Original subtitles

>>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.