It’s the phones, right?
Plus: pharmacogenomic tools and depression treatment, social isolation and mental health problems, and a rapid psychedelic response by The BMJ
Social media and mental health
It’s the phones, right? Recent media reports would make you think the case for social media’s negative effects on adolescent mental health are firmly established. Done and dusted, in fact.
It is, as they say, a bit more complicated than that.
This new paper in Nature Reviews Psychology by some adolescent mental health heavyweights (including Sarah-Jayne Blakemore) offers some sensible pointers for further inquiry. The first thing we need to do, it seems, is wean ourselves off metaphors:
“Social media is not similar to a toxin or nutrient for which each exposure dose has a defined link to a health-related outcome... Social media is a diverse environment that cannot be summarized by the amount of time one spends interacting with it, and individual experiences are highly varied.”
It is, the authors suggest, time to get to grips with the specifics: both in terms of mechanisms, and particular groups (eg, by age). The authors focus particularly on “affordances”, “the perceptions of action possibilities users have when engaging with social media and its features, such as anonymity… and quantifiability”. Figure 3 gives us a concrete example of affordances in action, as an adolescent starting at a new school considers the affordances offered by social media: the permanence of shared images, the impact of quantifiable interactions (“likes”), and the potential delay in social responses.
As for how we should study this issue, the authors answer: any which way you can. “Researchers must embrace methodological diversity, which in turn will facilitate triangulation. Surveys, experience sampling designs in conjunction with digital trace data, as well as experimental or neuroimaging paradigms and computational modelling (such as reinforcement learning) can all be used to address research questions comprehensively.”
I’d recommend reading the whole thing, but if you can’t, suffice it to say that this story is far from over.
Pharmacogenomic tools to select depression treatment: are we in the clear yet?
Thinking about using pharmacogenomic tools to select depression treatment? The American Psychiatric Association working group have just updated their 2018 report. And it’s still a “no” from them. Some notable issues with the literature: of eleven new trials identified, “none adopted a fully blinded study design, only two studies attempted to blind the treating clinician, and none incorporated measures to estimate the effectiveness of the blinds or the influence of lack of blinding on the study results.”
Social isolation and mental health problems: a particularly risky combination in men?
Fine-grained Scandinavian data come to the fore again in this BJPsych cohort study on social isolation, mental health, and mortality. The authors included data from 162,497 individuals who participated in the Danish National Health survey in 2013 and 2017, and followed them up to 2021.
The authors linked survey data on social disconnectedness with register data on mental disorders diagnosed in secondary care and mortality. Here’s one big issue: the survey response rate was 57.5%, which clearly throws up a problem of responder bias (the authors tried to get around this via weighting).
As readers of last week’s Thought Formation will know, there is a difference between solitude and loneliness; the authors therefore used a three-item loneliness scale, an index of social contact, and a measure of social support (the latter two were “inspired by” existing measures; not sure what this implies about validity).
There’s plenty to chew on in the results, including the fact that “Among individuals with a mental disorder, 3869 (40.6%) experienced loneliness, social isolation and/or low social support, whereas this was the case for 24 414 (18.3%) of the individuals without a mental disorder.”
But the headline is the gender-specific nature of the main finding: among men, but not women, a co-occurring mental disorder and social disconnection were associated with elevated mortality compared with the general population.
Why is this? The authors suggest that men who have mental health problems and social disconnection might have:
· A greater prevalence or progression of diseases with an impact on mortality
· A greater case fatality rate as a result of suboptimal treatment outcomes
· A greater number of deaths because of external causes of death (eg, suicides and accidents)
It’s impossible to figure out causality from these data. For the present, though, this paper highlights an association that it’s worth digging further into, and maybe some pointers for gender-specific service provision.
Psychedelics: a rapid response to a Rapid Response
Kudos to The BMJ (to use its official title) for its swift publication of an expression of concern regarding this meta of psychedelics for depression following criticism in the Rapid Response section. I honestly don’t know what conclusions we can draw from the paper given that there is much work to be done in re-evaluating the data (and preferably making this analysis as transparent as possible).
The attention to detail shown by Ioana Cristea and colleagues in their Rapid Response, and the editors’ reaction, are of huge importance here. At stake is not just the future of a potential new treatment for depression, but the ability of mental health science to break out of the cycle of over-hype and under-delivery that it has been stuck in for far too long.