Inequality and the brain
Plus: New data on familial risks of mental health problems; the limits of shared decision-making; and living with—and researching—bipolar disorder
Inequality and the brain
A massive study in European Psychiatry pools structural MRI data from 7962 healthy adults (4110/52% women) in 29 countries to analyse associations between country-level development and brain structure. Headline findings were that higher human development was associated with larger hippocampi and a more expanded cortical surface area (especially in the frontal lobes); increased inequality was associated with smaller hippocampi and a thinner cortex.
It isn’t very surprising to read the authors’ conclusion that “the macro-economic conditions of a country are reflected in its inhabitants’ brains”. And with so many potential routes linking economic factors and brain structure (nutrition, education, exposure to violence…), it’s hard to figure out any immediate actions on the basis of this paper other than to reduce poverty and inequality, which are things I hope we’d be doing anyway. I’m also very aware of the potential for data showing average national differences in brain structure to be misused. Still, I think this study provides a valuable starting point for turning the current broad conversations about “Global Brain Health” into a focused plan for research and action.
Northern exposure: new data from Denmark
While there aren’t any major surprises in this new Lancet Psychiatry paper on familial risks of mental health problems, it’s still worth a read, and definitely worth a bookmark. As anyone with a passing interest in the subject knows, those Scandinavians just can’t be beaten when it comes to their population data collection. I’d speculate that this phenomenon has its origins in the complex state bureaucracies built to cope with the numerous Danish-Swedish wars of the Early Modern period. Whatever the root cause, the excellent and comprehensive record-keeping has proved a boon for mental health science.
I was once assured that the Danish databases have the edge in terms of precision (admittedly, this was by a Danish researcher). Whether or not that’s the case, this study is a gem. It links up data from several sources to provide absolute and relative risks of mental health problems, including their heritability across different degrees of relation. With the caveats that global generalisability from national data is tricky, and that risk is not the same thing as prophecy, this paper provides the field with a useful reference for many years to come. As I said, bookmark it.
From shared decision-making to shared deliberation
It’s good to see this thoughtful JAMA Psychiatry piece on the limitations of “shared decision-making”, in which, the authors imply, the parameters of the discussion are too often bounded by clinical anxiety around risk. A decision is certainly made, but it’s not always truly “shared”; indeed, it might end up fracturing the patient-clinician relationship. The authors propose instead a model of “shared deliberation”:
In [shared decision-making], patients are presented with more than 1 treatment option, including information on the average risks and benefits of each… Shared deliberation pursues a deeper, ongoing dialogue that requires both parties to openly share their values, fears, and experiences in accord with the principles of open dialogue. It thus moves beyond binary yes/no decisions in favor of an iterative process in which new treatment options can appear.
A humane and appealing idea. To what extent it can be made a reality in financially and politically pressured health systems is another issue.
Living with—and researching—bipolar disorder
This Nature interview with Imtiaz Zafar, a neuroscientist at the National Institute of Mental Health and Neuro Sciences in Bengaluru, India, is a short but powerful read. Zafar describes an all-too-common story of a long road to diagnosis and appropriate treatment for the condition (it’s an issue which the Royal College of Psychiatrists and Bipolar UK have identified as a priority). However, Zafar remains very positive about the insight his condition has given him: “The biggest plus point has been that I am incredibly motivated and committed to doing meaningful research to help create effective treatments for bipolar”, he tells Nature. “Because my research has helped me to learn deeply about it, I feel enabled to help others who have the condition.”