEALTH
DURING THE PANDEMIC. IN OUR
LONGITUDINAL WORK STUDYING KIDS
IN ADOLESCENCE OVER TIME WE LOOK
AT FACTORS THAT MIGHT PROTECT
AGAINST DEVELOPING MENTAL HEALTH
PROBLEMS DURING THE PANDEMIC. WE
FOCUSED ON STRESS BUFFERS THAT
WERE LOW COST, EASILY ACCESSIBLE
AND DIDN'T REQUIRE ANY
CONNECTION TO SPECIALIZED
SERVICES, GIVEN THE CONSTRAINTS
THAT MANY FAMILIES FACE DURING
THE EARLY PART OF THE PANDEMIC
IN PARTICULAR. AND THE POSITIVE
MESSAGE HERE IS WE FOUND MANY
SOURCES OF WHAT HAVE IS CALLED
ORDINARY MAGIC CHARACTERISTICS
THAT HELP PREVENT ONSET OF
PSYCHOPATHOLOGY EVEN IN KIDS
EXPERIENCING HIGH LEVELS OF
PANDEMIC RELATED STRESS. SO YOU
CAN SEE THESE LISTED HER HERE. I
WILL WALK THROUGH THREE
EXAMPLES. SOME FROM DATA IN MY
LAB AND SOME FROM DATA IN OTHER
LABS. UNSURPRISINGLY THE FIRST
IS SOCIAL SUPPORT. THIS IS
UNSURPRISING BECAUSE WE HAVE
KNOWN FOR DECADES THAT OF ALL OF
THE POTENTIAL PROTECTIVE FACTORS
THAT HELP TO BUFFER AGAINST
STRESS RELATED PSYCHOPATHOLOGY,
SOCIAL SUPPORT IS AMONG THE MOST
POWERFUL. THIS WAS A CHALLENGING
DURING THE PANDEMIC BECAUSE
ACCESS TO SOCIAL SUPPORT WAS SO
MUCH MORE DIFFICULT FOR MANY
PEOPLE THAN IT WAS PRIOR TO THE
PANDEMIC BUT WHAT YOU SEE IN OUR
DATA DURING THE EARLY PHASE OF
PANDEMIC IS POWERFUL LINK
BETWEEN STRESS AND
PSYCHOPATHOLOGY FOR
INTERNALIZING PROBLEMS IS
ESSENTIALLY ABSENT IN CHILDREN
WHO REPORTED THAT THEY FELT HIGH
LEVELS OF SOCIAL SUPPORT FROM
THEIR PEERS. THIS IS PEERS
SPECIFICALLY. I WANT TO MENTION
THIS IS TRUE NOT JUST IN KIDS
AND ADOLESCENTS BUT ALSO ADULTS.
THIS IS A STUDY THAT I THINK IS
PARTICULARLY RELEVANT TO THE
EVENTS OF THE PAST COUPLE OF
YEARS, THIS WAS A SAMPLE OF
ASIAN AMERICANS AT THE BEGINNING
OF THE PANDEMIC. WHAT THEY FOUND
IS SIMILARLY HIGH LEVELS OF
SOCIAL SUPPORT BUFFERED AGAINST
EXPERIENCES OF DISCRIMINATION
AND MICROAGGRESSIONS THAT P HAD
DURING THE EARLY PHASE OF THE
PANDEMIC SUCH THAT THE SORT OF
STRONG LINK BETWEEN
DISCRIMINATION AND PHYSICAL
SYMPTOMS OF ANXIETY, SOMATIC
SYMPTOMS WAS ABOUT SENTENCE IN
PEOPLE WHO REPORTED FEELING HIGH
LEVELS OF EMOTIONAL SUPPORT FROM
THEIR FAMILY AND FROM THEIR
FRIENDS. A SECOND PROTECTIVE
FACTOR, I THINK THIS IS SORT OF
SCIENCE YOU CAN USE WHEN YOU
THINK ABOUT YOUR OWN LIFE AND
YOUR FAMILY, IS THAT KIDS WHO
ENGAGE IN LOWER LEVELS OF
PASSIVE SCREEN TIME, WHEN I SAY
PASSIVE SCREEN TIME WHAT I MEAN
IS SORT OF SCROLLING THROUGH
YOUTUBE VIDEOS LOOKING AT SOCIAL
MEDIA, WE ARE NOT TALKING ABOUT
ENGAGING IN SCREEN TIME FOR
SCHOOL OR SOCIAL ENGAGEMENT BUT
THAT MORE SORT OF PASSIVE INTAKE
OF CONTENT, WHAT WAY SAW IS THIS
LINK BETWEEN STRESS AN
PSYCHOPATHOLOGY FOR BOTH
INTERNALIZING AND EXTERNALIZING
PROBLEMS DURING THE EARLY PHASE
OF PANDEMIC WAS SUBSTANTIALLY
SMALLER IN KIDS WHO HAD LESS
EXPOSURE TO SCREEN TIME. I KNOW
JOSH WAS TALKING ABOUT SOME
INITIATIVES ABOUT SOCIAL MEDIA
AND MENTAL HEALTH, THESE DATA
DON'T SPEAK TO THAT DIRECTLY BUT
THEY DO SUGGEST THAT LIMITING
THE AMOUNT OF SCREEN TIME KIDS
HAVE THAT ISN'T FOCUS ON SCHOOL
OR SOCIAL ENGAGEMENTED MIGHT BE
PROTECTIVE AGAINST STRESSFUL
PSYCHOPATHOLOGY. THIS IS NOT
DATA FROM MY LAB, THIS IS FROM
(INAUDIBLE) LAB BUT WE REPLICATE
THIS THIS IN OUR DATA, FAMILY
WHOSE ARE ABLE TO MAINTAIN A
STRUCTURED DAILY ROUTINE, EVEN
IF THAT ROUTINE WAS DIFFERENT
THAN THE ROUTINE OBVIOUSLY WE
HAD PRIOR TO THE PACK, HAVING
THAT DAILY STRUCTURE SEEMS TO
PROTECT IN THEIR DATA AGAINST
INTERNALIZING PROBLEMS IN THE
FACE OF STRESS AND OUR DATA WE
SAW THIS EFFECT MORE STRONGLY
FOR EXTERNALIZING PROBLEMS BUT
BASICALLY THE SAME PATTERN. THAT
FOR KIDS WHO HAD MORE STRUCTURE
IN THEIR DAILY ROUTINES WERE
LESS VULNERABLE TO DEVELOPING
STRESS RELATED PSYCHOPATHOLOGY.
SO FINALLY, I WILL TOUCH BRIEFLY
ON STRESS MECHANISMS. WHICH IN
SOME WAYS IF WE ARE THINKING
INTERVENTIONS THIS IS WHAT WE
WANT TO BE THINKING ABOUT. SO WE
KNOW THAT EXPOSURE TO STRESS
INCREASE RISK FOR
PSYCHOPATHOLOGY THROUGH A
VARIETY OF INTERVENING PATHWAYS
AND MECHANISMS. PATHWAYS THAT
HAVE GARNERED EMPIRICAL SUPPORT
INCLUDING SLEEP AND CHANGES IN
EMOTIONAL RELATION, CHANGES IN
THE WORD PROCESSING, SUCH THAT
STRESS LEADS TO CHANGES IN THESE
MECHANISMS WHICH IN TURN PREDICT
THE EMERGENCE OF PSYCHOPATHOLOGY
SYMPTOMS. WHAT I WILL SAY IS
THAT BECAUSE OF THE NATURE OF
THE PANDEMIC MOST RESEARCH HAD
TO BE CONDUCTED REMOTELY DURING
THE EARLY PHASE OF THE PANDEMIC,
THE WORK ON MECHANISMS HERE IS
LESS RICH THAN SOME OF THE OTHER
AREAS I DESCRIBE MOSTLY BECAUSE
IT IS DIFFICULT TO STUDY A LOT
OF MECHANISMS USING SELF-REPORT
AND ONLINE REPORTING TOOLS THAT
WERE AVAILABLE TO RESEARCHERS AT
THE BEGINNING OF THE PANDEMIC SO
I WILL APPLY ONE EXAMPLE OF
STRESS MECHANISMS FROM MY LAB
AND TALK A LITTLE BIT ABOUT TWO
RELEVANT PATHWAYS USING DATA
THAT WERE CHECKED PRIOR TO THE
PANDEMIC. SO -- COLLECTED PRIOR
TO THE PANDEMIC. IS FIRST IS
CHANGES IN EMOTION REGULATION. I
WILL PROVIDE A SIMPLE EXAMPLE.
RUMINATION IS AN EMOTION
REGULATION STRATEGY THAT
INVOLVES PASSIVELY REPETITIVELY
THINKING ABOUT CAUSES AN
CONSEQUENCES OF NEGATIVE MOOD
WITHOUT MOVING INTO ACTIVE
PROBLEM SOLVING. MUCH DATA
COLLECTED PRIOR TO THE PANDEMIC
SUGGESTS THAT PEOPLE RUMINATE
MORE WHEN EXPERIENCING LOTS OF
STRESS. AND THIS IS A MECHANISM
THAT LINKS STRESS WITH
PSYCHOPATHOLOGY, WE SEE THAT
MIRED IN OUR DATA DURING THE
PANDEMPANDEMIC. SO FIRST WE SAWS
WITH HIGHER NUMBER OF THESE
PANDEMIC RELATED STRESSORS WERE
MORE LIKELY TO HAVE INCREASES IN
RUMINATION RELATIVE TO BEFORE
THE PANDEMIC. NOT SURPRISINGLY
RUMINATION PREDICTED HIGHER
LEVELS OF INTERNALIZING
SYMPTOMS. THIS IS NOT
SURPRISING WE KNOW THAT AND IT
HELPS TO EXPLAIN, DIDN'T
COMPLETELY BUT HELPED TO EXPLAIN
OR MEDIATE THE LINK BETWEEN
PANDEMIC RELATED STRESSORS AN
INTERNALIZING SYMPTOMS. SO I
WILL HIGHLIGHT TWO OTHER
RELEVANT PATHWAYS THAT MIGHT
HELP TO EXPLAIN THE LINK BETWEEN
PANDEMIC RELATED STRESSORS AND
PSYCHOPATHOLOGY WE ARE
CHALLENGING TO STUDY DURING THE
PANDEMIC ESPECIALLY EARLY PHASE.
SO I WILL SHOW YOU DATA
COLLECTED JUST BEFORE THE
PANDEMIC STARTED THAT HAS
RELEVANCE TO EXPERIENCES WE HAVE
ALL HAD THE PAST COUPLE OF
YEARS. FIRST INVOLVES
EXPERIENTIAL DIVERSITY. I WILL
SHOW YOU DATA FROM AARON HULLER
UNIVERSITY OF MIAMI AND KATE
HEARTILY, NYU. EXPERIENTIAL
DIVERSITY REFLECTS VARIABILITY
IN OUR ENVIRONMENTAL CONTEXTS
OVER TIME. SO WHAT I'M SHOWING
HERE EXAMPLES FROM ONE
PARTICIPANT IN THE STUDY ON TWO
SEPARATE DAYS. ON THE LEFT YOU
SEE A DATA CHARACTERIZED BY LOW
EXPERIENTIAL DIVERSITY, THE
LARGER BUBBLE MORE TIME SPENT IN
PLACE. THIS IS DATA SCRAPED FROM
CELL PHONES ON GPS LOCATION. YOU
CAN SEE THIS KID SPENT MOST TIME
HERE AT HOME, THEY WENT TO ONE
OTHER LOCATION, CAME BACK. IN
CONTRAST THIS IS A DAY
CHARACTERIZED BY HIGH
EXPERIENTIAL DIVERSITY, THIS
CHILDS TRAVERSE A LOT OF
LOCATIONS, SPENT TIME IN
DIFFERENT PLACES. SAME DATA FROM
THAT WAS NEW YORK THIS IS MIAMI.
SAME EXAMPLE, A DAY
CHARACTERIZED BY LOW
EXPERIENTIAL DIVERSITY, A DAY
CHARACTERIZED BY HIGH
EXPERIENTIAL DIVERSITY. WHAT I
WILL SAY IS WE THINK ABOUT LIFE
DURING THE PANDEMIC IT LOOKED
MORE LIKE THIS. RIGHT? SO OUR
LIVES PARTICULARLY IN EARLY
PHASE OF THE PANDEMIC WERE
EXTREMELY CONSTRAINTED IN TERMS
OF DIVERSITY OF ENVIRONMENTAL
VARIABILITY AND NOVELTY AND
CONTEXT THAT WE WERE
EXPERIENCING OVER TIME. WHAT
THIS STUDY SHOWED IS THAT --
THEY QUANTIFY THIRD DEGREE WITH
MEASURE CALLED ROAMING ENTROPY,
HAPPY TO TALK ABOUT THAT MORE,
HIGHER LEVELS MEANS MORE
DIVERSITY IN CONTEXT AND TIME
YOU SPENT IN DIFFERENT PLACES.
WHAT THEY SAW IS THAT THE MORE
DIVERSITY YOU HAD IN THOSE
EXPERIENCES, THE HIGHER YOUR
POSITIVE AFFECT WAS ON THOSE
DAYS RELATIVE TO OTHER DAYS.
THE IDEA THAT WHEN OUR CONTACTS
ARE CONSTRAINED AND NOT
EXPERIENCING A LOT OF NOVELTY OR
VARIABILITY IN ENVIRONMENTAL
CONTEXT, THIS REDUCES POSITIVE
AFFECT AND WHEN WE JUST REFLECT
ON EXPERIENCES THE PAST COUPLE
OF YEARS PROBABLY REIGNS TRUE
FOR MANY OF US, THAT SORT OF
LACK OF NOVELTY AND DIVERSITY
AND ENVIRONMENTAL VARIABILITY IS
SOMETHING THAT DRAINED POSITIVE
AFFECT WE KNOW HAS HUGE IMPACT
ON MENTAL HEALTH PROBLEMS
PARTICULARLY DEPRESSION. SO A
SECOND POTENTIAL MECHANISM,
OBVIOUSLY RELEVANT TO STRESS,
THOSE THINGS OPENED UP OUR
CONTEXT VERSUS STARTED TO CHANGE
MORE, BUT IDEA FOLKS MORE
FEARFUL ABOUT GETTING COVID WHO
ARE EXPERIENCING MORE STRESSORS
MAYBE ARE LESS LIKELY TO BE
REENGAGING WITH NUMBER OF
CONTEXT THEY DID PRIOR TO
PANDEMIC SO THIS IS A
POTENTIALLY INTERESTING TARGET
TO THINK ABOUT IN TERMS OF
INTERVENTION. THEN FINALLY, I
HAVE TIME, I WILL TALK A LITTLE
BIT ABOUT CHANGES IN BRAIN
FUNCTION. THIS IS PILOT DATA
FROM MY LAB THAT SERVED AS BASIS
FOR MY CURRENT R 37 FROM NIMH I
SHOULD BE PROBABLY THANKING
EVERYBODY IN THIS ROOM FOR WHICH
FOCUSES ON EMOTIONAL AND
COGNITIVE AND NEURAL MECHANISMS
THAT LINK STRESSFUL
PSYCHOPATHOLOGY DURING THE
ADOLESCENCE.
WHAT I WILL HIGHLIGHT IS
EXISTING WORK ON THESE
MECHANISMS PARTICULARLY WITH
BRAIN FUNCTION, HAS LARGELY
RELIED ON BETWEEN PERSON CROSS
SECTIONAL STUDIES. THE WAY
STUDIES HAVE TRADITIONALLY
WORKED YOU RECRUIT A GROUP OF
KIDS WITH HIGH LEVEL STRESS,
ANOTHER WHO HAS NOT EXPERIENCED
THOSE STRESSORS AND THEN YOU
COMPARE THEIR BRAIN RESPONSE TO
SOME TYPE OF TASK. YOU ASSUME IF
YOU SEE A DIFFERENCE, THAT
DIFFERENCE IS ATTRIBUTABLE TO
THE DIFFERENCES IN STRESS THAT
THESE TWO GROUPS OF CHILDREN
EXPERIENCE. WE KNOW WILL IS A
LOT OF CHALLENGES WITH THIS KIND
OF INTERPRETATION. BECAUSE THESE
GROUPS OF KIDS DIFFER IN MANY
WAYS TYPICALLY, HAVING
DIFFERENCES IN LEVELS OF STRESS,
DIFFER IN SOCIAL ECONOMIC
STATUS, PSYCHOPATHOLOGY,
COMMUNAL EXPOSURE, EXPOSURE TO
LEAD, I CAN LIST A HUNDRED
CONFOUNDSERS THAT ARE
CHALLENGING TO MEASURE CONTROLS
FOR THESE KIND OF BETWEEN PERSON
STUDIES BUT MORE IMPORTANT THAN
THAT, WHAT WE REALLY WANT TO
KNOW IS HOW STRESS IS PRODUCING
CHANGES WITHIN AN INDIVIDUAL.
RELATIVE TO THEIR OWN
FUNCTIONING WHEN IT HAPPENS SO I
AM SHOWING YOU THREE THEORETICAL
KIDS, ONE ON AVERAGE HIGHER
LEVELS OF STRESS, MORE MODERATE
AND LOWER LEVELS OF STRESS AND
TRADITIONAL APPROACH WOULD
SIMPLY COMPARE THESE AVERAGE
LEVELS OF STRESS ACROSS THE KIDS
AND ASSUME THAT IF WE SEE
DIFFERENCES IN THEIR BRAIN IT IS
BECAUSE OF STRESS BUT WHAT WE
REALLY WANTS TO KNOW FROM AN
INTERVENTION PERSPECTIVE AND
TRANSLATIONAL PERSPECTIVE IS
WHAT HAPPENS WHEN A KID
EXPERIENCES MORE STRESS THAN IS
TYPICAL FOR THEM? WHAT CHANGES
ABOUT THEIR BRAIN FUNCTION,
COGNITION, EMOTIONS, THAT THEN
PREDICTS EMERGENCE OF
PSYCHOPATHOLOGY? THAT IS WHAT WE
NEED TO UNDERSTAND TO LEVERAGE
MECHANISTIC RESEARCH INTO
INTERVENTION. SO IDENTIFYING
THESE MECHANISMS REQUIRES A
DESIGN THAT CAN CAPTURE THEM ON
THE TIME SCALE WHICH THEY
ACTUALLY UNFOLD IN REAL TIME.
WHICH IS TYPICALLY WEEKS OR
MONTHS SO IN THE PILOT STUDY I
WILL SHOW YOU A SNEAK PEAK
ONGOING R 37 WE BRING
ADOLESCENTS IN THE LAB ONCE A
MONTHS FOR AN ENTIRE YEAR. WE
COLLECT DATA ON STRESS, EMOTION,
BEHAVIOR, BRAIN FUNCTION,
COGNITION, EACH MONTH SO WE CAN
SEE WHEN STRESS FLUCTUATES FOR
CHILDREN RELATIVE TO THEIR OWN
BASELINE, HOW DOES THAT PRODUCE
CHANGES IN THESE POTENTIAL
STRESS MECHANISMS? I WILL SHOW
YOU ONE EXAMPLE. SO BECAUSE IN
PERSON RESEARCH INCLUDING NOT
POSSIBLE AT THE BEGINNING OF THE
PANDEMIC I WILL SHOW YOU DATA
COLLECTED BEFORE THE PANDEMIC
STARTED. WE WERE EXAMINING
NEURAL RESPONSES TO A REALLY
STANDARD TASK THAT LOOKS AT
RESPONSES TO AVERSIVE STIMULI.
RESPONSES TO FEARFUL FACES WHICH
SUGGEST COULD BE A THREAT IN THE
ENVIRONMENT. RELATIVE TO FACES
THAT ARE NEUTRAL. AND WHAT YOU
SEE IN THIS MAP IN WARM COLORS
ARE REGIONS OF THE BRAIN WE SEE
WITHIN PERSON CHANGES. SO
RELATIVE TO YOUR OWN LEVEL OF
BRAIN RESPONSE TO THIS TASK ON
MONTHS WHEN YOU EXPERIENCE MORE
STRESS AND THAN NORMAL FOR YOU
HOW DOES BRAIN FUNCTION
FLUCTUATE? WARM REGIONS
RESPONDING MORE TO AVERSIVE
STIMULI ON MONTHS CONTACT RISED
BY HIGHER LEVELS OF STRESS AND
BLUE COLORS ARE REGIONS
RESPONDING LESS. SO WHAT WE SEE
SORT OF INCREASE -- DECREASED
ACTIVITY AND MULTIPLE NODES OF
FRONTAL PARIETAL NETWORK IN
REGIONS WE ASSOCIATE WITH
COGNITIVE CONTROL INCLUDING
DORSAL CINGULATE CORTEX.
MULTIPLE REGIONS OF LATERAL PFC,
THE MFG AND IFG. THIS IS
INTERESTING, THIS REPLY CASE
RECENT WORK IN MY LAB, IN
BETWEEN PERSON LONGITUDINAL
STUDY KIDS EXPOSE TO MAL TREAT
ONCE YOU ADJUST FOR THIS
RECRUITSMENT IN FRONTAL PARIETAL
TREATMENT, IN AVERSIVE QUEUES
CUTS ACROSS MULTIPLE FORMS OF
STRESS AN ADVERSITY TO INCREASE
RISK FOR DEPRESSION AND ANXIETY,
BUT WE ALSO SEE INCREASE
RECRUITMENT IN MULTIPLE REGIONS
OF THE DEFAULT MODE NETWORK
INCLUDING VENTRAL MEDIAL
PREFRONTAL CORTEX, POSTERIOR
CINGULATE, ANGULAR GYRUS AND
CORTEX, WHAT IS INTERESTING IS
THIS IS A PATTERN WE DON'T SEE
IN BETWEEN PERSON AND CROSS
SECTIONAL STUDIES. WHAT IS OF
NOTE IS THESE REGIONS OF
DEFAULTS MODE NETWORK, INCREASE
RESPONSE TO AVERSESSAL QUEUES
WHICH SUGGEST INCREASE
SELF-THINKING LIKE RUMINATION ON
MONTHS CHARACTER RIDESSED BY
HIGHER THAN USUAL STRESS, THESE
ARE REGIONS STRONGLY PREDICTED
INCREASE IN SYMPTOMS OF ANXIETY
AND DEPRESSION FOLLOWING MONTH
SO R 37 BEEXAMINE IN PERSON
FLUCTUATIONS IN RESPONSE TO MUCH
WIDER RANGE OF TASK AN LARGER
SAMPLES SO STAY TUNED, I WILL
COME BACK WITH SOMEDEAL DATA
TELLING YOU WHAT WE FIND. I WILL
END BY TALKING ABOUT THE
CLINICAL IMPLICATIONS OF THE
EMERGING DATA I JUST SHARED WITH
YOU. SO THIS KIND OF EMERGING
EVERYDAY ON STRESS AN
PSYCHOPATHOLOGY CAN BE LEARNED
IN TWO WAYS. TO THINK ABOUT --
LEVERAGED IN INFORMING
INTERVENTION TO PREVENTS STRESS
RELATED PSYCHOPATHOLOGY AS THE
PANDEMIC CONTINUES. BEFORE I
TALK ABOUT THAT, I WANT TO
HIGHLIGHT A KEY ISSUE, HOW TO
REACH PEOPLE IN NEEDS. I THINK
IT GOES WITHOUT SAYING THAT
ACCESS TO MENTAL HEALTH SERVICES
DURING THE PANDEMIC HAS BECOME
MORE CHALLENGING AS THE NEEDS
FOR THOSE SERVICES HAS INCREASED
SUBSTANTIALLY. WE ALSO KNOW THAT
DISPARITIES RACIAL AND ETHNIC
DISPARITIES AND ACCESS TO MENTAL
HEALTH SERVICES HAVE WIDEN AND
BECOME MORE PRONOUNCED DURING
THE PANDEMIC AND FAMILY WHOSE
ARE MOST VULNERABLE TO STRESS
RELATED PSYCHOPATHOLOGY AS A
RESULT OF CUMULATIVE EXPOSURE
MAYBE LYSES LIKELY TO HAVE TIME
OR RESOURCES TO SEEK OUTS
INTENSIVE MENTAL HEALTH SERVICE.
SO IN LIGHT OF THAT, I WILL
FOCUS IN PARTICULAR ON THINKING
ABOUT BRIEF DIGITAL KINDS OF
INTERVENTIONS THAT HAVE THE
POTENTIAL TO BE SCALED TO HELP
ADDRESS INCREASE NEED IN WAYS
ACTUALLY FEASIBLE. MORE FEASIBLE
THAN JUST THINKING EVERYBODY IS
GOING TO RECEIVE SPECIALTY
MENTAL HEALTH SERVICE WHICH IS
IS NOT REALISTIC. SO THE
ENVIRONMENTAL STRESS MODELS I
STARTED WITH THAT ARE FOCUSED ON
ENVIRONMENTAL CONCEPTUALIZATION
OF STRESS CAN HIGHLIGHT THE
CHARACTERISTICS OF STRESSORS
THAT MIGHT BE IMPORTANT FOR
IDENTIFYING WHO IS IN NEED OF
INTERVENTION. SO WHAT WE LEARN
FROM THIS EMERGING WORK IS THAT
SORT OF UNSURPRISINGLY FAMILIES
WITH HIGH LEVELS OF CHRONIC AND
CUMULATIVE STRESS EXPOSURE
PARTICULARLY RELATED TO THINGS
LIKE ONGOING FINANCIAL
ADVERSITY, AND DISRUPTIONS IN DA
DAILY LIFE ARE VULNERABLE TO
PSYCHOPATHOLOPATHOLOGY. HEALTHCE
WORKERS AND THEIR CHILDREN,
BECAUSE THEY WORK IN INDUSTRIES
THAT HAVE BEEN AFFECTED IN AN AN
GOING WAY BY THE PANDEMIC LIKE
RESTAURANT OR HOSPITALITY
SERVICE. FAMILIES WHO --
CHILDREN WHO EXPERIENCED ONGOING
SOCIAL ISOLATION AND
DISCONNECTION FROM PEERS SEEM TO
BE PARTICULARLY LIKELY TO
DEVELOP PSYCHOPATHOLOGY DURING
THE ADVERSITY AND UNSURPRISINGLY
KIDS WHO HAVE HISTORY OF TRAUMA
OR OTHER FORMS OF EARLY LIFE
ADVERSITY WE KNOW IN GLOBAL WAY
ARE MORE VULNERABLE TO
PSYCHOPATHOLOGY IN GENERAL.
THAT'S MIREED FROM THE DATA WE
SEE IN PANDEMIC. I HAVE NOT
ENCOUNT IRED RESEARCH ON
CHILDREN AND AD LET SENSE BUT
AMONG ADULTS THOUGH WHITE ADULT
VERSUS THE HIGHEST LEVELS OF
ANXIETY AND DEPRESSION BEFORE
THE PANDEMIC, THAT THE RELATIVE
INCREASE IN MENTAL DISORDERS WAS
HIGHER FOR ASIAN AMERICANS,
BLACK AMERICANS, LATINX
AMERICANS, THAN WHITES DURING
THE PANDEMIC. SO SORT OF
INCREASING HEALTH DISPARITIES AS
WELL AS INCREASING DISPARITIES
IN ACCESS TO SERVICES, FOR FOLKS
IN THESE GROUPS.
I HAVE NOT SEEN THE DATA ON THIS
IN CHILDREN AND WANT TO
HIGHLIGHT THAT WE EXPECT THAT
SIMILAR PATTERNS MIGHT BE TRUE
FOR KIDS, THIS IS AN UNDERSTUDY
AREA THAT NEEDS MORE ATTENTION.
THEN FINALLY, WHEN WE THINK
ABOUT STRESS PATHWAY MODELS THAT
HELP THINK ABOUT HOW YOU MIGHT
INTERVENE, WHAT IS THE CONTENT
OF INTERVENTIONS THAT MIGHT BE
HELPFUL TO PREVENT STRESS
RELATED PSYCHOPATHOLOGY. FIRST
WITH REGARD TO THAT CONTENT,
INTERVENTIONS TARGETING STRESS
APPRAISALS OR REAPPRAISAL ARE
ONE PROMISING AVENUE. THAT MIGHT
SEEM A TIRED SUGGESTION BECAUSE
COGNITIVE RESTRUCTURING IS A
MAIN STAY OF CBT FOR 20, 30
YEARS. WHAT IS INTERESTING THERE
IS RECENT WORK SUGGESTING THAT
VERY BRIEF SELF GUIDED DIGITAL
INTERVENTIONS THAT ARE DELIVERED
ESSENTIALLY THROUGH VIDEOS
ONLINE THAT TEACH PEOPLE TO
REAPPRAISE STRESS TO THINK ABOUT
ADAPTIVE BENEFITS, HAVE HAD
POSITIVE IMPACT THROUGH SINGLE
SESSION INTERVENTIONS, SOME
THINGS LIKE ANXIETY, DEPRESSION,
AND EVEN PHYSIOLOGICAL RESPONSES
TO STRESS. THESE KINDS OF ONLINE
INTERVENTIONS WERE ADAPTED BY
SOME GROUPS DURING THE PANDEMIC
TO TARGET SPECIFIC KINDS OF
STRESSORS LIKE RELATIONSHIP
CONFLICT AND ALSO A POSITIVE
INFLUENCES ON RESPONSES TO
STRESS DURING THE PANDEMIC SO
THINKING ABOUT HOW TO INCREASE
ACCESS, IMPLEMENT AND
DISSEMINATE THESE KINDS OF
INTERVENTIONS INSTEAD OF ONE
POTENTIALLY USEFUL STRATEGY. I
THINK PSYCHOLOGISTS WE ALWAYS
THINK ABOUT PSYCHOSOCIAL
INTERVENTIONS THAT ARE FOCUS ON
CHANGING THE WAY YOU THINK, HOW
WE PROCESS EMOTION, THE STRESS
BUFFERSNA HAVE EMERGED IN
RESEARCH DURING THE PANDEMIC
PHYSICAL ACTIVITY SCREEN TIME,
THERE ARE BRIEF DIGITAL
BEHAVIORAL KINDS OF
INTERVENTIONS THAT EXIST TO
TARGET THESE STRESS BUFFERS THAT
ARE WIDELY AVAILABLE AND
THINKING ABOUT HOW TO LEVERAGE
THESE EXISTING INTERVENTIONS, TO
PREVENTS OR REDUCE STRESS
RELATED PSYCHOPATHOLOGY IS
ANOTHER PROMISING AREA THAT WE
DON'T FOCUS ON AS MUCH IN THE
MENTAL HEALTH SPHERE AS WE
COULD, AS ONE SIMPLE EXAMPLE,
ADULTSES WHO PARTICIPATED IN
DIGITAL PLATFORMS FOR PHYSICAL
ACTIVITY, SO LIKE A STREAMING
SERVICE OR SOMETHING THAT GAVE
YOU ACCESS TO SOME PHYSICAL
ACTIVITY CONTENT DURING THE
PANDEMIC MAINTAINED HIGHER
LEVELS OF PHYSICAL ACTIVITY WERE
LESS LIKELY TO DEVELOP STRESS
RELATED PSYCHOPATHOLOGY. THEN
FINALLY, I WANT TO GIVE A SHOUT
OUT TO EMERGING WORK ON SELF
GUIDED BRIEF DIGITAL
INTERVENTIONS INCLUDING SINGLE
SESSION INTERVENTIONS. SORT OF A
ACCUMULATING EVIDENCE SUGGESTS
THESE VERY BRIEF SINGLE SESSION
INTERVENTIONS CAN LEAD TO
LASTING CHANGES IN SYMPTOMS OF
DEPRESSION, ANXIETY AND SOME OF
THESE INTERVENTIONS TARGET
STRESS MECHANISMS SO JESSICA
SCHNEIDERS LAB PUBLISHED A
INTERESTING SINGLE INTERESTING
BEHAVIOR INTERVENTION CONDUCT
WITH ADOLESCENTS DURING THE
COVID-19 PANDEMIC ONE SESSION
THAT LED TO SIGNIFICANT
REDUCTIONS IN SYMPTOMS OF
DEPRESSION OVER TIME. AND I
THINK FINDING WAYS TO
DISSEMINATE AND INCREASE ACCESS
TO THESE BRIEF SELF-GUIDED
INTERVENTIONS MAYBE ONE FEASIBLE
STRATEGY FOR REDUCING STRESS
RELATED SYMPTOMATOLOGY AS THE
PANDEMIC CONTINUES. TO WRAP UP I
HAVE SHOWN YOU DATA INCREASES IN
OUR EXPERIENCES OF STRESS ARE
MAYER JOE CONTRIBUTOR TO
SYMPTOMS OF PSYCHOPATHOLOGY WE
OBVIOUS SEVERED THE PAST COUPLE
OF YEARS IN CHILDREN. AND THAT
WHEN WE THINK ABOUT WHO IS MOST
VULNERABLE WE KNOW A LOT, GIVEN
PRIOR WORK AND EMERGING WORK
FROM THE PANDEMIC, ON STRESS
RELATED VULNERABILITY TO STRESS
RELATED PSYCHOPATHOLOGY. AND
THAT WE CAN LEVERAGE EMERGING
WORK ON MECHANISMS THAT LINK
EXPERIENCES OF STRESSFUL
PSYCHOPATHOLOGY TO THINK ABOUT
WAYS WE CAN TARGET OR REDUCE
STRESS RELATED PSYCHOPATHOLOGY
IN CHILDREN VULNERABLE. ONE
FINAL SHOUT OUT, I WANT TO MAKE
SURE I GIVE CREDIT WHERE IT IS
DUE TO THE AMAZING EARLY CAREER
SHINTIESES IN MY LAB. WHO LED
MOST OF THE DATA I SHOWED YOU
FROM MY OWN LAB. I ALSO WANT TO
THANK THE PEOPLE IN THIS ROOM
BECAUSE THESE ARE ALL SCIENTISTS
SUPPORTED BY NIH, ALEXANDER
RODMAN WHO HAS A K99 FROM NIMH
AND DAVID WISEMAN WHO JUST GOT A
K99 AND MAYA ROSEN, LED A LOT OF
WORK YOU SAW TODAY SO SHOUT OUT
TO THEM APPROXIMATE THANK YOU TO
ALL OF YOU FOR SUPPORTING THESE
AMAZING YOUNG SCIENTISTS. THAT
IS I WILL WRAP THERE. WANT TO
THANK MY LAB AND NIMH FOR THE
FUNDING THAT SUPPORTED MOST OF
THE WORK THAT YOU SAW TODAY. I'M
GOING TO STOP SHARING MY SCREEN
AND HAPPY TO ANSWER ANY
QUESTIONS PEOPLE HAVE.
>> THANK YOU FOR THAT WONDERFUL
TALK. JOSEPH YOU PUT QUESTIONS
IN THE CHAT. WOULD YOU LIKE THE
ASK THEM OUT LOUD?
>> GREAT QUESTION, 7 TO 15, THE
TEENAGERS THE CHILDREN AND
TEENAGERS IN THE SAMPLE FROM MY
LAB.
DID YOU CONSIDER -- SO SECOND
QUESTION IS DID YOU CONSIDER
COMPOUND VARIABLES IN PHYSICAL
AND SOCIAL ENVIRONMENT, IS
INTERACTIONS BETWEEN STRESSORS.
WE DIDN'T SO WE LOOKED AT HOW
ACCUMULATION OF STRESS AND HOW
PSYCHOPATHOLOGY AND LOOKED AT
WHETHER THERE WAS DIFFERENTIAL
INFLUENCE OF PARTICULAR STRESSOR
TYPES WE DIDN'T LOOK AT WHETHER
THERE WERE PARTICULAR
INTERACTIONS WHETHER YOU HAD
SOCIAL STRESS AND HAVING TROUBLE
AT SCHOOL DID THAT COMPOUND THE
EFFECT OF ONE COMPOUND THE
OTHER, I WOULD GUESS PROBABLY
YES. WE DIDN'T EXAMINE THAT IN
OUR DATA. DO YOU WANT TO
SUMMARIZE THE THIRD QUESTION?
>> THANK YOU FOR THE VERY GOOD
PRESENTATION AND JUST POINTING
CLARIFICATION, WHY I ASKED ABOUT
THE COMPOUND VARIABLE. BECAUSE
ONE OF THE THINGS THAT A LOT OF
THE EMERGING WORK COMING OUT OF
THOSE THAT HAVE DONE STUDIESES
WITH THE COLLEGE AGE STUDENTS
ARE FINDING THAT THERE ARE
COMPOUNDS THERE, AND THAT IS
REALLY MORE PREDICTIVE EVEN
SOMETIMES IN MANY CASES IN
ISOLATION SO I WANTED TO BRING
THAT UP BECAUSE SINCE YOU ARE
LOOKING AT ADOLESCENT AND TRYING
TO LOOK AT INTERVENTIONS YOU
MENTIONED A LOT OF DIGITAL TYPE
OF THINGS, WHATEVER, SO I WANTED
TO BRING THAT UP BECAUSE THAT IS
VERY MUCH RELATED. IF YOU AND
OTHERS HAVE A OPPORTUNITY TO
LOOK AT THAT YOU MIGHT CONSIDER
THAT LATER IN ADOLESCENTS
BECAUSE THAT'S WHAT SO MANY
PEOPLE ARE LOOKING. THE LAST
PART HAS MORE TO DO WITH THE
REALITY QUESTION. THIS INSTITUTE
IS VERY INVESTED IN LOOKING AT
THE TYPES OF WORK THAT CAN BE
DONE TO ADDRESS DISPARITIES
ACROSS THE BOARD. NOT JUST
ETHNIC ABOUT RACIAL DISPARITIES
BUT ALSO DISPARITIES RELATED TO
HOMELESSNESS AND OTHER THINGS.
SO IT BECOMES REALLY IMPORTANT
WHEN LOOKING AT CHILDREN AND
FAMILIES THAT THEY DO NOT
NECESSARILY HAVE ACCESS TO
THINGS LIKE INTERNET, ACCESS TO
A LOT OF THINGS MANY
INTERVENTIONS THAT I THINK ARE
EXCELLENT THAT YOU MENTIONED BUT
THEY DON'T HAVE ACCESS TO THOSE.
SO THE REAL QUESTION IS THAT
RECOMMENDATION BASED UPON YOUR
FINDINGS BASED UPON PEOPLE YOU
WORK WITH THAT THIS PANEL OR
THIS INSTITUTE CAN LOOK AT AS
CONSIDERING CONCEPTUALLY HOW IT
MIGHT BE WORKING. THAT IS WHAT
I'M LOOKING AT. IN PARTICULAR
ONE WAYS FUNDING CAN BE USED TO
THAT. A LOT OF THE PEOPLE WHO
ARE DOING THIS WORK ARE NOT AS
ADEPT AT GETTING THE FUNDING
EVEN THOUGH THEY ARE VERY MUCH
-- VERY CLEAR TO ABILITY
INTERVENE, JUST ARE NOT THAT
WAY. SO IT IS A COMBINATION
QUESTION OF REALLY HOW YOU GET
TO HARD TO REACH HARD TO ACCESS
HISTORICAL POPULATIONS AND
SECONDARILY HOW DO YOU SUPPORT
THOSE THAT ACTUALLY ARE ACTIVELY
DOING BOTH CLINICAL WORK AS WELL
AS TRYING TO BUILD RESEARCH
PARTICULARLY HEALTH SERVICE
RESEARCH PROJECTS RELATED IN
THAT DIRECTION. IT IS A LONG
QUESTION, IT IS A LOT BUT YOU
PRESENTED SOME REALLY GOOD STUFF
THAT GOT MY BRAIN RUNNING SO
THANK YOU.
>> GREAT QUESTION, THANK YOU.
THANK YOU FOR ASKING. I THINK
THAT YOU ARE REALLY GETTING TO
THE HEART OF THE ISSUE HERE,
WHICH IS THAT WE HAVE
INTERVENTIONS THAT WE KNOW WORK
THAT CAN BE HELPFUL FOR
ADDRESSING STRESS RELATED
PSYCHOPATHOLOGY AND WHAT WE
DON'T KNOW IS HOW TO BEST GET
THOSE INTERVENTIONS INTO THE
HANDS OF CHILDREN AND FAMILIES
WHO NEED THEM. T THAT IS REALLY
A QUESTION OF IMPLEMENTATION
SCIENCE AND HEALTH SERVICES
RESEARCH WHICH IS NOT MY AREA OF
EXPERTISE BUT WHATLY SAY
ANECDOTALLY ON PREVENTIVE
INTERVENTIONS WHERE STEPPING
INTO THAT SPACE WHICH HASN'T
HISTORICALLY BEEN FOCUS OF OUR
RESEARCH IS THAT DIGITAL
INTERVENTIONS EVEN FOR FAMILIES
WHO EXPERIENCE EXTREME FINANCIAL
ADORERSTY OR LOW SOCIOECONOMIC
STATUS ONE CHANGE OVER TEN YEARS
IS VIRTUALLY EVERYONE WE HAVE
ENCOUNTERED WE RECRUIT FAMILIES
THROUGH PEDIATRIC PRIMARY CARE
OR OTHER CONTEXT, WIDE RANGE OF
SES. EVERYBODY HAS A SMART
PHONE, MIGHT NOT HAVE COMPUTER
AND ACCESS TO INTERNET THROUGH
BROADBAND AT HOME BUT MOST DO
HAVE A CELL PHONE AND SOME KIND
OF PLAN THAT ALLOWS THEM TO
ACCESS THE INTERNET AND I THINK
THINKING ABOUT CREATING
INTERVENTIONS THAT ARE CAPABLE
OF BEING ADMINISTERED TRUE THE
SMALL HOE THROUGH THE SMALL
SCREEN DEVICES PEOPLE DO HAVE
ACCESS TO AND DON'T TAKE UP
BANDWIDTH OR PEOPLE HAVE IN
THEIR MONTHLY PLANS WHAT THEY
CAN VIEW IS SOMETHING THAT IS
FEASIBLE I AM NOT THE RIGHT
PERSON TO THINK HOW A TO DO THAT
BUT I THINK IT IS POSSIBLE. TO
THE POINT OF YOUR SECOND
QUESTION, I DON'T KNOW PROBABLY
A QUESTION FOR THIS GROUP WHO
HAS A MUCH BETTER SENSE OF
LANDSCAPE OF WHAT IS GOING ON IN
HEALTH SERVICES RESEARCH THAN
ME. BUT WHAT I WOULD SAY IS THAT
INVESTING IN THAT KIND OF WORK
IS PROBABLY GOING TO GIVE
BIGGEST RETURN ON INVESTMENT FOR
ADDRESSING THE STRESS RELATED
MENTAL HEALTH PROBLEMS WE SEE
RIGHT NOW. AND THE DISPARITIES
IN THOSE HEALTH PROBLEMS DURING
THE PANDEMIC. THANK YOU FOR THE
QUESTION. HOPE I ANSWERED IT.
SORT OF.
>> THANK YOU. WE ARE A BIT OVER
BUT IF THERE IS ANOTHER BURNING
QUESTION OR TWO FROM THE COUNCIL
GLAD TO HAVE IT FIELDED. IF
NOT, THANK YOU VERY MUCH KATIE,
APPRECIATE YOGINNING US TODAY.
-- YOU JOINING US AND TELLING US
ABOUT THIS EXCITING WORK.
>> THANKS FOR THE INVITATION TO
BE HERE. CHEERS.
>> SO NEXT ON THE AGENDA, IS A
DISCUSSION THAT I WANT TO HAVE
WITH YOU ALL ABOUT SETTING UP A
NEW COUNSEL WORK GROUP, ONE THAT
FOCUSES ON HIGH DIMENSIONAL DATA
SETSETS. IF I CAN HAVE THE
PRESENTATION ALEX.
>> IT IS UP ON MY SCREEN.
>> MAY NOT HAVE THE RIGHT WINDOW
SHOWING. HOLD ON A SECOND. NOW
I CAN SEE IT ON MY BUSY DESKTOP
SO I GET THIS RIGHT I DID
SOMETHING UNCHARACTERISTIC FOR
ME I WROTE OUT WHAT I WANTED TO
SAY TO Y'ALL. SO MIC A LITTLE
MORE STILTED THAN MY USUAL
CONVERSATIONAL TONE BUT I WANT
THE MAKE SURE TO COVER THINGS
THE WAY I WANT TO COVER THEM.
BASIC APPLIED RESEARCH ON HIGH
DIMENSIONAL PHENOTYPES WHICH
INCLUDES BUT IS NOT LIMITED TO
STUDIES TARGETING GENOMICS
EPIGENOMICS, TRANSCRIPTOMICS
PROTEOMICS METABOLOMICS, LOTS OF
OMICS AS WELL AS NEUROIMAGING
STUDIES AND COMBINATION HAVE
BEEN INCREASING DRAMATICALLY. IN
RECENT YEARS. SUCH RESEARCH
TYPICALLY SEEKS TO IDENTIFY
MARKERS OF DIAGNOSTIC PROGNOSTIC
OR THERAPEUTIC VALUE OR TO
EXAMINE PATHOPHYSIOLOGICAL
PROCESSES UNDERLYING MENTAL
ILLNESS. FOR CAMEL, NIMH FUNDED
NUMEROUS STUDIES SEEKING TO
EXAMINE EPIGENETIC CHANGES THAT
HAPPENED AFTER STRESS OR IN
RESPONSE TO OTHER ENVIRONMENTAL
RISK FACTORS, SEEKING TO LINK
THOSE EPIGENETIC CHANGES TO
DOWNSTREAM BEHAVIORAL EFFECTS.
THE COMPLEXITY AND SIZE OF THESE
DATA SETS AND THE RELATIVE
NOVELTY OF STATISTICAL MACHINE
LEARNING APPROACH USED TO
ANALYZE THEM, HAVE LED TO
CONCERNS REGARDING RIGOR AND
REPRODUCIBILITY. FOR EXAMPLE,
THIS PAPER I HAVE HERE ON THE
SLIDE REPRODUCIBLE BRAIN WIDE
ASSOCIATION STUDIES REQUIRE
THOUSANDS OF INDIVIDUALS, IS ONE
THAT COMES OUT OF RESEARCH WE
SUPPORT BUD THAT DEMONSTRATES
THROUGH USE OF LARGE SCALE
NEUROIMAGING DATA SETS THAT
REPRODUCIBILITY FINDINGS ARE
CHALLENGING AND REQUIRE FROM THE
TITLE THOUSANDS OF INDIVIDUALS.
THIS IS NOT THE ONLY PAPER OF
ITS KIND. IN FACT SEVEN YEARS
AGO, THESE INVESTIGATORS
PUBLISHED A PAPER ON THE
VARIABLE REPRODUCIBILITY IN
GENOMICS SCALE PUBLIC DATA USING
ANOTHER RESOURCE THAT NIMH
HELPED DEVELOP, THE ENCODE CHIP
SEQUENCING RESOURCE. ENCODE IS
THE CHIP CHROMOSOME
IMMUNOPRECIPITATION STUDY IS AN
EPIGENETIC MARKER SCATTERED
THROUGHOUT THE GENOME THAT IS
SIMILARLY HIGH DIMENSIONAL IN
TERMS OF DATA THAT CAN BE
DERIVED IN THIS PAPER DESCRIBED
THE CHALLENGES AND SAMPLE SIZES
NECESSARY TO ACHIEVE REASONABLE
LEVELS OF REPRODUCIBILITY IN
THAT DATA SET AS WELL.
MEANWHILE COSTS ARE ASSOCIATED
WITH ACQUIRING THESE DATA
MAINTAINING THESE DATA, AND
FUNDING THE RESEARCH TO CONNECT
THOSE DATA TO MENTAL HEALTH
RELEVANT PHENOTYPES, CONTINUE TO
INCREASE DRAMATICALLY AS WELL.
NIMH NEEDS TO DEFINE PRIORITIES
AND APPROACHES THAT WILL ENSURE
RIGOR AND REPRODUCIBILITY WHILE
ALSO ENABLING FISCAL
RESPONSIBILITY. PROGRESS IN THE
FIELD OF GENOMICS PROVIDES AN
EXAMPLE HOW NIMH SUCCESSFULLY
NAVIGATED SIMILAR ISSUES IN THE
STUDY OF GENOMICS BUT LEADING
EXTRAMURAL INVESTIGATORS AND
SEEKING HELP AND ADVICE FROM
THIS COUNCIL. THIS EFFORT, WORK
GROUP GENOMICS WORK GROUP OF THE
NATIONAL ADVISORY MENTAL HEALTH
COUNSEL CULMINATED IN SERIES OF
RECOMMENDATIONS MEANT TO DEFINE
RIGOROUS PRIORITIES AN
APPROACHES IN THE ACQUISITION
ANALYSIS AND INTERPRETATION OF
GENETIC FINDINGS AND THEIR
APPLICATION TO SUBSEQUENT
BIOLOGICAL AND CLINICAL
INQUIRIES. NIMH FUNDED GENOMICS
VERGE HAS RESULTED AS WE
DISCUSSED EARLIER IN UPDATE IN
SUCCESSFUL IDE PCATION OF
NUMEROUS COMMON AND RARE
VARIANTS ROBUSTLY IMPLICATED IN
NEURAL DEVELOPMENTAL AND
PSYCHIATRIC DISORDERS. IN THE
2018 REPORT FROM NATIONAL
ADVISORY MENTAL HEALTH COUNCIL
WORK GROUP ON GENOMICS IS BUILT
ON THAT SUCCESS, BASED ON THE
RECOMMENDATIONS FROM THAT
REPORT, THE NIMH HAS PROMULGATE
AND ACTED UPON GUIDANCE THAT
CLARIFIES TO THE FIELD STRENGTHS
OF REQUIRED EVIDENCE FOR GENERAL
IT CAN ASSOCIATION PRIORITIES
FOR FUTURE STUDIES OF GENETIC
LINKAGE AND ACCEPTABLE DESIGNS
AND APPROACHES FOR BIOLOGICAL
AND CLINICAL STUDY THAT SEEK TO
BUILD UPON THESE FINDINGS. BY
CONTRAST, THERE HAS BEEN LINTED
SUCCESS IN GENERATING
REPRODUCIBLE FINDINGS FROM
STUDIES THAT USE EPIGENETICS,
OTHER OMICS NEURAL IMAGING AND
SIMILARLY COMPLEX HIGH
DIMENSIONAL DATA SETS. THERE
MAYBE SEVERAL REASONS FOR THIS
FAILURE. ONE PARTICULAR
CHALLENGE WITH THIS NEW CROP OF
HIGH DIMENSIONAL DATA SETS,
THESE DATA SETS THAT USE THINGS
LIKE GENE EXPRESSION MICROBIOME
COMPOSITION OR WHOLE BRAIN
NEURAL ACTIVITY ARE DYNAMICALLY
REGULATED AND CONTEXT DEPENDENT.
UNLIKE THE GENOME A SINGLE SNAP
SHOT OF THE EPIGENOME OR WHOLE
BRAIN NEURAL ACTIVITY DOESN'T
CAPTURE OR MAY NOT CAPTURE A
RELIABLE PICTURE OF A DISEASE
STATE OR A BEHAVIOR OR THE
UNDERLYING PATHOBIOLOGY OR
PHYSIOLOGY. A SECOND ISSUE IS
THE FIELD SEEMS NOT TO HAVE
ARRIVED UPON A STANDARDIZED
FRAMEWORK FOR EXPERIMENTAL
DESIGN AND STATISTICAL
INFERENCE. LEADING TO THE
PERSISTENCE OF CONFOUNDING
EFFECTS, AND DIFFICULTIES IN
INTERPRETING THE RELIABILITY AND
SIGNIFICANCE OF FINDINGS.
FINALLY, MANY OF THESE
FUNCTIONAL STUDIES OF HIGH
DIMENSIONAL PHENOTYPES ARE
FURTHER LIMITED BY LACK OF
COHERENT CONCEPTUAL FRAMEWORK
FOR UNDERSTANDING THE
RELATIONSHIP BETWEEN MOLECULAR,
NEURAL AND BEHAVIORAL VARIATION.
NIMH IS THEREFORE SEEKING
ADVISORY INPUT FROM THE NAMHC
THROUGH CONVENING AD HOC COUNCIL
WORK GROUP ON HIGH DIMENSIONAL
DATA SETS. THE PURPOSE IS FOR
THIS GROUP TO DEVELOP
RECOMMENDATIONS REGARDING
APPROPRIATE CONCEPTUAL FRAME
WORKS AND EXPERIENCAL ANALYTIC
DESIGNS FOR EXPERIMENTS THAT USE
OR GATHER HIGH DIMENSIONAL DATA
SETS. POTENTIAL AREAS FOR
CONSIDERATION BY THE WORK GROUP
INCLUDE, ONE, ENSURING
STATISTICAL RIGOR AND ENHANCING
REPRODUCIBILITY. QUESTIONS THAT
WORK GROUP MIGHT ASK ARE INCLUDE
ARE THERE PROVEN APPROACHES OR
EXPERIMENTAL DESIGNS THAT CAN BE
USED TO MAXIMIZE OR VERIFY THE
STATISTICAL RIGOR OF FINDINGS
FROM THESE DATA SETS. CAN WE
DEFINE HIERARCHY OF APPROACHES
FOR ENSURING REPRODUCIBILITY.
FOR EXAMPLE WITH MACHINE
LEARNING APPROACHES REPEATED
LEAVE ONE OUT STUDIES VERSUS
REPRODUCING INDEPENDENT DATA
SETS APPROACHES, IS ONE BETTER
THAN THE OTHER AND CAN WE
RECOMMEND SUCH HIERARCHY. THIRD,
A QUESTION IN THIS AREA WOULD
INCLUDE WHAT ARE THE SAFE GUARDS
NECESSARY WHEN USING DIMENSION
REDUCTION TECHNIQUES CLUSTERING
OR OTHER DATA DRIVEN APPROACHES
TO REDUCE COMPLEXITY TO ENSURE
THAT THEY ARE NONETHELESS ROBUST
AND REPRODUCIBLE. THE SECOND
AREA OF CONSIDERATION IS IN THE
UNDERSTANDING -- IN
UNDERSTANDING THE ROLE OF
HYPOTHESIS AND CONCEPTUAL FRAME
WORKS IN THE DESIGN OF THESE
STUDIES. WHAT IS THE ROLE OF
HYPOTHESIS BASED VERSUS DATA
DRIVEN STUDIES IN THE CONDUCT OF
RESEARCH ON HIGH DIMENSIONAL
DATA SETS? SHOULD WE USE
DIFFERENT LEVELS OF SURETY WHEN
WE DESIGN SUCH EXPERIMENTS? WHAT
ARE THE DIFFERENT DESIGN
EXPERIMENTS THAT APPLY TO
HYPOTHESIS BASED VERSUS DATA
DRIVEN APPROAC APPROACHES? AND S
ACCEPTABLE LEVEL OF EVIDENCE
USING HYPOTHESES TO REDUCE
DIMENSIONALITY OR COMPLEXITY OF
THE DATA SETS BEING CONSIDERED?
THE THIRD AREA OF CONSIDERATION
ARE STUDIES INVOLVING PERIPHERAL
BIOMARKERS. DOES QUESTIONS GROUP
MIGHT ASK INCLUDE DOES THE
AVAILABILITY OF OMICS AND OTHER
HIGH DIMENSIONAL APPROACHES
ALONE OR IN COMBINATION INCREASE
THE POTENTIAL CLINICAL OR
SCIENTIFIC EWE UNTIL/OF
PERIPHERAL BIOMARKERS? OR SHOULD
NIMH CONTINUE TO DISCOURAGE
PERIPHERAL BIOMARKER STUDIES?
WHAT APPROACHES OR DESIGNS MIGHT
BE USED TO JUSTIFY OR ENHANCE
THE POTENTIAL RELEVANCE OF
EXPERIMENTS THAT UTILIZE
PERIPHERAL BIOMARKER DATA? AND
HOF MIGHT PERIPHERAL AND CENTRAL
HIGH DIMENSIONAL MEASURES BE
EVALUATED FOR PREDICTIVE OR
MECHANISTIC RELEVANCE? FINAL
AREA OF CONSIDERATION INCLUDES
STUDIES OF POTENTIAL CLINICAL
UTILITY. TO WHAT EXTENT HIGH
DIMENSIONAL MEASURES BE OF
CLINICAL VALUE IN PSYCHIATRY,
WHETHER IT BE PREDICTIVE
DIAGNOSTIC THERAPEUTIC OR
PROGNOSTIC. ARE THERE DESIGN
DIFFERENCES THAT WOULD BE
APPROPRIATE FOR STUDIES AIMED AT
CLINICAL UTILITY AS OPPOSE TO
THOSE AIMED AT UNDERSTANDING
DISEASE MECHANISMS. I WILL
MENTION THESE QUESTIONS AND THIS
DRAFT CHARGE ARE MY FIRST
ATTEMPT TO DEFINE THE PROBLEM
AND THEN I WOULD LOOK FORWARD TO
INPUT FROM THE WORK GROUP, OTHER
AREAS OF DISCUSSION OR
CONSIDERATION. SO I FRAMED THE
WORK GROUP REALM OF
RESPONSIBILITY OR CHARGE FOR
YOU. I WANT TO GIVE YOU A SENSE
OF THE TIME LINE WE ARE HOPING
FOR THEN ASK FOR VOLUNTEERS WHO
MIGHT BE INTERESTED IN
PARTICIPATING IN THE THIS WORK
GROUP. THE NIMH IS AIMING FOR
SERIES OF VIRTUAL MEETINGS THAT
WOULD TAKE PLACE BETWEEN NOW AND
THE WINTER, EARLY -- OF EARLY
2023. WITH THE BASIC FRAMEWORK
FOR RECOMMENDATIONS TO BE
PRESENTED AT THE MAY 2023
MEETING, PERHAPS IN THE FORM OF
A FINALIZED REPORT OR A FINAL
REPORT COULD BE DELIVERED
SHORTLY AFTER THAT MAY MEETING.
WE HAVE IDENTIFIED NIMH PROGRAM
STAFF LEADS WHICH INCLUDE
JONATHAN PEVSNER AND GEETHA
SENTHIL CO-LEADS OF THE TEAM AT
NIMH. OTHER PROGRAM STAFF WITH
EXPERTISE IN OTHER ASPECTS OF
HIGH DIMENSIONAL AN DATA SET
RESEARCH. WE ARE LOOKING FOR
VOLUNTEERS FROM COUNCIL AND IN
PARTICULAR, WE ARE LOOKING FOR
VOLUNTEER FOR A WORK GROUP
CO-LEAD, WE ANTICIPATE HAVING
TWO LEADS FOR THE WORK GROUP,
ONE COUNCIL MEMBER AND ONE
MEMBER OF THE EXTRAMURAL
COMMUNITY. WE ANTICIPATE WORK
GROUP SIZE OF 10 TO 15
EXTRAMURAL AND COUNCIL PEOPLE TO
BE COMPLIMENTED BY A SLIGHTLY
SMALLER GROUP OF NIMH STAFF TO
HELP THEM OUT. THE
RESPONSIBILITY OF DRAFTING THE
REPORT WILL FALL ON NIMH STAFF
WITH HEAVY GUIDANCE AND THOROUGH
EDITING BY THE TEAM OF -- BY THE
WORK GROUP MEMBERS AND WORK
GROUP CHAIRS AND IF NECESSARY WE
CAN ALSO CONTRACT FOR SCIENCE
WRITER TO HELP WITH THAT AS
WELL. SO THAT IS THE CONTEXT OF
THE WORK GROUP, THE CONTENT WE
HOPE THAT THE WORK GROUP WILL
WORK ON AND THE PROCESS FOR THE
WORK GROUP. I'M OPEN TO
QUESTIONS, COMMENTS, VOLUNT
VOLUNTEERING NOW. YOU CAN NOW
CLOSE THE SLIDES DOWN, ALEX.
THANKS.
>> ALL RIGHT. THERE IS --
>> LOOKS LIKE JOSEPH HAS HIS
HAND UP.
>> JOSEPH, G GO AHEAD. JOEL AS
WELL.
>> SO THANK YOU FOR THAT. SO I
HAVE A COUPLE OF QUESTIONS,
WHENEVER WE LOOK AT THIS JUST A
POINT OF INFORMATION
CLARIFICATION. WHEN YOU -- WHAT
YOU ARE SUGGESTING IS THAT IT
MOSTLY BASIC SCIENCE THAT YOU
ARE LOOKING FOR YOU REPORT ON OR
ARE YOU LOOKING FOR SOMETHING
BROADER? PARTICULARLY SINCE YOU
ARE TALKING ABOUT CLINICAL
UTILITY, WHICH IS MY FIRST
QUESTION, MY SECOND QUESTION,
ARE YOU ALSO LOOKING AT
POTENTIAL FOR POPULATION
APPLICATION? THERE ARE A NUMBER
OF POPULATIONS MOSTRY SMALL
POPULATIONS BECAUSE OF THAT, --
MOSTLY SMALL POPULATION WHOSE
HAVE GENETIC DISORDERS THAT
THEMSELVES THAT HAVE A LOT OF
THESE EXPERIENCES THAT INFLUENCE
WHAT IT IS YOU ARE TALKING
ABOUT. AND SO IT IS SORT OF A
CONTINGENT QUESTION. IF IT IS
OUTSIDE THE LAB ARE THEY BEING
CONSIDERED AND IF -- BUT IF
INSIDE THE LAB THAT IS A
DIFFERENT STORY. SO THAT IS A
STARTING POINT AS A QUESTION,
THANK YOU.
>> SO THANKS, JOSEPH. THE VAST
MAJORITY OF THE EXPERIMENTS THAT
USE HIGH DIMENSIONAL DITSIEST
ARE TAKING PLACE IN HUMANS AND
MOST OF THEM USE A MIXTURE OF
CLINICAL POPULATIONS AND COHORT
DATA, SOME OF THESE KINDS OF
THINGS ARE FOR EXAMPLE,
EPIGENETIC MARKERS ON POSTMORTEM
BRAIN TISSUE, OR IN BLOOD TAKEN
FROM PATIENTS. OF COURSE NEURAL
IMAGING IS TYPICALLY COHORTS OR
GROUPS OF PATIENTS. SO MOST OF
THIS IN HUMANS, MOST OF THE DATA
COMES FROM HUMANS THOUGH
CERTAINLY QUESTIONS DEALING WITH
LARGE SIZE DATA SETS, HIGH
DIMENSIONAL DATA THAT ARE HE
WILL EVENTUAL FOR ANIMALS. --
RELEVANT FOR ANIMALS. THE WORK
IS BOTH MECHANISTIC AND ALSO
CLINICAL. SO THERE ARE LOTS OF
PEOPLE WHO ARE USING DRIVEN
APPROACHES ON LARGE TO TRY TO
ASK THOSE WHETHER THOSE FINDINGS
THEY CAN FIND PREDICT RESPONSE
TO A GIVEN MEDICATION. WE THINK
BIOMARKER APPROACH WOULD BE
VALUABLE. BUT QUITE FAMOUSLY
EXAMPLES EVEN EXAMPLES THAT I
HAVE TOUTED HERE, IN FRONT OF
THIS GROUP IN SCIENCE UPDATES
HAVE HAD CHALLENGES IN TERMS OF
REPLICATING THE FINDINGS. SO
ANOTHER EXAMPLE OF THE THIS SORT
OF WORK I GAVE DURING THE
INTRODUCTION JUST CLARIFY THERE,
IS A LOT OF PEOPLE LOOKING AT
EPIGENETIC MARKS WHETHER IN
BLOOD OR OTHER TISSUE,
CONSEQUENT TO STRESS SOMETIMES
AS PARTS OF DEVELOPMENTAL
COHORT. AND TRYING TO UNDERSTAND
REPRODUCIBILITY OF THE FINDINGS
FROM THOSE STUDIES IS ONE OF THE
MAIN DRIVERS FOR THIS WORK. SO I
WOULD SAY ABSOLUTELY DOES IMPACT
ON IN BOTH CLINICAL REALM AND
MECHANISTIC REALM AND ALMOST ALL
WORK DONE IN HUMANS. THEN TO
ANSWER YOUR FINAL QUESTION, I
THINK WHAT WE ARE NOT TALKING
ABOUT HERE SPECIALIZED
COLLECTIONS OF INDIVIDUALS WITH
PARTICULAR DISORDER THOUGH YES
SOMETIMES THOSE MIGHT BE
IMPACTED HERE. INSTEAD WE ARE
TALKING MORE ABOUT TEND TO BE
TALKING MORE ABOUT COHORT
STUDIES OR LARGE COLLECTIONS OF
PATIENTS, TYPICALLY FROM
MULTIPLE SITES, THAT ARE
HETEROGENOUS IN NATURE. THOUGH
SOME PRINCIPLES OF EXPERIMENTAL
DESIGN OUT-GROUP APPLY TO LARGE
COLLECTIONS OF INDIVIDUALS FROM
SPECIFIC -- SPECIFIED
POPULATIONS AS WELL. JOEL, I SEE
YOUR HANDS UP NEXT ANYONE LAURA.
ANYONE ELSE FEEL FREE TO GET IN
LINE.
>> JOSH I WANT TO PLOD THIS,
THIS IS THE RIGHT -- TO PLAID
THIS, RIGHT TRACK. WANT TO
HIGHLIGHT THE RELATIVE STUDIES
IN THESE FIELDS, I THINK YOU ARE
RIGHT TO REAWAKEN THAT
DISCUSSION A LITTLE MORE FOCUS
AS WELL AS REVISITING A
PERIPHERAL DIMERS THINGS LIKE
CYTOKINES WHICH WE STUDIED AND
OTHER THINGS OTHERS HAVE STUDIED
WHAT CAN IMAGINE POTENTIAL YOU
UNTILTY OF BIOMARKERS AS A
POTENTIAL PROBLEM SO IF YOU DO
IT THOROUGHLY SO, I THINK THOSE
ARE THE RIGHT QUESTIONS TO A
LARGE EXTENT. A LOT OF THE
PROBLEM HERE I SEE IS DIFFICULTY
OF SOLVING THE MULTIPLE TESTING
PROBLEM WITH SMALL SAMPLES.
THAT IS IMPLIED IN WHAT YOU SAID
BUT MIGHT BE WORTH CALLING OUT
BECAUSE IT IS ONE OF THE
PRINCIPLE CHALLENGES DON'T THINK
I HAVE SEEN THAT LACKS
IMAGINATION TO SOLVE, JUST
REMAIN AS BRUTE FORCE. SO THAT'S
SOMETHING THAT -- OVERALL THIS
IS REALLY GOOD SO I WANT TO JUST
SUPPORT IT.
>> THANK YOU, JOEL. LET ME
RESPOND TO THAT LAST COMMENT YOU
MADE YOU ARE RIGHT THE MULTIPLE
TESTING PROBLEM, DOES DRIVE A
LOT OF THE ISSUES IN THIS AREA.
I WOULD SAY THERE IS A LOT OF
CREATIVITY IN TRYING TO SOLVE IT
BUT NOT A LOT OF THE RIGOR IN
THAT CREATIVITY. SO TONS OF
DIFFERENT APPROACHES, AND THAT
ARE BEING USED IN PAPERS. AND
YET I DON'T SEE THE CANONICAL
AGREEMENT CONSENSUS IN THE FIELD
THAT ANY ONE OF THIS IS
APPROACHES IS AT ALL VALID. AND
IN FACT WHAT YOU GET, I HAVE
SEEN THIS AS REVIEWER ON THE
HANDFUL OF LARGE DATA STUFF THAT
I REVIEW IN ANIMAL WORK, WHERE
IT IS A NOVEL METHOD THAT THE
AUTHORS IN OUR CONDENSED WORK,
THEY HAVE HAD LOTS OF
COLLABORATORS ON THE PAPER WHO
DEVELOP THE METHOD THEY THINK
WORK, I HAVE NO EXPERTISE TO
REVIEW IT. SO THERE ARE LOT OF
THESE ONE OFFS AND NOT A GOOD
CONSENSUS IN THE FIELD IN TERMS
OF WHICH METHODS THAT ACTUALLY
RIGOROUS AND WHICH ARE PROVEN TO
BE REPRODUCIBLE OVER TIME.
APPRECIATE THE COMMENT.
>> AGREE WITH THAT LAST POINT AS
WELL. SOMETIMES THEY FORGET THE
-- THEY ARE FORGETS FUNDAMENTALS
HOW TO REDUCE NUMBER OF TESTS
GETTING TOO FANCY INSTEAD OF
SIMPLIFYING BUT NOT TO GET INTO
THE WEEDS.
>> THEN AS YOU POINT OUT THE
OTHER METHODS REDUCE THE
COMPLEXITY OF THE NUMBER OF
TESTS IS TO HAVE A SPECIFIC
HYPOTHESIS, THE IMAGING WORLD
HAS LEFT THAT BEHIND BECAUSE
FAILURE THE REPRODUCE AS WELL,
AS THAT HAS GENETIC WORLD. SO
UNDER WHAT CONSIDERATION WOULD
WE ALLOW THAT IN THIS REALM, IN
THE REALM OF OTHER HIGH
DIMENSIONAL DATA SETS. LAURA,
YOU ARE NEXT.
>> SO I WANT TO ECHO WHAT JOEL
SAID, I THINK YOU HAVE ASKED A
LOT OF GREAT QUESTIONS HERE AND
THAT COMING UP WITH STRATEGIES
TO ADDRESS THESE COMPLEX ISSUES
CAN REALLY HELP TO MOVE THE
FIELD FORWARD. I WILL SAY THAT I
WOULD BE HAPPY TO BE PART OF
THIS CONVERSATION SO YOU CAN PUT
ME DOWN ON THE LIST OF POTENTIAL
VOLUNTEERS. THAT IS REGARDLESS
OF YOUR ANSWER TO MY NEXT
QUESTION. WHICH IS YOU FRAMED
THIS STARTING FROM THE GUIDANCE
ON THE GENE LOCALIZATION AND
GENOMIC STUDIES. SO I'M
WONDERING WHETHER YOU SEE THE
WORK OF THIS COMMITTEE AS BEING
COMPLETELY SEPARATE FROM THAT OR
IN DIALOGUE WITH IT OR DO THE
GENE LOCALIZATIONS GET THROWN
BACK INTO THE MIX AS WELL NOW?
>> IT IS MY OPINION, AND --
Y'ALL MAY DISAGREE, BUT THAT THE
RECOMMENDATIONS OF THAT WORK
GROUP SORT OF HAVE STOOD THE
TEST OF TIME. THAT WE WILL
INSIST UPON GENOME WIDE LEVELS
OF SIGNIFICANCE IF WE ARE TO
DECLARE A GENE LINK FOR
SCHIZOPHRENIA, DOESN'T MEAN GWAS
BUT WE NEED TO SURVIVE THAT
MULTIPLE TESTING PROBLEM,S THE
REASON WHY PERHAPS IF IT HAS
STOOD THE TEST OF TIME, THE
REASON WHY IT HAS IS BECAUSE I
THINK THERE WAS A CONSENSUS IN
THE FIELD THAT THE MULTIPLE --
THE ONLY WAY TO SOLVE MULTIPLE
TESTING PROBLEM IS INCREASE
DRAMATICALLY SIZE OF SAMPLES.
THAT IS I THINK WORKING SO I
DON'T THINK THERE IS A NEED TO
REVISIT RECOMMENDATIONS IN SPACE
OF GENOMICS. BUT THOSE SAME
LEVEL OF RIGOR DOESN'T SEEM TO
BE BEING APPLIED TO THESE OTHER
FORMS OF HIGH DIMENSIONAL DATA
OR IS APPLIED PERHAPS LESS
UNIFORMLY. AND I DON'T SEE A
CONSENSUS IN THE FIELD, IF WE
WERE TO INSIST ON THE ABSOLUTE
SAME LEVEL OF STATISTICAL
CONFIDENCE, THE MULTIPLE TESTING
PROBLEM BEING SOLVED BY IMMENSE
DATA SETS WE ARE STUCK WITH THE
RECOMMENDATION THAT CAME OUT OF
THE (INDISCERNIBLE) WORK YOU
NEED THOUSANDS OF INDIVIDUALS
FOR NEURAL IMAGING AND PROBABLY
NEED TENS OR HUNDREDS OF
THOUSANDS IF YOU WANT TO LINK
MULTIPLE HIGH DIMENSIONAL DATA
SETS TOGETHER. SO THAT MAY BE
WHAT WE SAY IN WHICH CASE THE
VAST MAJORITY OF FUNDING ARE NO
LONGER GOING TO BE FUNDABLE IN
THE THIS BASIS. BUT IT MAY BE
THERE ARE METHODS FOR
DIMENSIONALITY REDUCTION THAT
ARE MORE ACCEPTABLE IN THESE
OTHER AREAS BECAUSE WE ARE
TALKING ABOUT BIOLOGICAL
MECHANISMS OR BECAUSE WE HAVE
CONFIDENCE IN THEIR
REPRODUCIBILITY OR MAYBE THE
GROUP SAYS YOU KNOW WHAT, WE
DON'T KNOW BUT WE URGE NIMH TO
SUPPORT THE KINDS OF STUDIES
THAT COMPARE DIFFERENT METHODS
FOR DIMENSIONALITY REDUCTION. SO
THOSE WILL THE KINDS OF THINGS I
CAN IMAGINE COMING OUT OF THIS
GROUP. ANSWER SPECIFIC QUESTION,
NO I DON'T THINK WE NEED TO
REVISIT GENE FINDING PER SE,
THOUGH OF COURSE IF THE GROUP
FELT SO, I WOULD BE OPEN TO
LISTEN TO THAT. TED.
>> THANKS, JOSH. I ECHO THE
COMMENTS. ONE COMMENT ABOUT
GENE FINDING IS TO REALIZE THAT
MOST OF THE GENOME IS ACTUALLY
COVERED BY WHAT YOU JUST
DISCUSSED WHICH IS EPIGENETICS
SO WE WILL WINDS UPCOMING IN TO
THAT. CONVERSATION BUT THAT
DOESN'T MEAN WE HAVE TO REWRITE
THOSE RECOMMENDATIONS. THE
COUPLE OF THINGS THAT COME TO
MIND, ONE IS STUPID LITTLE THING
THAT HAPPENED LESS THAN 15 YEARS
AGO OR LONGER WHEN WE LOOK BACK
ON OUR MICROARRAY STUDIES AND
REALIZE THE MOST SIGNIFICANT
COMPONENT OF VARIATION WAS THE
NAME OF THE TECHNICIAN WHO RAN
IT. IN FACT. SO THERE ARE SOME
ISSUES HERE WHERE WE DON'T HAVE
THE TECHNOLOGIES SORTED OUT AND
THAT IS A CHALLENGE. THERE ARE
ALSO BIOLOGICAL CHALLENGES. IT
IS WORTH NOTING IN THE BROADEN
BIOLOGY WE HAVE COMPLETE
SUPPOSEDLY COMPLETE CONTROL OF
OUR SUBJECTS, IF WE WERE TO TRY
TO LOOK GENOME WIDE FOR
EPIGENETIC CHANGES WITH BEHAVIOR
THEY ARE HARD TO FIND. YOU CAN
FIND WITH LOOKING AT SPECIFIC
GENES OR DOING SPECIFIC THINGS
BUT IT IS A DIFFICULT PROBLEM.
COUPLE OF THINGS YOU DIDN'T
MENTION THAT COME TO MIND, ONE
IS THIS DIFFERENCE BETWEEN
STATES AND TRAIT TRAITS. WE GET
CONFUSED IN THIS, WHERE WE THINK
OF WHAT WE HAVE IS LOOKING FOR
SOMETHING STABLE BUT SOMETHING
CHANGING AND YOU NOT TALKED
ABOUT OPPORTUNITIES ASSOCIATED
WITH DISEASE, YOU CAN IMAGINE
STABLE VERSUS THOSE ASSOCIATED
WITH STRESS WHICH MIGHT BE --
MORE CHANGE. THE OTHER ISSUE IS
OBVIOUSLY VARIABILITY.
>> TED, CAN I INTERRUPT THAT TO
FOCUS ON THAT. I THINK KATIE'S
TALK INTERESTINGLY ENOUGH
ADDRESSED THAT ISSUE. SHE'S
CHOSEN TO WORK WITH INDIVIDUALS
OVER TIME MULTIPLE REPEATED
THING. THAT MIGHT BE ONE
RECOMMENDATION THE GROUP TO COME
UP WITH TO EMPHASIZE, THAT WAS
ALSO RECOMMENDATION THE
DIZZENBACH PAPER. WE FOCUS ON
ONE EXPERIMENTAL DESIGN LESS
PRONE TO ISSUES OF MULTIPLE
COMPARISONS. KEEP GOING.
>> SO THE OTHER CHALLENGE IS
CONNECTING -- TALKING ABOUT BIG
DATA SETS AND YOU TALKED ABOUT
THE DATA, EPIGENETIC DATA. BUT
YOU DIDN'T TALK A LOT ABOUT
CLINICAL DATA FOR WHICH I HAVE
NO EXPERIENCE WITH. BUT THERE WE
HAVE SIGNIFICANT VARIATION TOO
IN THAT MAYBE WE HAVE A
DIAGNOSIS THAT ONE DOCTOR GIVE
AND NEXT DOCTOR GIVE SMIDDYING
SUPPOSE BUT IT DOESN'T REFLECT
THE SAME UNDERLYING BIOLOGY SO
THE OTHER CHALLENGE IS WE TRYING
TO CONNECT ALL THIS SEQUENCING
TO AND IT ALSO HAS COMPLEXITY.
>> THAT'S RIGHT. SO ONE COULD
ALSO IN THAT SAME VEIN ONE
RECOMMENDATION MIGHT BE DON'T DO
EPIGENETICS AND DIAGNOSES, DO
THEM MORE CAREFULLY DEFINED M.
OR WHAT ARE CHARACTERISTICS BY
WHICH YOU COULD IMAGINE DOING
THAT. APPRECIATE THAT
PERSPECTIVE. BRINE THEPER SPEC .
>> THIS IS A IDEA LONG OVERDUE.
WE WORK WITH BIG DATA OVER TIME.
COUPLE OF PERSPECTIVES, SO I WAS
RECENTLY AT THIS CELL SYMPOSIUM
AND DAMIAN FAIR PRESENT THIRD
DEGREE STUDY. THAT YOU JUST
SUMMARIZED. THERE WERE TWO
THINGS REMARKABLE TO ME. FIRST,
I THINK EVERYBODY AGREED IT WAS
AN ASTOUNDING SET OF FINDINGS
AND THE SECOND WAS AFTER HIS
TALK, HE WAS ABSOLUTELY MOBBED
BY STUDENTS AND POST-DOCS WHO
WANTED TO WORK WITH HIM ON THESE
PROBLEMS. SO IT CAPTURED THE
IMAGINATION OF THE NEXT COHORT
OF NEUROSCIENTISTS. AND I KNOW
YOU ARE AWARE BUT YOU PROBABLY
WANT TO PUT ON YOUR DEFLECTOR
SCREENS BECAUSE THERE WILL BE
JUST I REMEMBER THE SAME
CONVERSATION THAT WE HAD WHEN
THE INITIAL RECOMMENDATIONS FROM
THE GENETICIST CAME OUT, TO NO
LONGER DO TARGETED STUDY BUS TO
DO UNBIASED GENOME WIDE
ASSOCIATION STUDIES. THERE WAS
TREMENDOUS PUSH BACK, THERE
STILL IS PUSH BACK FROM SOME
QUARTERS BUT I THINK THE VAST
MAJORITY OF PEOPLE AGREE THAT
THAT WAS REALLY A BIG STEP IN
THE RIGHT DIRECTION. I THINK IT
WAS THE SAME FOR THIS. BUT THERE
WILL BE I MEAN YOU ARE AWARE
THERE WILL BE SOME PUSH BACK.
BUT I'M 100 -- 110% BEHIND IT.
>> THANKS, BRIAN. SOFIA, YOU GET
THE LUXURY OF THE PRIVILEGE OF
THE LAST QUESTION OR COMMENT IT
IS TIME TO MOVE ON. WE CAN'T
HEAR YOU. YOU HAVE TO UNMUTE.
>> BRIAN STOLE SOME OF MY
THUNDER BUT HAVING SEEN AN
WORKING NOW CAN DAMIAN FAIR, ONE
OF THE HIGHLIGHTS TO EMPHASIZE
IS THAT SOME OF THESE TECHNIQUES
ARE CHANGING RAPIDLY. SO NOW
THERE'S PRECISION BRAIN MAPPING
WHICH INTERESTINGLY REQUIRES A
LONG PERIOD OF SCAN TIME AND
IDEALLY REPEATED SCANS ACROSS
SESSIONS WITH INDIVIDUALS, SO WE
REALLY ARE TALKING ABOUT
SHIFTING PARADIGMS ON THEIR HEAD
SO THAT AGAIN IS SORT OF SUPPORT
OF WHAT BRIAN SAID. I WANT -- IN
THIS VEIN TO HIGHLIGHT A COMMENT
YOU JUST MADE, JOSH. WHICH IS
THAT PERHAPS THE DESIGNS WE NEED
TO START CONSIDERING ARE THESE
WITHIN SUBJECT LONGITUDINAL
DESIGNS. THE REASON I THINK THAT
WORTH HIGHLIGHTING IS WE
CONTINUE TO STRUGGLE ABOUT HOW
DO WE BRING THE RICHNESS OF THE
SCIENCE WE DO INTO THE CLINIC.
WE HAVE TO START THINKING THE
WAY CLINICIANS DO. AT SOME LEVEL
WHICH IS LONGITUDINAL WITHIN
INDIVIDUAL CHANGE OVER TIME. SO
I ACTUALLY SEE THAT WHILE THIS
WILL PERHAPS CREATE SOME HAVOC
AND GENERATE SOME PUSH BACK IT
POTENTIALLY ALSO OPENS UP A VERY
EXCITING NEW AVENUES FOR THE
TRANSLATIONAL COMPONENT OF THE
WORK.
>> THANK YOU VERY THANK YOU VERK
YOU ALL, THOSE WHO COMMENTED AND
THE REST OF YOU WHO THOUGHT
ABOUT IT AND WHICH WILL BE
SENDING OUT A REQUEST FOR
VOLUNTEERS TO SERVE ON THE WORK
GROUP AND ENCOURAGE YOU TO BE
GENEROUS WITH YOUR TIME EVEN IF
YOU FEEL LIKE YOU DON'T HAVE THE
EXPERTISE. ALONG THAT WE WILL
ALSO BE ASKING FOR
RECOMMENDATIONS OF INDIVIDUAL
THE EXTRAMURAL WORLD. WE HAVE
OUR OWN LIST THAT WE COMPOSED
BUT Y'ALL KNOW HAVE A WIDER NET
THAN WE DO. T SO WE WILL BE
ASKING FOR RECOMMENDATIONS OF
EXTRAMURAL SCIENTISTS YOU THINK
WOULD BRING EXPERTISE TO THE
PROBLEM AS WELL AS AN OPEN MIND
TO THINKING ABOUT WAYS TO SOLVE
THE PROBLEM.
ALL RIGHT. THANK YOU, VERY MUCH.
WITH THAT WE WILL MOVE ON TO THE
NEXT PHASE OF THE PROGRAM WHICH
I BELIEVE IS COUNCIL CLEARANCES
LET ME NAVIGATE BACK TO MY
AGENDA.
>> WE ACTUALLY HAVE TIME FOR
JUST A SHORT BREAK.
>> EXCELLENT.
>> TRYING TO MAKE SURE WE ALLOW
BREAKS SINCE WE ARE DOING A ZOOM
MARATHON.
>> EXCELLENT. YOU ARE RIGHT. I
SEE THAT. WE ARE GOING TO TAKE A
BREAK UNTIL 3:45. WHICH GIVES US
TEN MINUTES FROM NOW. SO AGAIN
FEEL FREE TO TURN OFF YOUR
VIDEOS AND MUTE YOURSELVES, BE
BACK AT 3:45.
>>WE'RE GOING TO GET STARTED.
3:45. THANK YOU AGAIN FOR YOUR
INPUT ON THE POTENTIAL WORK
GROUP. NOW WE'LL SWITCH TO
CONCEPT CLEARANCES AS YOU ARE
AWARE, AT EACH COUNCIL MEETING
NIMH STAFF PRESENTS SEVERAL
SCIENTIFIC CONCEPTS FOR YOUR
INPUT. THE PURPOSE OF THESE
CONCEPT CLEARANCES IS FOR NIMH
STAFF AND LEADERSHIP TO HEAR
YOUR FEEDBACK ON THESE FUTURE
RESEARCH DIRECTIONS. INCLUDING
SUGGESTIONS THAT WILL HELP
FURTHER SHAPE INITIATIVES. A
BRIEF DESCRIPTION OF EACH
CONCEPT WAS MADE AVAILABLE TO
YOU VIA THE COUNCIL SOFTWARE
PACKAGE WITH YOUR FEEDBACK NIMH
AIMS TO PROCEED WITH THE
ACTIVITY. HOWEVER, THE
PUBLICATION AND TIMING IS NOT
CERTAIN AND DEPENDS ON
SUFFICIENT FUNDS BEING
AVAILABLE. ONCE PRESENTED
PUBLICLY AT COUNCIL CONCEPTS ARE
POSTED ON THE NIMH WEBSITE AND
ARE AVAILABLE FOR FURTHER
COMMENT. THE PURPOSE OF TODAY'S
DISCUSSION WE HAVE ASKED TWO
COUNCIL MEMBERS TO MAKE COMMENTS
ON EACH CONCEPT THOUGH WE
WELCOME FEEDBACK FROM ALL OF
YOU. THE FIRST CONCEPT WILL BE
PRESENTED BY JULIA ZEHR,
DIVISION OF TRANSLATIONAL
RESEARCH TITLED UNDERSTANDING
SOCIAL MEDIA AND YOUTH MENTAL
HEALTH.
>> YES, THANK YO THANK YOU. I'D
TO PRESENT THIS CONCEPT AND I
WOULD LIKE TO THANK DR. SMITH
AND (INAUDIBLE) FOR THEIR WORKED
WELL. THE GOAL OF THE CONCEPT
IS BETTER UNDERSTAND THE ROLE OF
SOCIAL MEDIA BEHAVIORS IN YOUTH
MENTAL HEALTH. IN SEPTEMBER THE
SURGEON GENERAL ADMINISTERED A
ADVISORY, HIGHLIGHTING THE NEED
FOR MORE SOCIAL MEDIA. RESEARCH
HAS BEEN CHALLENGING FOR MANY
REASONS ONE IS IT IS DIFFICULT
TO CAPTURE SOCIAL MEDIA
BEHAVIORS ENGAGEMENT AND CONTEXT
FROM DIGITAL ECOSYSTEM. A SECOND
REASON IS THAT THE WAYS IN WHICH
YOUTH ACT WITH SOCIAL MEDIA AS
WELL AS DIGITAL PLATFORMS AND
THE SYSTEMS THEMSELVES HAVE
CHANGE VERY RAPIDLY OVER THE
PAST YEARS. METHODS FOR
QUANTIFYING BEHAVIORS COMBINED
WITH ADVANCES IN BIOINFORMATICS
MADE THIS RESEARCH IN THIS AREA
MORE TRACTABLE AND READY FOR
ADDITIONAL WORK. NEXT SLIDE. SO
THERE'S SEVERAL RESEARCH AREAS
THAT WOULD BENEFIT FOR MORE
RESEARCH, THESE INCLUDE
UNDERSTANDING THE POTENTIAL
HARMS OF SOCIAL MEDIA AND YOUTH
MENTAL HEALTH AS WELL AS
INTERVENTIONS. WE WANT TO
UNDERSTAND WHETHER WE CAN USE
SOCIAL MEDIA AS A TOOL TO
IDENTIFY CHILDREN AT RISK FOR
PSYCHOPATHOLOGY. WE WANT TO BE
ABLE TO CHARACTERIZE THE ROLE OF
DIGITAL SOCIAL INTERACTIONS IN
YOUTH SOCIAL DEVELOPMENT AND
CONTRIBUTIONS TO RISK AND
RESILIENCE FOR PSYCHOPATHOLOGY.
WE NEED TO BUILD MORE
INFORMATION ON THE METHOD
LOGICAL AND ETHICAL
CONSIDERATIONS FOR RESEARCH ON
SOCIAL MEDIA BEHAVIORS AND
YOUTH. AND WE WANT TO UNDERSTAND
HOW SOCIAL MEDIA BEHAVIORS
INTERACT WITH THE EFFICACY AND
EFFECTIVENESS OF MENTAL HEALTH
INTERVENTIONS. SO THERE'S
SEVERAL ANTICIPATED OUTCOMES.
FIRST WEAPON HOPE TO BETTER
UNDERSTAND BIDIRECTIONAL
INFLUENCE OF SOCIAL MEDIA AND
MENTAL HEALTH. WE WANT TO BE
ABLE TO IDENTIFY YOUTH AT RISK
FOR NEGATIVE MENTAL HEALTH
OUTCOMES ASSOCIATED WITH SOCIAL
MEDIA USE AS WELL AS IDENTIFY
THE RISK OF PROTECTIVE FACTORS
THAT EVERYBODY IS AS MODIFIABLE
TARGETS FOR FUTURE
INTERVENTIONAL DEVELOPMENT
EFFORTS. FINALLY, WORK SUPPORTED
IN THIS CONCEPT COULD USED TO
GENERATE DEVELOPMENTALLY
INFORMED FINDINGS, ENABLE YOUTH
FAMILIES AN COMMUNITIES TO MAKE
HEALTHY DECISIONS ABOUT SOCIAL
MEDIA USE. WITH THAT I WOULD BE
HAPPY TO HEAR FEEDBACK AND
COMMENTS FROM COUNCIL.
>> THANK YOU, JULIA. I BELIEVE
DR.S LIGHTFOOT WERE ASKED TO
PROVIDE FEEDBACK ON THIS
PROPOSAL. MARGUERITA WOULD YOU
LIKE TO START?
>> I CAN ABSOLUTE WILL I GO
FIRST. THANK YOU. THANK YOU VERY
MUCH FOR THAT AS WELL. I REALLY
SUPPORTED AND EXCITED TO SEE
THIS WORK, OR THIS CONCEPT
SUPPORTING AND ENCOURAGING WORK
ON SOCIAL MEDIA AND YOUTH,
MAINLY ALL WE NEED TO DO IS LOOK
AT ADOLESCENT AND THE FACT THEY
ARE STARING AT THEIR PHONE ALL
DAY TO KNOW THIS KIND OF
RESEARCH IS NEEDED BUT WE ALSO
HAVE SEEN EMERGING LITERATURE
THAT SUGGESTS SOCIAL MEDIA HAS
AN IMPACT ON A HOST OF MENTAL
HEALTH OUTCOMES. AMONG THIS
POPULATION. INCLUDING DEPRESSION
BODY IMAGE DYSFUNCTION, THOSE
KINDS OF THINGS. I RATELY LIKED
AND THOUGHT IT WAS IMPORTANT TO
SEE THAT BIDIRECTIONALTY THAT'S
CRITICAL BECAUSE WE DONE KNOW
ENOUGH ABOUT THINGS LIKE SOCIAL
MEDIA CAUSE, PEOPLE TO BE
DEPRESSED OR DO DEPRESSED YOUNG
PEOPLE GO TO PARTICULAR
PARTICULAR TYPES OF SOCIAL MEDIA
PLATFORMS AND THAT WORSENS THEIR
DEPRESSION. I APPRECIATED THE
FOCUS ON BOTH RISK AND
PROTECTIVE FACTORS FOR SOCIAL
MEDIA USE. OFTENTIMES WE TALK
ABOUT RISK BUT ANYONE WHO
INTERACTS WITH ADOLESCENT KNOWS
SOCIAL MEDIA AND HOW YOUNG
PERSON ENGAGES WITH SOCIAL MEDIA
IS PART OF WHO THEY ARE. IT'S
PART OF THE IDENTITY. SO WE HAVE
OPPORTUNITIES TO LEVERAGE SOCIAL
MEDIA TO PROMOTE HEALTHY
BEHAVIORS AND PROMOTE MENTAL
HEALTH AND SO REALLY LOOKING AT
-- WE WANT TO ENSURE THAT WE
INCLUDE THAT AS WELL. I
APPRECIATE THAT WAS ALSO BROUGHT
UP BECAUSE WE TEND TO ONLY LOOK
AT THE RISK. I ALSO APPRECIATE
FOCUS ON ETHICS. I THINK THE
ETHICS OF SOCIAL MEDIA AND OUR
METHODS FOR STUDYING SOCIAL
MEDIA ARE COMPLICATED AND
COMPLEX SO REALLY INVESTIGATING
AND LOOK AT THAT IS IMPORTANT. I
REALLY ALSO APPRECIATED THE NEED
TO UNDERSTAND THE RELATIONSHIPS
AMONG SOCIAL MEDIA BEHAVIOR,
SOCIAL MEDIA ENGAGEMENT, SOCIAL
CONTEXT AND MENTAL HEALTH. AND
PARTICULARLY GIVEN TODAY'S
PRESENTATION, BY DR. MCLAUGHLIN,
ENSURING WE ARE ALSO LOOKING --
ENSURING THIS EXAMINATION
INCLUDES SOCIAL SUPPORT AND
ENGAGEMENT SO THINGS LIKE THE
LEVEL OF ACTIVE OR PASSIVE
ENGAGEMENT SEEMS IMPORTANT. AND
WILL BE IMPORTANT MOVING
FORWARD. THE ONE THING I WOULD
ALSO COMMENT ON IS WE KNOW THE
SOCIAL MEDIA LANDSCAPE IS
CHANGING. OFTENTIMES VERY
QUICKLY FOR YOUNG PEOPLE.
THERE'S NEW PLATFORMS POPPING UP
ALL THE TIME. SO I THINK OUR
METHODS AND STUDIES REALLY NEED
TO TAKE INTO ACCOUNT AND LOOK AT
DIFFERENT THE BIGGER PICTURE OF
THE WHY, HOW THE WHERE AND THE
WHO WITH REGARDS TO USING SOCIAL
MEDIA AS OPPOSED TO JUST
FOCUSING ON A PARTICULAR
PLATFORM WHY ARE YOUNG PEOPLE
USING A PARTICULAR PLATFORM HOW
THEY ARE ENGAGING IN PARTICULAR
PLATFORMS WHAT ARE THEY GETTING
OUT WHAT ARE THE IMPACTS, VIDEO
VERSUS PICTURES VERSUS WORDS.
ALL THOSE THINGS NEED TO BE
IMPORTANT SO IT WILL BE
IMPORTANT FOR US TO ALSO LOOK AT
THAT I VERY MUCH SUPPORT THIS
AND THANK YOU FOR SHARING IT.
>> THANK YOU. NEXT UP WE HAVE
ANOTHER DISCUSSANT. PLEASE.
>> I FEEL SIMILARLY, THIS IS
VERY TIMELY, IF WE THINK ABOUT
THE RAPIDLY -- EVOLUTION OF
SOCIALIZATION ENVIRONMENT OF
YOUTH OVER THE LAST 30 YEARS, 40
YEARS 20 YEARS, 10 YEARS, 2
YEARS IT MAKES DIFFICULT TO KNOW
WHAT TO MAKE OF DEVELOPMENTAL
STUDIES FROM LONG AGO SO NEED TO
CONTINUALLY UPDATE AND BE NIMBLE
IN TRACKING THESE SOCIAL
ENVIRONMENTS INCLUDING SOCIAL
MEDIA IS VERY TIMELY STRONGLY
SUPPORT, I THINK I WANT TO
HIGHLIGHT ISSUES EVEN MORE. ONE
IS AS I LOOK AT THIS LITERATURE
REVIEW IN PREPARATION, AND
THERE'S META ANALYSES, THE
CORRELATION OF SOCIAL MEDIA WITH
MENTAL HEALTH PROBLEMS IS
BECOMING -- ON THE REALLY ALMOST
ESTABLISHED OR CERTAINLY
BECOMING VERY ESTABLISHED BASED
ON RECENT META ANALYSES BUT
THERE'S CLEAR GAP IN CAUSE OF
CAUSALITY SO I WANT TO EMPHASIZE
THAT. THE TWO ELEPHANTS IN THE
ROOM ARE CAUSALITY AND THEN THE
HEAVY RELIANCE ON SELF-REPORT.
SO I THINK YOU ARE RIGHT TO
FOCUS ON HOW CAN WE BETTER
MEASURE WHAT THEY ARE DOING ON
THE SOCIAL MEDIA AND BETTER
MEASURE PSYCHOPATHOLOGY AS WELL.
TWO CRITICAL ISSUES YOU ARE
RIGHT TO EMPHASIZE AND I
UNDERSCORE. I WOULD ALSO
HIGHLIGHT AS YOU DEVELOP THE
RELEVANCE OF THE ACTIVITY THAT
ALSO NOTED. ONE ACTIVITY
FRIENDLY CLOSE CONNECTION WITH A
FRIEND IS VERY DIFFERENT FROM
BEING SUBJECTED TO GROUP NOISE
AND GROUP ACTIVITY AND WHAT USES
ARE HEALTHY OR UNHEALTHY AS YOU
IDENTIFY HERE IS IMPORTANT BUT
FOCUSING ON CONTENT AND TYPE OF
USE. THEN THIS ISSUE OF
MODERATORS AND AGAIN ALSO ECHO
THAT KATIE MCLAUGHLIN THIS
MORNING, WHAT ABOUT EXERCISE,
PARENTING ALL THESE DIFFERENT
MODERATORS THAT MAY IMMUNIZE
SOME CHILDREN INOCULATE SOME
AGAINST THE RISKS WHEREAS OTHERS
ARE CLEARLY AT RISK SO THERE'S
TREMENDOUS AMOUNT TO DO HERE.
ONE QUESTION TO KEEP -- THAT I
STRUCK ME, THINKING ABOUT THIS
IS THERE'S ENTIRE LITERATURE
AROUND THINGS SO CALLED
ADDICTION MEDIA ADDICTION OR
SCREEN ADDICTION, SO MAYBE
CLARIFY WHETHER THAT IS INTENDED
TO BE SWEPT UNDER THIS OR NOT,
REALLY FOCUSING ONLY ON SOCIAL
MEDIA OR ON SCREEN USE
GENERALLY. I DON'T HAVE A
RECOMMENDATION THERE BUT JUST
PUT CLEAR BOUNDARY ON THIS.
SIMILARLY THERE IS OBVIOUSLY
EVEN WE HEARD TODAY, TREMENDOUS
INTEREST IN USING DIGITAL MEDIA
TO ENHANCE MENTAL HEALTH
INTERVENTION AND CLINICAL TRIALS
AND SO ON. IS THAT BEING SWEPT
INTO THIS AS WELL? OR DO YOU
WANT TO BRACKET THAT AS SEPARATE
CATEGORY? SO THE BOUNDARIES OF
THIS INITIATIVE AND HOW MUCH OF
THIS UNIVERSE TO SWEEP UNDER IT
NEEDS TO BE CLARIFIED. DEPENDING
WHETHER INTERVENTIONS, ISSUES
NIMH HAS. BUT VERY GOOD JULIA.
THIS IS REALLY NECESSARY.
>> THANKS TO BOTH COMMENTERS.
MARGUERITA AND JOEL. ANY
COMMENTS OR QUESTIONS FROM THE
REST OF THE COMMITTEE?
>> PAT HAS HER HAND UP.
>> GO AHEAD. PATRICIA.
>> THANK YOU, VERY MUCH. I AM
ALSO INCREDIBLY ENTHUSIASTIC
ABOUT THIS PROPOSAL. AND THE ONE
AREA THAT I WOULD LIKE TO SEE
PROMOTED A LITTLE BIT MORE WOULD
BE THE CONSIDERATION OF THE
ETHICS. JUST BECAUSE WE CAN
COLLECT SOME DATA DOES THAT MEAN
WE OUGHT TO COLLECT THE DATA, IS
ONE CONCERN. BUT MY BASIC
CONCERN IS, THAT THE YOUTH MAY
OR MAY NOT UNDERSTAND WHAT THEY
ARE BEING ASKED TO TURN OVER OVY
ALLOWING ACCESS TO THEIR PHONE
OR THEIR SOCIAL MEDIA ACCOUNTS
OR -- AND WHAT THE POTENTIAL
CONSEQUENCES ARE OF OTHER PEOPLE
BEING ABLE TO FOLLOW THEM IN
THIS WAY. SO I THINK THAT AS WE
GO AHEAD AND TRY TO DEVELOP
THESE STUDIES, HOW WE GO ABOUT
GETTING INFORMED CONSENT AND HOW
WE GO ABOUT PROTECTING THE DATA
ARE NEW ISSUES THAT I THINK
DESERVE ADDED ATTENTION FROM OUR
TRADITIONAL ADULT FOCUSED
ACTIVITIES.
>> THANK YOU, PATRICIA. THANK
YOU. WE APPRECIATE THE FEEDBACK.
AND JULIA AND OTHERS WILL
INCORPORATE IT AS THEY MOVE
FORWARD WITH PLANNING THAT
INITIATIVE. NEXT UP WE HAVE DR.
LAURA ROLAND, GERIATRIC AND
AGING PROCESSES RESEARCH BRANCH
DIVISION OF TRANSLATIONAL
RESEARCH, SCHIZOPHRENIA AND
RELATED DISORDERS DURING MID TO
LATE LIFE.
>> THANK YOU. I WANT TO THANK MY
COLLEAGUE DR. EVANSS. SO THIS
CONCEPT ALIGNS WITH OUR NIMH
STRATEGIC PLAN GOAL NUMBER 2.
EXAMINE MENTAL ILLNESS
TRAJECTORIES ACROSS THE LIFE
SPAN. ONE OF THE PROBLEMS IS
THAT WE HAVE A PAUCITY OF
RESEARCH ON SCHIZOPHRENIA, AND
RELATED PSYCHOTIC DISORDERS IN
MID TO LATE LIFE. AND THIS HAS
IMPACTED THE EMERGENCE OF NEW
INTERVENTIONS AND PREVENTATIVE
STRATEGIES. SO THE OVERARCHING
GOAL OF THIS CONCEPT IS TO
ADVANCE TRANSLATIONAL RESEARCH
IN THIS CLINICAL POPULATION.
WITH THE HOPE TO AXEL RATE
DEVELOPMENT OF PREVENTION AND
INTERVENTION EFFORTS. NEXT SLIDE
PLEASE. SO THE MAJORITY OF
PEOPLE LIVING WITH SCHIZOPHRENIA
AND RELATED PSYCHOTIC DISORDERS
ARE IN THE MID TO LATE LIFE.
THAT'S THE MIDDLE FIGURE. THIS
INCLUDES THOSE WHO HAVE AN
ILLNESS ONSET AFTER THE AGE OF
35, 40, THAT IS THE LEFT FIGURE,
AND THOSE AGING WITH ILLNESS.
THIS ILLNESS IS AMONG THE TOP 15
LEADING CAUSES OF DISABILITY
WORLDWIDE. THE HIGHEST BURDEN OF
DISEASE OCCURS DURING MID LIFE
OUTLINED IN THE RIGHT FIGURE.
UNFORTUNATELY THIS POPULATION
HAS A SHORTER LIFE SPAN AND
GREATER MORBIDITY THAN THE
GENERAL POPULATION. AND WE
CURRENTLY HAVE POOR
UNDERSTANDING OF THE MECHANISMS
UNDERLYING ILLNESS EMERGENCE,
TRAJECTORIES AND OUTCOMES DURING
LATER LIFE. NEXT SLIDE PLEASE.
SOME POTENTIAL RESEARCH AREAS
INCLUDE BUT ARE NOT LIMITED TO
PHENOMMOLOGY, ETIOLOGY AND
PATHOPHYSIOLOGY OF FIRST EPISODE
PSYCHOSIS THAT EMERGES MID TO
LATE LIFE. THE UNDERLYING
MECHANISMS AND TRAJECTORIES OF
PSYCHOSIS, NEGATIVE SYMPTOMS
COGNITION, SOCIAL COGNITION AND
EVERY DAY FUNCTIONING MID TO
LATE LIFE. UNDERLYING BIOLOGICAL
AND OTHER MECHANISMS SUCH AS
BEHAVIORAL AND SOCIAL
DETERMINANTS OF HEALTH FOR THE
INCREASE RISK OF DEMENTIA IN
THIS POPULATION. ACCELERATED
BIOLOGICAL AGING THAT MAY
INFLUENCE PSYCHOPATHOLOGY
PREMATURE MORBIDITY AND
MORTALITY IN THIS POPULATION.
AND THE IDENTIFICATION OF
TREATMENT TARGETS AND
DEVELOPMENT OF NOVEL
INTERVENTIONS TO IMPROVE HEALTH
OUTCOMES. SO RESEARCH NEEDS AND
EXPECTED OUTCOMES. AS I STATED
PREVIOUSLY OLDER ADULTS ARE
UNDER-REPRESENTED IN PSYCHOSIS
RESEARCH. HAVING TARGETING --
TARGETED FUNDING OPPORTUNITIES
ANNOUNCEMENTS IS GOING TO
ENCOURAGE RESEARCH IN THIS
POPULATION. THERE'S ALSO A NEED
FOR RESEARCH EXAMINING
UNDERSTUDIED GROUPS WITHIN THIS
CLINICAL POPULATION. THAT
INCLUDES WOMEN AND MINORITIZED
GROUPS. SO WITH ADDITIONAL
RESEARCH WE WOULD IMPROVEMENT
OUR UNDERSTANDING OF MECHANISMS
UNDERLYING THE ILLNESS AND MID
TO LATE LIFE AND THEREFORE HELP
ACCELERATE DEVELOPMENT OF NEW
INTERVENTIONS AND PREVENTATIVE
EFFORTS. THANK YOU FOR YOUR
ATTENTION. HAPPY TO ANSWER ANY
QUESTIONS.
>> THANK YOU VERY MUCH, LAURA
AND FOR DISCUSSANTS WE HAVE DR.
SOFIA AND KILL BORN. AMY START
US A OFF.
>> YES, I CAN BE BRIEF BECAUSE
I'M HIGHLY SUPPORTIVE OF THIS
CONCEPT AND I THINK IT ADDRESSES
A VERY IMPORTANT POPULATION BOTH
CLINICALLY AND IN TERMS OF
QUESTIONS AND MYSTERIES WE HAVE
ABOUT PERSISTENT PSYCHOSIS. TWO
ADDITIONAL POINTS TO MAKE IS
THAT IF WE CAN GAIN GREATER
INSIGHT INTO WHAT IS UNIQUE
ABOUT THE MECHANISMS THAT OCCUR
IN PEOPLE WHO ARE EXPERIENCING
INITIAL ONSET OF PSYCHOSIS LATER
IN LIFE, THAT WILL HIGHLY --
THAT WE HIGHLY LIKELY TO YIELD
NOVEL WAYS OF THINKING WHAT IS
HAPPENING IN THE MORE
TRADITIONAL DEVELOPMENTAL LIFE
SPAN OR TRADITIONAL
DEVELOPMENTAL PICTURE THAT WE
SEE IN PSYCHOSIS, WHAT
MECHANISMS ARE SIMILAR, WHAT ARE
DISTINCT, AGAIN SORTING OUT
THEIR INFLUENCE OF ENVIRONMENT,
DRUG EXPOSURE, ET CETERA. THE
SECOND POINT I WOULD MAKE IS I
THINK THIS KIND OF RESEARCH
OFFERS SOME VERY INTERESTING
OPPORTUNITIES TO PROBE INTO THE
RELATIONSHIP OF BETWEEN
PSYCHOSIS AND OTHER SERIOUS
MENTAL DISORDERS AND BRAIN
AGING. WE KNOW THAT THERE STARTS
TO BE DISREGULATIONS IN CELLULAR
PLASTICITY PROCESSES OF THE
BRAIN ADVANCES IN AGE, LIKELY
RELATED TO SENSORY NOISE AND
UNDERSTANDING THOSE KINDS OF
MECHANISMS AND HOW THEY ARE
APPEARING IN PSYCHOSIS SPECTRUM
ILLNESSES MAY AGAIN GIVE
ADDITIONAL INSIGHT INTO THE
ILLNESS PHENOTYPE MORE BROADLY.
>> THANK YOU SOFIA. AMY.
>> THANKS FOR THE OPPORTUNITY TO
REVIEW. THIS IS REALLY
INTERESTING AND I AGREE WITH
WHAT SOFIA HAS SAID. TO ADD TO
WHAT SHE'S COVERED, I'M VERY
INTERESTED IN AND CURIOUS WHAT
KINDS OF MECHANISMS COULD BE
STUDIED AROUND SOCIAL
DETERMINANTS IN PARTICULAR FROM
A REAL WORLD EXPERIENCE WE HAVE
SEEN AT LEAST IN SOME TREATMENT
SETTINGS, THERE IS A NATIONAL
STUDY THAT CAME OUT THAT LOOKED
AT THE FACT THAT THERE IS A PUSH
TO DEIMPLEMENT SOME
OVERPRESCRIBING OF
ANTI-PSYCHOTIC IN NURSING HOMES
FOR EXAMPLE HAS LED TO AN
INCREASE UNINTENDED INCREASE OF
PRESCRIPTIONS FOR MEDICATIONS
THAT MAY NOT BE THE BEST THINGS
FOR PEOPLE AND I THINK WE NEED
MECHANISMS STUDIES BECAUSE WE
DON'T KNOW WHAT IS HAPPENING
WITH THESE INDIVIDUALS AND WHAT
IS GOING ON IN THE NURSING HOMES
AND THEY HIGHLY VULNERABLE TO
GETTING TREATMENT INAPPROPRIATE
TREATMENT AND NOT THE RIGHT
TREATMENT DEPENDING ON ETIOLOGY.
SO THIS WORK AROUND MECHANISMS
IS GOING TO BE REALLY IMPORTANT
FROM NOT JUST A BIOLOGICAL
NATURE BUT ALSO SOCIO LOGICAL
NATURE AS WELL, WHAT ARE SOME OF
THE EXPERIENCES PEOPLE HAD WITH
PRIOR TREATMENT, WHAT WILL THEIR
SITUATION HAS BEEN, SORT OF LIFE
JOURNEY WITH HOMELESSNESS AND
ALSO BEING INSTITUTIONALIZED
CARE. I WOULD BE INTERESTED IN
LOOKING AT LOT OF MECHANISMS AT
THESE MULTIPLE LEVELS SO REALLY
EXCITED ABOUT THIS AND LOOK
FORWARD TO SEEING IT HAPPEN.
THANKS.
>> THANK YOU, AMY AND SOFIA. ANY
QUESTIONS OR COMMENTS FROM OTHER
MEMBERS OF THE COMMITTEE?
>> PATRICIA AND MARJORIE HAVE
THEIR HANDS UP.
>> START WITH YOU PAT.
>> I THINK THIS IS EXCEPTIONALLY
INTERESTING AND IMPORTANT AREA.
I WAS JUST WONDERING HOW STUDY
IN THIS AREA WOULD BE ABLE TO
IDENTIFY AND RECRUIT PEOPLE WHO
ARE NOT ALREADY ENGAGED IN
TREATMENT?
>> GOOD QUESTION. DO WE HAVE AN
ANSWER? NOT SURE WE HAVE A
RESPONSE TO THAT.
>> DO YOU WANT ME TO ANSWER?
FROM MY UNDERSTANDING WE HAD A
WORK SHOP ON THIS SUBJECT SO
THERE ARE PEOPLE THAT HAVE
ILLNESS ONSET LATE IN LIFE SO
THEY HAVE NOT HAD TREATMENT.
THEY ARE SOMEWHAT RARE SO ABOUT
25% HAVE THEIR ILLNESS ONSET AT
AGE 35 AND BEYOND. SO THERE IS
THAT GROUP BUT YOU ARE RIGHT WE
NEED TO STUDY PEOPLE WHO ARE
ALREADY IN CARE AND AGING WITH
ILLNESS. SO THAT IS THE CONCEPT
COVERS, IT IS BROAD.
>> I WAS POTENTIALLY THINKING
ABOUT PEOPLE WHO MAY HAVE HAD AN
ONSET AT TRADITIONAL AGE BUT
HAVE BEEN KEPT AT HOME OR LIVED
IN A COMMUNITY WITHOUT BEING
TREATED.
>> RIGHT. SO THAT IS ANOTHER
GROUP TOO. INTERESTINGLY THERE
ARE POPULATIONS WORLDWIDE WHO
HAVE TRADITIONAL ILLNESS ONSET
EARLIER IN LIFE AND HAVEN'T BEEN
TREATED. SO THAT SOMETHING WE
ARE THINKING ABOUT.
>> I HAVE A COMMENT AS WELL ON
THAT. I WILL JUMP IN HERE IF YOU
DON'T MIND JOSH.
>> GO AHEAD.
>> VERY BRIEFLY, IF YOU SET UP
ONLINE RESEARCH PROJECTS, YOU
CAPTURE AN INTERESTING GROUP OF
INDIVIDUALS WHO HAVE NOT BEEN
ENGAGED IN TRADITIONAL MEDICAL
TREATMENT SETTINGS.
>> THANKS FOR THAT INSIGHT.
MARJORIE.
>> I TOO VERY ENTHUSIASTIC ABOUT
THIS CONCEPT AND I WOULD LIKE TO
ENCOURAGE YOU TO ALSO LOOK AT
PEOPLE WHO ARE DOING WELL WITH
SCHIZOPHRENIA. PEOPLE DIAGNOSED
WITH SCHIZOPHRENIA AT YOUNGER
AGE BUT THEY ARE DOING WELL. MID
TO LATER LIFE BECAUSE I THINK
THAT THERE'S A LOT OF LESSONS WE
CAN LEARN WHAT FACTORS
CONTRIBUTED TO THIS SUCCESS.
IT'S ALMOST WHEN I SAY THIS,
PEOPLE ALMOST SAY WELL THIS JUST
DOESN'T HAPPEN, PEOPLE DON'T
RECOVER FROM THESE DISEASES,
WELL SOME PEOPLE DO. AND IN FACT
WE JUST RECENTLY COMPLETED A
STUDY WHERE WE INTERVIEWED OVER
800 PEOPLE, DIAGNOSED WITH
SERIOUS MENTAL ILLNESS, NOT ALL
WITH SCHIZOPHRENIA BUT MANY WITH
SCHIZOPHRENIA WHO ARE EMPLOYED
AND WORKING. NOT A DISABILITY
AND SUPPORTING THEMSELVES AND
DOING WELL. SO I THINK THIS IS
AN INTERESTING GROUP TO LOOK AT
AS WILL AS PEOPLE HAVING
CONTINUED ISSUES WITH THIS.
THANK YOU FOR TAKING ALL THIS.
>> SOFIA, SOMETHING ELSE TO ADD?
THANK YOU VERY MUCH FOR IF
DISCUSSION. AGAIN, LAURA AND
COLLEAGUES WILL TAKE THIS UNDER
CONSIDERATION AS THEY MOVE
FORWARD WITH THE INITIATIVE
WHICH I HEAR WITH VERY GOOD
AGREEMENT. NEXT UP WE HAVE A DUO
JENNIFER HUMENSKY, DIVISION OF
SERVICES INTERVENTION RESEARCH
AND LEO CUBILLOS, DEVELOPING
QUALITY MEASURES TO ADVANCE
MENTAL HEALTHCARE ACCESS AND
OUTCOMES.
>> THIS IS A JOINT CONCEPT LED
BY DIVISION OF SERVICES AND
INTERVENTION RESEARCH AND CENTER
FOR GLOBAL MEN DATA RESEARCH.
URGENT NEED EXISTS FOR VALIDATED
QUALITY MEASURES TO ACCESS
ANDANTE SENTIVE IMPROVEMENTS IN
ORDER TO ASSESS VALUE OF
SERVICES WE HAVE TO MEASURE
THEM. STANDARDIZE INSTRUMENTS
FOR ASSESSING CLINICAL STATS ARE
PLENTIFUL; THERE'S QUALITY
MEASURES ENDORSING USED AND
PRACTICE. IN ORDER TO
INCENTIVIZE HIGH QUALITY CARE
THROUGH IMPROVEMENT ACCESS AND
OUTCOMES EFFECTIVE QUALITY
MEASURES ASSESSING CONCEPTS ARE
NEEDED AND THESE SHOULD BE
ENDORSED BY RELEVANT GOVERNING
BODIES TO FA SIGNATURE AT A TIME
TAKE UP BY PAYERS. O FACILITATE.
TO DEFINE CONCEPTS QUALITY
MEASURES ASSESS THE RATE OF
TARGET OUTCOME ACROSS THE
POPULATION. AND AS ENDORSED
OUTCOMES FOCUS MEASURE IS AMONG
INDIVIDUALS ASSESS WITH
DEPRESSION, WHAT PERCENT REACH
CERTAIN LEVEL IMPROVEMENT BY SIX
OR 12 MONTHS. DOES DEPRESSION
SCORES CLINICAL MEASURE AND
CHANGE IN SYMPTOM LEVEL'S CROSS
POPULATION LEVEL AS THE OUTCOME
MEASURE. ACCESS FOCUS QUALITY
MEASURES ASSESS TIMELY USE OF
SERVICES OVERLAPPING
AFFORDABILITY AVAILABILITY AND
TIME THROUGHLINESS AND ENDORSED
ACCESS MEASURE IS PROPORTION OF
ADULTS WITH MAJOR DEPRESSIVE
EPISODES RECEIVING TREATMENT.
THESE ARE USED TO DEVELOP
DELIVER MONITOR AND IMPROVE
CARE. FOR EXAMPLE FACILITY AT A
TIME MEASUREMENT BASED CARE
EVALUATE EFFECTIVENESS OF
SERVICES, AND IMPLEMENT
CONTINUOUS QUALITY IMPROVEMENT
INITIATIVES AND TEST AND CAM
PAIR ALTERNATE MODELS SERVICE
DELIVERY AND PAYMENT OVAL WAIT
SHIFTING FROM DIVISIONAL FEES
FOR SERVICE TO VALUE BASED
PAYMENT MODELS. NEXT SLIDE
PLEASE. THIS CONCEPT AIMS TO
SUPPORT DEVELOPMENT TESTING
VALIDATION AND IMPLEMENTATION OF
MEASURES TO ADVANCE MENTAL
HEALTH CARE ACCESS OUTCOMES AND
QUALITY IN THE UNITED STATES
OTHER HIGH INCOME COUNTRIES AND
LOW AND MIDDLE INCOME CRIBS.
FACILITATION OF FINDINGS TO
PRACTICE THIS CONCEPT SEEKS TO
SUPPORT DEVELOPMENT AND
VALIDATION OF MEASURES AN DATA
COLLECTION REVIEWED ENDORSED BY
RELEVANT GOVERNING OR REGULATORY
BODIES. FOR EXAMPLE IN THE
UNITED STATES THIS COULD INCLUDE
THE NATIONAL QUALITY FORUM
FUNDED BY CONGRESS AND ENDORSED
BY OFFICE OF MANAGEMENT AND
BUDGET O TO SUPPORT ASSESSING
QUALITY MEASURES. OTHER
COUNTRIES INCLUDE ADMINISTRATIVE
HEALTH OR OTHER RELEVANT
GOVERNING BODIES.
CONSISTENT WITH STRATEGIC FOUR
OF NIH PLAN RESEARCH THIS IS
RESEARCH TO DO THE FOLLOWING
DEVELOPING TESTING MEASURES OF
ACCESS TO MENTAL HEALTHCARE AND
CONTINUITY OF CARE OR DEVELOPING
AND TESTING NEW MEASURES OF
MENTAL HEALTH QUALITY BASTED ON
EXISTING STANDARDIZED CLINICAL
MEASURES, IN EXAMPLE GIVEN
PREVIOUSLY USING TESTIMONY
CLINICAL MEASURE OF DEPRESSION
TO DEVELOP POPULATION BASED
OUTCOMELESS MEASURES. OR
DEVELOPING TESTING NEW MEASURES
WHICH ARE NOT BASED ON CURRENTLY
EXISTING CLINICAL MEASURES. OR
TO ADAPTS AND TEST EXISTING
GENERAL HEALTHCARE MEASURES THAT
COULD BE ADAPTED TO MENTAL
HEALTH SERVICES. FINALLY SHOULD
BE NOTED PROJECTS WILL BE
EXPECTED TO DEVELOP WITH INPUT
OF KEY STAKEHOLDERS. WITH THAT
WE WOULD WELCOME FEEDBACK FROM
COUNCIL.
>> THANK YOU VERY MUCH, LAURA.
WE HAVE DR.s MARJORIE BALDWIN.
WOULD YOU START OFF.
>> THANKS, JOSH. I'M VERY
ENTHUSIASTICALLY ENDORSE THIS
CONCEPT AND GLAD TO SEE NIMH
PUTTING IT FORWARD. RECENT
ARTICLE IN WORLD PSYCHIATRY
NOTED THAT THE OVERALL QUALITY
OF MENTAL HEALTHCARE GLOBALLY IS
POOR AND IMPROVEMENTS IN QUALITY
HAVE LAGGED BEHIND IMPROVEMENTS
IN QUALITY OF CARE FOR PHYSICAL
CONDITIONS. THE AUTHORS SAY THAT
EMPHASIZING THE IMPORTANCE OF
QUALITY MEASURES CANNOT IMPROVE
WHAT WE CANNOT MEASURE. SO I
WOULD SAY THAT THIS CONCEPT IS
ESSENTIAL TO DEVELOPING AND
IMPROVING -- YOU MUTED YOURSELF
AT THE VERY END THERE.
>> I ONLY BACK NOW. OKAY. I DO
HAVE A COUPLE OF SUGGESTIONS
BASICALLY ABOUT WHAT OUTCOMES
ARE GOING TO BE MEASURED. I
NOTICE THAT THE CONCEPT MENTIONS
CLINICAL STATUS AND CLINICAL
IMPROVEMENT AND I THINK CLINICAL
MEASURES ARE NECESSARY BUT ARE
NOT SUFFICIENT WHEN TALKING
ABOUT MENTAL HEALTH ISSUES.
GIVEN THE COMPLEXITY OF THE WAY
MENTAL ILLNESS AFFECTS PATIENT
WELL BEING I THINK THAT NEED TO
FOCUS ON BROAD RANGE OF OUTCOMES
MEASURES INCLUDING QUALITY OF
LIFE, MEANINGFUL RECOVERY
MEASURES, AND MEASURES OF
ENGAGEMENT WITH THE COMMUNITY
INCLUDING WORK AND FAMILY. I
NOTICE THAT JENNIFER MENTIONED
THEY WERE GOING TO REQUIRE THAT
APPLICANTS GET INPUT FROM KEY
STAKEHOLDERS, REALLY GLAD TO
HEAR THAT, ULTIMATELY THAT IS
WHAT COUNTS IS WE ARE PROVIDING
TREATMENT AS WELL AS INDIVIDUALS
WITH MENTAL ILLNESS TO OBTAIN
WHAT THEY FEEL IS RECOVERY BUT
-- AND OUTCOMES THEY FEEL ARE
IMPORTANT ALSO ARGUE IN FAVOR OF
THE FAMILY AND CAREGIVERS THAT
THEY ARE ALSO KEY STAKEHOLDERS
IN WHAT OUTCOMES ARE IMPORTANT.
COMMENT ON OUTCOMES OF ACCESS TO
CARE. WHEN I GOOGLED THESE I
FOUND WERE PRETTY MUCH GLOBAL
MEASURES OF PERCENT OF PEOPLE
THAT MEANS, PERCENT O P PEOPLE
NOT RECEIVING CAREER, PERCENT
NOT FOLLOWING UP, HE IS MEASURES
AREN'T INFORMATIVE HOW WE
IMPROVE I WOULD ARGUE GOING TO
BE IMPORTANT TO FOCUS ON
SPECIFIC SERVICES WHERE PEOPLE
ARE NOT BEING ABLE TO ACCESS,
FOR EXAMPLE SHORE TERM ACUTE
CARE IN PATIENT, AND JUST FROM
AN ECONOMIST ACCESSING GOOD OR
SERVICE THERE'S BASICALLY TWO
REASONS, ONE IS THEY NOT ABLE TO
PAY FOR THE SERVICE, AND THE
OTHER REASON IS POSSIBLE REASON
IS THERE IS INADEQUATE SUPPLY,
IN OTHER WORDS SHORTAGE. OF HOSE
SERVICES. THAT IS TWO DIFFERENT
ISSUES AND IT IS IMPORTANT IN
LOOKING AT OUTCOMES WITH RESPECT
TO ACCESS TO UNDERSTAND WHY ARE
PEOPLE UNABLE TO ACCESS IS IT
BECAUSE OF LACK OF INSURANCE,
LACK OF ABILITY TO PAY, LACK OF
WILLINGNESS TO PAY OR ARE THERE
SHORTAGES RELATED TO OUR
POLICIES REGARDING MENTAL HEALTH
SERVICES. THAT NEED TO BE
ADDRESSED. STRONGLY SUPPORT
THITHITHIS.
>> THANKS MARJORIE. ANYTHING TO
ADD?
>> I HUNDRED PERCENT AGREE
CONCUR I SHOULD SAY. WITH MY
COLLEAGUE, SHE COVERED A LOT OF
THE INITIAL POINTS I MAKE HER
LATTER COMMENTS SO I WILL KEEP
-- FOCUS MINE ON OTHER ISSUES SO
I DO SUPPORT BECAUSE IT IS
CLEARLY CONCEPTUALLY SOUND IN
TERMS OF WHAT IS INTENDED TO DO.
HOWEVER, THE REAL CHALLENGE IS
THAT IT IS REALLY BROAD. THE
BREADTH OF WHAT IT IS TRYING TO
ADDRESS PARTICULARLY AROUND
QUALITY MEASURES, IS THAT YOU
ARE LOOKING AT MULTIPLE TIERS
WITHIN SORT OF THE ECONOMIC
LEVELS OF THE DIFFERENT TYPES OF
COUNTRIES YOU ARE LOOKING AT SO
WHAT I'M SAYING IS THAT IT IS
GOING TO BE A TRANSLATIONAL
CHALLENGE WHEN YOU DEVELOP --
DEVELOPING TOOLS IN THE UNITED
STATES, HOWEVER YOU ALSO ARE
GOING TO LOOK AT ACCRUAL AND
SEIZE ACROSS MIDDLE INCOME
COUNTRIES EQUIVALENCIES ACROSS
LOW INCOME COUNTRIES IF THAT IS
THE INTENT TO COME UP WITH THAT
BECAUSE YOU EMPHASIZE THE NEED
FOR STANDARDIZATION PARTICULARLY
AROUND QUALITY IN TERMS OF
SERVICE DELIVERY AND WORK. SO I
WOULD ADD THAT TO MY -- THE
COMMENTS WITH MY COLLEAGUE AS
EVEN A QUESTION ON THAT. ALSO AS
CONCEPT THAT WE HAVE COVERED
BEFORE, AT LEAST SINCE I HAVE
BEEN ON THE COUNCIL. AND IF IT
IS, THE MODIFICATIONS
THEMSELVES, STILL SHOULD BE
ADDRESSING THOSE TRANSLATIONAL
TYPE OF CHALLENGES PARTICULARLY
AROUND METHODOLOGY. SO
IDENTIFICATION OF WHAT IS TO BE
MEASURED PARTICULARLY WITHIN THE
CONTEXTUAL AREAS IS IMPORTANT.
BECAUSE BOTH OPERATIONAL
DEFINITION AS WELL AS TYPE OF
MEASUREMENT METHOD LOGICAL
APPROACH GATHERING THE
INFORMATION IS GOING TO BE REAL
CHALLENGE TO INVESTIGATORS WHO
ARE TRYING TO LOOK AT MEANS
WHICH THEY CAN STANDARDIZE THIS
AND ALSO LEVEL OF COST THAT IS
GOING TO REQUIRE TO BE INCLUSIVE
OF THE POPULATION ITSELF IS
GOING TO BE A CHALLENGE IN THE
LONG RUN. SO WHAT I'M SAYING IS
THAT NEEDS MORE WORK IN TERMS OF
JUST THINKING THROUGH METHOD
LOGICALLY HOW YOU ACTUALLY GET
AT THIS OR HOW YOU WOULD
INSTRUCT THOSE WHO ARE GOING TO
BE APPLYING THIS RESEARCH AND
THIS WORK PARTICULARLY THOSE WHO
ARE METHOD DOLL GISTS, THOSE WHO
ARE EXPERTS IN THINGS LIKE
QUALITY CONTROL AND QUALITY
ASSESSMENT AS WELL AS CALL OF
LIFE ISSUES THEY NEED TO HAVE A
LITTLE BIT MORE INSTRUCTION AND
CLARIFICATION OF WHAT IT IS THAT
YOU NEED SO IT LINES UP WITH
WHAT THEY ALREADY KNOW WHICH IS
BEST PRACTICES AS WELL AS WHAT
IS GOING TO BE DONE. SO I WOULD
SAY THAT. THEN MY LAST PART IS
ACCOUNTABILITY IN THIS WORK
PARTICULARLY WITH THE MIDDLE LOW
INCOME COUNTRIES PART IS THE
NEED TO ESTABLISH SOME KIND OF
CRITERIA FOR DEVELOPMENT AND
IMPLEMENTATION. THAT WILL ALLOW
YOU TO MAKE A JUDGMENT OF
WHETHER OR NOT WHAT IS BEING
APPLIED CONTEXTUALLY WHAT IT IS
YOU ARE LOOKING AT BASED ON A
WHOLE SLEW OF FACTORS IS GOING
TO BE REALLY IMPORTANT SO
ASSESSING THAT AND ASSESSING
EFFICACY OUTCOMES AND HAVING
SOME KIND OF PLAN CRITICALLY
BECAUSE YOU ARE DEVELOPING AND
LOOKING AT WAYS TO DEVELOP NEW
WAYS TO ASSESS AND NEW MEASURES
IS GOING FORWARD. THAT'S MY
COMMENT. THANK YOU. I APPRECIATE
BEING ASKED TO COMMENT ON THIS.
THANK YOU.
>> THANK YOU, JOSEPH. PATRICIA
DO YOU STILL HAVE YOUR HAND UP
FROM ABOVE OR COMMENT?
>> COMMENT ON THIS ONE TOO
PLEASE.
>> THANK YOU.
>> INTERESTINGLY, IN MANY OF THE
LOWER SOCIOECONOMICALLY
DEVELOPED COUNTRIES ACCESS TO
CELL PHONES IS EXTREMELY
WIDESPREAD. I THINK THAT THAT
MIGHT BE SOMETHING THAT WE MIGHT
WANT TO HIGHLIGHT SPECIFICALLY
AS FAR AS UTILIZING TOOLS TO
ASSESS NOT JUST HAVING PEOPLE
COMPLETE A CHECKLIST ON THEIR
PHONE BUT ALSO THINGS LIKE A
WATCH THAT EVEN IN AREAS WHERE
YOU ARE UNABLE TO BE SURE PEOPLE
HAVE ACCESS TO PHONE YOU CAN
GIVE A WATCH LIKE THIS TO
SOMEBODY AND IT WILL MONITOR
LEVEL OF ACTIVITY TIME OF SLEEP,
THEIR HEART RATE ALL KINDS OF
THINGS THAT ARE CLEARLY
ASSOCIATED WITH BIPOLAR
DISORDER. OBVIOUSLY THE PERSON
WITH -- WILL BE ROOTING FOR THEM
THE PERSON WITH DEPRESSION AND
SLEEP MIGHT BE ALSO AN ISSUE
THAT MIGHT BE ASSOCIATED WITH
DIAGNOSIS AS WELL SO SOME OF THE
PHYSIOLOGICAL COMPONENTS OF OUR
DISORDERS CAN BE EASILY MEASURED
IN A VERY PASSIVE WAY JUST
BYPASSING OUT ONE OF THESE
DEVICES. IN MY PAST LIFE AT THE
HOSPITAL WE HAD RESEARCH ON
SLEEP THAT PEOPLE REALLY DID
WELL WITH THE DEVICES AND THEY
WERE MUCH MORE EXPENSIVE THAN
THIS SO THIS MIGHT BE A SPECIFIC
AREA THAT WE MIGHT WANT TO CALL
OUT OUR REQUEST FOR
APPLICATIONS.
>> THANK YOU, PAT. ANY OTHER
COMMENTS OR QUESTIONS? ALL
RIGHT. I'M STILL HEARING
AGREEMENT WITH MOVING FORWARD
WITH THE INCORPORATION OF THE
COMMENTS, MOVE TO THE NEXT ONE.
WHICH IS ANDREA HORVATH MARQUES
CENTER FOR GLOBAL HEALTH
RESEARCH PRESENTING INITIATIVE
FOR RESEARCH SUICIDE PREVENTION
ACROSS THE LIFE SPAN IN LOW AND
MIDDLE INCOME COUNTRIES. AND
DR. MARQUES, PLEASE TAKE IT
AWAY.
>> THANK YOU, JOSH. I HAVE THE
HONOR TO PRESENT THIS CONCEPT
FROM THE CENTER FOR GLOBAL
MENTAL HEALTH DISAGGREGATION
ACROSS THE LIFE SPAN IN LOW AND
MIDDLE INCOME COUNTRIES BEFORE I
MOVE FORWARD I WOULD LIKE TO
THANK THE SUPPORT OF THE NIMH
SOCIETY IN DEVELOPING THIS
CONCEPTS. SUICIDE IS MAJOR
GLOBAL PUBLIC HEALTH PROBLEM.
OPT LEFT-HAND SIDE OF THIS SLIDE
SUICIDE IS AMONG LEADING
PREVENTABLE CAUSES OF DEATH
WORLDWIDE WITH MORE DEATH DUE TO
SUICIDE THAN MALARIA, HIV, AND
BREAST CANCER. OVER 700,000
PEOPLE DIE BY SUICIDE EACH YEAR
AND 77% OF THE GLOBAL SUICIDE
OCCURS IN LOW MIDDLE INCOME
COUNTRIES. THE GLOBAL ADJUSTED
SUICIDE RATE IS NOT HOWEVER RATE
VARY BUSINESS COUNTRIES AND
LOCATIONS SO THERE IS MUCH TO BE
DONE IN MARCH 2021, THE CENTER
HIGHLIGHTED NIMH INTEREST
IMPLEMENTING INTERVENTION
STRATEGIES TO REDUCE SUICIDE
RISK AND PROMOTE LOW AND MIDDLE
INCOME COUNTRIES, TODAY WE
PRESENT THE CONCEPT TO SUPPORT
RESEARCH TO IMPLEMENT AND
EVALUATE SCALABLE AND FINANCIAL
SUSTAINABLE PREVENTATIVE
INTERVENTIONS AND STRATEGIES TO
REDUCE SUICIDE RISK AND PROMOTE
-- RESEARCH APPLY MULTI-LEVEL
APPROACH EVALUATING UNIVERSAL
SELECTIVE AND INTERCOUNTRY
PREVENTION STRATEGIES AND
APPLYING WORLD HEALTH
ORGANIZATION LIFELINE APPROACH
TO GUIDE LIMITATION PROCESS AND
SUPPORT IDENTIFICATION OF
PREVENTATIVE STRATEGIES THAT ARE
RELEVANT AND APPROPRIATE FOR
EACH SETTING. RESEARCH THAT
APPLY BASED A APPROACH WHICH
FOCUSES NOT ONLY ON MENTAL
HEALTH CONCERNS WHICH IS
IMPORTANT BUT ALSO FOCUS ON THE
SPECIAL DETERMINANTS OF HEALTH
SUCH AS DOES CRIMINATION AND
POOR ACCESS TO CARE. WE ALSO
UNDERSTAND THE COLLABORATION
WITH GOVERNMENT SECTORS
INTERNATIONAL DEVELOPING
AGENCIES AND HEALTH AGENCIES AND
OTHERS AT NOT ONLY IMPORTANT BUT
NECESSARY TO ABLE TO ADDRESS
THIS MAJOR HEALTH ISSUE. HERE
THE NEXT SLIDE PLEASE, EXAMPLES
OF RESEARCH WE ANTICIPATE
SUPPORT. RESEARCH THAT WE
IDENTIFY IN PROTECTIVE RISK
FACTORS THAT MIGHT SERVICE
TARGETS FOR PREVENTIVE
INTERVENTION SUCH AS MENTAL
ILLNESS, SOCIAL DETERMINANTS OF
HEALTH TO TEST AND IMPLEMENT
UNIVERSAL PREVENTIVE STRATEGY,
RESTRICTION MEANS AND TEST
IMPLEMENTED SELECTIVE PREVENTIVE
STRATEGIES TO INTEGRATE SUICIDE
SCREENING, ASSESSMENT AND
INTERVENTION HEALTH SYSTEMS AND
LEVELS. FINALLY WE ALSO LOOK
INTO SUPPORT RESEARCH THAT
IMPLEMENT AND EVALUATE
SURVEILLANCE SYSTEMS AND
IMPLEMENT STRATEGIES FOCUS ON
FINANCIAL MODELS OR POLICIES AND
REGULATIONS THAT COULD INFLUENCE
THE SUCCESS OF SCALING UP AND
SUSTAINING PREVENTIVE
STRATEGIES. THANK YOU FOR YOUR
ATTENTION. HAPP HAPPY TO TAKE
QUESTIONS AND LOOK FORWARD TO
YOUR FEEDBACK.
>> THANK YOU, ANDREA. WE HAVE
ASKED DR.S MATT KNOCK AND
MARGUERITA LIGHTFOOT TO COMMENT.
MATT LEAD OFF? HAPPY TO. THANKS
FOR THE OPPORTUNITY TO COMMENT.
I STRONGLY SUPPORT THIS CONCEPT
CLEARANCE. IT FOCUSES ON AS
OUTLINED REALLY IMPORTANT TOPIC
SUICIDE CONTINUES TO BE A
LEADING CAUSE OF DEATH IN THE
U.S. WORLDWIDE AS NOTED THREE
QUARTERS, MORE THAN THREE
QUARTERS OF SUICIDE HAPPEN IN
LOW AND MIDDLE INCOME COUNTRIES
WE HAVE DATA FROM THE WORLD
HEALTH ORGANIZATION HEALTH
SURVEY INITIATIVE FUNDED IN
LARGE PART BY NIMH LOOK AT
SUICIDE IN TWO DOZEN COUNTRIES
AROUND THE WORLD AND FOUND
SIMILAR RISK FACTORS IN LOW AND
MIDDLE INCOME COUNTRIES, TO
THOSE SEEN IN HIGH INCOME
COUNTRIES THOUGH THERE WERE
IMPORTANT DIFFERENCES, THAT
BEING SAID THERE A LOT WE DON'T
KNOW AS HIGHLIGHTED SO THIS
CONCEPT CLEARANCE FOCUSES ON
THIS PROBLEM AND IMPORTANT GAPS
ONE FEW QUICK THINGS TO NOTE IF
THIS MOVE FORWARD REQUEST
PROPOSAL ENCOURAGE DEVELOPERS TO
BE EXPLICIT WHAT KINDS OF
PROJECTS SHOULD BE THE FOCUS. I
THOUGHT AS WRITTEN IT IS REALLY
BROAD AND COVERS LOOKING AGENT
THE SLIDE EVERYTHING FROM
IDENTIFYING PEOPLE LOOK AT RISK
FACTORS PROTECTIVE FACTORS
WORKING ACROSS LEVELS, UNIVERSAL
PREVENTION, FOCUS TREATMENTS
THERE IS A LOT IN THERE, WHICH
MAYBE IS FINE BUT THERE IS A LOT
THAT NEEDS TO BE IMPROVED IN
SUICIDE PREDICTION AND
PREVENTION LITERATURE, A LOT OF
THIS STUDIES PREVENTION STUDIES
FOR INSTANCE THAT ARE DONE IN
THE U.S. ARE SMALL AND
UNDERPOWERED. THERE IS NOT AS
MUCH FOCUS AS THERE NEEDS TO BE
ON ACTUAL PREVENTION OF SUICIDE
BEHAVIORS AND DEATH. AND FOCUS
ON LOW MIDDLE FIRST QUARTER
COUNTRY THERE'S DANGER FOR THOSE
DESIGN TO BE REPLICATED. WE
WANT TO FOCUS ON SCALABLE
EFFICIENT INTERVENTIONS
PREVENTION PROGRAMS, THAT HAVE
REAL SHOT AT DECREASING RISK OF
SUICIDAL BEHAVIOR AND DEPLOYED
IN RANGE OF DIFFERENT OUTCOMES.
SO THIS IS A REALLY GREAT FOCUS
THAT TO MY VIEW SHOULD BE HAVE A
LITTLE FINER POINT PUT ON IT TO
MAKE HUER STUDIES DONE ARE
METHOD LOGICALLY RIGOROUS AND
FOCUS ON OUTCOMES WE WANT TO
PREVENT. AND I THINK THIS COULD
BE A GOOD MECHANISM WHAT WORKS
GENERALLY, A LOT CAN BE LEARNED
IN LOWER AND MIDDLE INCOME
COUNTRIES THAT CAN BE USED IN
HIGH INCOME COUNTRIES WHERE
RESOURCES ARE LESS AVAILABLE SO
GREAT CHANCE TO LEARN A GREAT
DEAL. I SUPPORT THIS. THANKS
AGAIN.
>> THANK YOU, MATTHEW.
MARGUERITA.
>> I ALSO STRONGLY SUPPORT THIS
AND THE IDEA THAT THE RECORDED
SUICIDE THAT OCCUR IN THE WORLD
ARE AMONG LOW AND MIDDLE FIRST
QUARTER COUNTRIES IS STAGGERING
AND -- INCOME COUNTRIES IS
STAGGERING AND UNDERESTIMATE OF
SUICIDE RISK AND SUICIDE IS
HAPPENING. I REALLY ALSO JUST TO
UNDERSCORE WHAT WAS SAID BEFORE,
FOCUS ON IMPLEMENTATION SCIENCE
AND SCALABILITY IS GOING TO BE
CRITICAL. SO THAT WE ARE NOT
REPLICATING SOME OF THE
LIMITATIONS THAT WE HAVE SEEN IN
STUDIES THAT HAPPENED IN THE US
AND OTHER WESTERN COUNTRIES. ON
THAT NOTE I WOULD ALSO WHILE I
AGREE THERE IS A NEED TO
IMPLEMENT CULTURALLY ADAPTIVE
INTERVENTIONS, I WANT TO ENSURE
THAT WE ARE ALSO VALUE PROMOTE
IN COUNTRY KNOWLEDGE AND
EXPERTISE AND CAREFUL NOT TO
TAKE A COLONIAL APPROACH WITH
WESTERN KNOWLEDGE DICTATING WHAT
WE THINK WORKS AND WE ARE TRYING
TO REPLICATE THOSE THINGS AND
LMIC SO WE WANT TO MAKE SURE WE
HAVE ROOM AND ENCOURAGE
PARTNERSHIPS FOR THOSE AND
LMICs ABOUT THE MODEL
STRATEGIES AND INTERVENTIONS
THAT WOULD WORK WORK IN THOSE
PARTICULAR SETTINGS. I ALSO
REALLY APPRECIATE THE FACT THAT
THERE IS AN APPRECIATION IN THIS
CONCEPT THAT TREATMENT OR
PREVENTION OF SUICIDE INVOLVES A
WIDER RANGE OF APPROACHES BEYOND
JUST LOOKING AT PSYCHIATRIC
ILLNESS AND SO REALLY MAKING
EFFORTS TO INCORPORATE A WIDER
RANGE OF ACTIVITIES, SUCH AS
REDUCTION OF ACCESS TO
PESTICIDES, THINGS LIKE SOCIAL
DETERMINANTS OF HEALTH POVERTY,
ALSO INCLUDE THINGS LIKE
DOMESTIC VIOLENCE AND ALCOHOL
MISUSE AND ABUSE AS PART OF
THAT. GIVEN SUICIDE IS
PARTICULARLY HIGH AMONG
ADOLESCENTS THAN ADULTS, I WOULD
ENCOURAGE INCLUSION OF
DEVELOPMENTALLY APPROPRIATE
APPROACHES. FOR SUICIDE
PREVENTION. DOING THAT WITH
YOUNG PEOPLE IS GOING TO BE
REALLY IMPORTANT AND SPECIFIC.
MANY COUNTRIES SUICIDE BEHAVIORS
ALSO CRIMINALIZED SO WE HAVE TO
THINK ABOUT HOW WE -- WHAT IT
LOOKS LIKE WHAT THE CONTEXT LOOK
LIKE WHEN TRYING TO DO
PREVENTION SUICIDE WHEN IN MANY
COUNTRIES SUICIDAL BEHAVIOR IS
ILLEGAL. I ALSO APPRECIATE VERY
MUCH THE INCLUSION OF STIGMA AND
DISCRIMINATION NOT ONLY FOR
SUICIDE PREVENTION, BUT FOR
MENTAL HEALTH PROBLEMS. IN
GENERAL. SO INCORPORATING THAT
AND HAVING THAT AT THE FOREFRONT
IS GOING TO BE REALLY IMPORTANT
I ALSO VERY MUCH AGREE THAT THIS
WAS REALLY BROAD AND SO IT WAS
REALLY HARD TO -- GIVEN ALL THE
THINGS WE HAVE TALKED ABOUT
HAVING A LITTLE BIT MORE FINER
POINT WOULD BE HELPFUL IN TERMS
OF BUILDING THE SCIENCE FOR
THIS. VERY, VERY SUPPORTIVE AND
EXCITING ABOUT THIS. THANK YOU.
>> THANK YOU VERY MUCH. I'LL
NOTE MATT'S COMMENT IN THE CHAT
BOX READ FOR THE RECORD I WANT
TO SECOND DR. LIGHTFOOT'S
SUGGESTION DON'T JUST TRY TO
IMPLEMENT WESTERN PROGRAMS WE
HAVE STRONG INTERVENTION
PROGRAMS AND SO WOULD BENEFIT
FROM CONSIDERING APPROACHES
PROPOSED IN OTHER COUNTRIES AND
NOT YET TESTED. THERE OTHER
COMMENTS FROM MEMBERS OF THE
COUNCIL? SEEING NONE, ANDREA,
YOU HAVE YOUR CHARGE, DEVELOP A
LITTLE BIT STRONGER OF A FOCUS
AND THERE WAS SUGGESTIONS MAYBE
SPECIFIC FOCI. AND REALLY
APPRECIATE THE COMMENTS FROM
MATTHEW AND MARGUERITA. FINAL
CONCEPT CLEARANCE, YES GOING TO
GO PAST THE 4:30 HOUR, SHOULD
FINISH BEFORE 5 BUT THOSE WHO
NEED TO LEAVE PLEASE DO. WE
DON'T, TRACY, TAKE A VOTE ON
THESE CONCEPT CLEARANCES SO WE
DON'T NEED A QUORUM. FINAL
PRESENTATION IS WHICH GREGORY
GREENWOOD DIVISION OF AIDS
RESEARCH, HE WILL PRESENT ON
INNOVATIONS IN HIV PREVENTION
TESTING ADHERENCE AND RETENTION
TO OPTIMIZE HIV PREVENTION AND
CARE CONTINUUM OUTCOMES.
>> GREA GREAT. THANK YOU SO MUCI
WANT LIKE TO THANK MY COLLEAGUES
SUSANNA ALISON AND SUSIE POLLARD
IN HELPING PREPARING THIS
CONCEPT. SO THE GOAL OF THIS
CONCEPT IS TO ENCOURAGE YOU KNOW
INVESTIGATIVE BEHAVIORAL AND
SOCIAL SCIENCE RESEARCH TO
OPTIMIZE HIV PREVENTION AND
CARE, WHICH IS ALIGNED WITH THE
NIH OFFICE OF AIDS RESEARCH AND
NIMH DIVISION OF AIDS RESEARCH
PRIORITIES. APPLICATIONS
ENCOURAGED BY THIS INITIATIVE
COULD INCLUDE FORMATIVE BASIC
BEHAVIORAL AND SOCIAL SCIENCE
RESEARCH, INITIAL DEVELOPMENT
AND PILOT TESTING, OR
INTERVENTION EFFICACY AND
EFFECTIVENESS TRIALS. OR
IMPLEMENTATION SCIENCE RESEARCH
THE NIH STRATEGIC PLAN FOR HIV
AND HIV RELATED RESEARCH FOR
FISCAL YEARS 21 TO 25 OUTLINES A
ROBUST RESEARCH AGENDA WITH
HIGHLIGHTS OF KEY PRIORITY
AREAS. SO THERE'S BEEN GROUND
BREAKING ADVANCES IN BIOMEDICAL
HIV RESEARCH THAT HAVE LED TO
EFFECTIVE TREATMENTS SUCH AS
ANTI-RETROVIRAL THERAPY, AN
EFFECTIVE PREVENTION SUCH AS
PRE-EXPOSURE PROPHYLAXIS THAT
ALLOWS PEOPLE LIVING WITH HIV TO
LIVE LONGER HEALTHIER LIVES AND
PEEP AT RISK OF ACQUIRING HI TO
PROTECT THEMSELVES. RISING RATES
OF NEW INFECTIONS OR LOW RATES
OF VIRAL SUPPRESSION, ARE STILL
EVIDENT. FOR EXAMPLE, HIV
DISPARITIES EXIST GLOBALLY IN
SUB SAHARAN AFRICA AS SEEN ON
THE MAP ON THE RIGHT AND
DOMESTICALLY IN SOUTHERN REGION
AT THE U.S. AS SEEN ON THE MAP
ON THE LEFT. ALSO
DISPROPORTIONATELY HIGHER AMONG
KEEP POPULATIONS AND MANY
REGIONS OF THE WORLD FOR EXAMPLE
HIV IN THE U.S. CONTINUES TO
IMPACT MEN WHO HAVE SEX WITH
MEN, PARTICULARLY IN THE SOUTH
AND SUB SAHARAN AFRICA HIV
CONTINUES TO DISPROPORTIONATELY
IMPACT ADOLESCENT GIRLS AND
YOUNG WOMEN. THIS INITIATIVE
WILL ENCOURAGE BEHAVIORAL AND
SOCIAL SCIENCE RESEARCH STUDIES
THAT ARE COMMUNITY CENTERED,
MULTI-DISCIPLINARY AND
MULTI-SECTORAL AND MULTI-LEVEL
TO UNDERSTAND AND ADDRESS
COMPLEX PSYCHOSOCIAL FACTORS,
SUCH AS MENTAL HEALTH, TRAUMA
VIOLENCE. HIV RELATED
INTERSECTIONAL STIGMA ANIS AND
DISCRIMINATION MOBILITY AND
SOCIAL DETERMINANTS OF THE
HEALTH. HIV SCIENCE AND
COMMUNICATIONS VERGE ARE
STRONGLY ENCOURAGED. SO THE
RESEARCH QUESTIONS THAT COULD BE
ADDRESSED BY THIS INITIATIVE
ALIGN WITH THE NIH OFFICE OF
AIDS RESEARCH PRIORITY AREAS AND
I WILL OFFER AN EXAMPLE OF A
POTENTIAL BEHAVIORAL AND SOCIAL
SCIENCE RESEARCH FOR EACH
PRIORITY AREAS. SO STARTING WITH
REDUCING INCIDENCE OF HIV ON THE
LEFT, STUDIES MIGHT TEST
INTERVENTIONS DESIGNED TO
ADDRESS PSYCHOSOCIAL FACTORS TO
IMPROVE UPTAKE OF HIV TESTING
AND LINK US TO PREVENTION OR
CARE. DEVELOPING NEXT GENERATION
HIV THERAPIES ON THE RIGHT
STUDIES TEST INNOVATIVE MODELS
OF CARE, USING LONG ACTING ART
FOR TREATMENT OR PREVENTION
AMONG PEOPLE FACING MULTIPLE
BARRIERS. . CONDUCTING RESEARCH
TO HIV CURE STUDIES TO
INVESTIGATE EXPERIENCES OF HIV
CURE TRIAL PARTICIPANTS TO
INFORM ETHICAL PROCEDURES.
ADDRESSING HIV ASSOCIATED
CO-MORBIDITIES STUDIES MIGHT
INCLUDE DATA SCIENCE RESEARCH
THAT ADDRESS MEN DATA NEEDS FOR
ACHIEVING SUSTAINED VIRAL
SUPPRESSION. FINALLY ADVANCING
CROSS CUTTING AREA, STUDIES
MIGHT TEST COMMUNICATION
STRATEGIES TO REDUCE
DISPARITIES. WITH THAT THANK
YOU FOR YOUR ATTENTION AND
WELCOME FEEDBACK FROM NIMH
COUNCIL.
>> THANK YOU, GREG DISCUSSANTS
ARE PAMELA COLLINS AND JOSEPH
TELFAIR. JOSEPH START US OFF.
>> THANK YOU FOR THE OPPORTUNITY
TO COMMENT. I VERY MUCH SUPPORT
THE INITIATIVE. I HAD A LOT OF
QUESTIONS BUT THIS LAST SLIDE
CLARIFIED WHAT I WAS CONCERNED
ABOUT WHICH WAS THE FOCUS ON
WHAT IS INNOVATION, EXAMPLES OF
INNOVATION AND AREAS IN WHICH
YOU CAN BUILD ON EXISTING
INFORMATION. THAT ANSWERED MY
QUESTION. THE ONLY THING THAT I
ACTUALLY HAVE IS -- HAS TO DO
WITH THE OTHER CHALLENGE WHICH
IS I THINK A SLIDE MAYBE A SLIDE
BACK OR SO. THAT HAVE TO DO WITH
ADDRESSING THE CHALLENGES THAT
WAS PLENTY OBVIOUS WHICH WAS THE
MAP THAT INDICATED INCIDENCE AN
PREVALENCE, THAT MAP, THE
LEFT-HAND SIDE IN PARTICULAR,
AND THEN THE CHALLENGES THEN OF
IMPLEMENTATION, WHAT IS IT GIVEN
WHAT WE KNOW IN THE YEARS SPENT
AND TIME SPENT PARTICULARLY
AROUND PREVENTION, WHAT IS IT
THAT WE NEED TO REALLY FOCUS ON
BUILDING ON WHAT WE KNOW THAT
WILL ADDRESS THE IMPLEMENTATION
SO THAT WE CAN BEGIN TO
REALISTICALLY SEE REDUCTIONS IN
NEW INFECTIONS AND THINGS THAT
-- EFFORTS THAT ALLOW US TO
PREVENT THAT. THAT'S MY COMMENT
ON THAT. I HOPE THAT THAT IS
WHEN -- I APPRECIATE THE
EXAMPLES GIVEN, I HOPE THOSE
EXAMPLES ARE ALSO SOMETHING
INSTRUCTIVE TO YOU APPLICANTS.
THANK YOU.
>> THANK YOU, JOSEPH. PAM,
ANYTHING TO ADD?
>> YES, THANK YOU AGAIN FOR THE
CHANCE TO REVIEW THIS CONCEPT. I
WAS EXCITED TO SEE IT AND VERY
SUPPORTIVE OF IT. I WAS
ENCOURAGED BY THE BREADTH,
PROVIDES IMPORTANT OPPORTUNITY
TO UNDERSTAND THE GREATER DETAIL
WHERE SPECIFIC POPULATIONS AT
RISK MIGHT FALL OFF THE CARE
CONTINUUM AND TO FOCUS ATTENTION
ON DESIGNING OR OPTIMIZING
INTERVENTIONS FOR THOSE GROUPS.
T I WAS ALSO CHALLENGED BY ITS
BREADTH AND WONDER IF YOU CAN
ADD SPECIFICITY TO GUIDE THE
KINDS OF SCIENCE YOU ARE LOOKING
FOR TO HELP APPLICANTS RESPOND
AND IN PARTICULAR PERHAPS
EXPLAINING THINGS YOU WERE NOT
INTERESTED IN. I THINK THE SLIDE
I FOUND MOST HELPFUL SEEING YOU
ARE ORGANIZING BY THE OAR
PRIORITY GROUPS SO MAYBE IN THE
RFA SOME OF THOSE SUB HEADS
MIGHT MAKE IT CLEAR FOR PEOPLE
WHAT KINDS OF SCIENCE YOU ARE
INTERESTED IN. AS I THOUGHT
ABOUT THIS BROAD SET OF
QUESTIONS, I WAS THINKING IN
TERMS OF WHAT DO WE UNDERSTAND
ABOUT PREVENTION, THERE'S GREAT
EVIDENCE FOR EXAMPLE FOR
PSYCHOSOCIAL INTERVENTIONS THAT
REDUCE HIV RISK AS WELL AS
REDUCING SYMPTOMS OF MENTAL
DISORDERS WHEN EVIDENCE BASED
MENTAL HEALTH INTERVENTIONS ARE
INTEGRATED. DO WE KNOW WHAT
ENABLES BROADER IMPLEMENTATION
OF THESE INTERVENTIONS. WITH
THIS CONCEPT ALSO BE INTERESTED
IN MORE DATA ON STRUCTURAL
INTERVENTIONS AND THEIR ROLE IN
HIV PREVENTION. .
I ALSO HAD A QUESTION ABOUT
SOCIETAL OR POLICY ENABLERS
WHICH FOR EXAMPLE THINGS THAT
INFLUENCE WHETHER GROUPS HAVE
ACCESS TO PREP IN THE UNITED
STATES AND WHICH GROUPS ARE MORE
SYSTEMATICALLY DENIED ACCESS
BECAUSE OF INSURANCE POLICIES,
ET CETERA. OR UNDERSTANDING HOW
DECRIMINALIZATION OF KEY
POPULATIONS OR THEIR BEHAVIORS
INFLUENCE UPTAKE OF PREVENTION
TESTING AND CARE. MIGHT THERE BE
OPPORTUNITIES FOR NATURAL
EXPERIMENTS IN SETTINGS WHERE
SUCH POLICY REFORM IS UNDERWAY.
SIMILARLY, ARE YOU INTERESTED IN
PMTCT PERINATAL DEPRESSION AND
MANAGEMENT OF PMPCT AND BROADLY
WONDERING HOW MUCH ISSUE OF
INTEGRATION. I SAW THAT IS ONE
OF THE AREAS FOR OAR HOW MUCH
INTEGRATION WOULD BE EMPHASIZED
SO I THINK MORE SPECIFICALLY IS
THERE -- IS THERE SOMETHING YOU
DON'T WANT IN THIS RFA OR
WHATEVER THIS MAY BE, IT WOULD
BE IMPORTANT TO SPECIFY THAT.
THANK YOU.
>> DO YOU HAVE ANY RESPONSE TO
ISSUE OF THE BREADTH?
>> I DO. THIS IS MEANT TO BE A
VERY BROAD INITIATIVE FOR THE
BEHAVIORAL SOCIAL SCIENCE
RESEARCH THAT OUR DIVISION
SUPPORTS. THAT REALLY RUNS
ACROSS OUR DIVISION. SO THESE
WILL BE VERY BROAD INITIATIVES
TO SIGNAL TO THE COMMUNITY AND
TO IMPLEMENTERS AND RESEARCHERS
ABOUT OUR PRIORITIES AS THEY
ALIGN WITH NIH OFFICE OF AIDS
RESEARCH.
>> ANY QUESTIONS OR COMMENTS
FROM OTHER MEMBERS OF THE
COUNCIL?
>> I'M ENTHUSIASTIC ABOUT THIS
AS WELL, AS I WAS GOING THROUGH
IT THE IDEA THAT HIV IS A BRAIN
DISORDER OR CREATED DISORDER
VERY ON IN THE EFFECTIVE PROCESS
AND HOW THAT CONCEPT OF IT BEING
A BRAIN DISORDER IMPACTS THE
CARE CONTINUUM OUTCOMES. WAS
SOMETHING I THOUGHT THAT COULD
BE EMPHASIZED A LITTLE BIT MORE
>> THANK YOU. ANY OTHER COMMENTS
OR QUESTIONS? THEN WE WILL CLOSE
THIS PART OF THE MEETING. THANK
YOU VERY MUCH TO ALL THE
DISCUSSANTS AND ALL OTHER
COMMENTS. WE WILL MOVE FORWARD
WITH THESE CONCEPTS WITH THOSE
QUESTIONS AND COMMENTS IN MIND.
AND OF COURSE DEPENDING UPON THE
AVAILABILITY OF FUNDS, THE
SPECIFICS THAT WILL BE WORKED ON
IN THE FUTURE. TYPICALLY WE
CLOSE OUR OPEN SESSION WITH
PUBLIC COMMENTS BUT WE CONTINUE
TO BE UNABLE TO ACOME DATE THOSE
DURING THIS ERA OF LIVE VIRTUAL
COUNCIL. HOWEVER PUBLIC COMMENTS
WERE RECEIVED PRIOR TO THE
MEETING WERE CONVEYED TO IN
ADDITION THESE COMMENTS WILL BE
APPENDED TO OUR MEETING MINUTES
THANK YOU ALL FOR THIS ATTENDING
THIS OPEN SESSION. TRACY, DO YOU
HAVE ANY CLOSING WORDS OR
REMINDERS ABOUT TOMORROW FOR US
>> JUST GET A GOOD NIGHT SLEEP
AND WE WILL START PROMPTLY AT 12
NOON EASTERN TIME TOMORROW.
Y'ALL RECEIVED YOUR VIDEO LINKS
PERSONALIZED LINKS FOR THE
CLOSED SESSION SO WE LOOK
FORWARD TO REJOINING THEN.
>> ALL RIGHT. THANK YOU, THAT
ALREADY FOR THE CLOSED GRANT
REVIEW SESSION OF COUNCIL. LOOK
FORWARD TO SEEING COUNCIL
MEMBERS THEN AND TO PUBLIC WHO
JOINED US, THANK YOU VERY MUCH
FOR JOINING. HOPEFULLY YOU FOUND
IT INFORMATIVE AND ENTERTAINING
AS WELL. SEE EVERYONE ELSE TO
YOUR KNOWLEDGE. BYE-BYE.