Mental health disorders are not only common but on the rise, with one report suggesting that by 2021, 1 in 6 children are likely to have a mental health condition.
The NHS spends £15.5 billion on treatment every year and still thousands of people who could benefit from help are unable to get it. But what if there was a way to detect people at risk of a mental health condition and intervene before they even start experiencing symptoms?
That’s exactly what a new paper published in the journal says NeuroImage claims to have done.
The researchers used a database of brain scans of teenagers from the Sunshine Coast, on the eastern edge of Australia. The first scans were done when the teenagers were 12, and again every four months for the next five years.
The researchers were able to use the scans to predict which participants would score high on a “mental distress” survey that measured symptoms of anxiety and depression.
This is especially important because 50 percent of mental health disorders begin before the age of 14, and 75 percent before the age of 25. Early intervention can often be the difference between a person experiencing a single episode or a lifetime. condition.
“I think the brain is one of the most complex things on Earth and there’s a lot we still don’t know,” said Associate Professor Zach Shan, head of the Neuroimaging Platform at the University of the Sunshine Coast’s Thompson Institute. and lead author of this new study.
“More and more people believe that mental health problems start in adolescence, so our team wanted to see if we could use brain imaging to track or determine when they start.”
Adolescent brain vs. adult brain
Our brains go through huge changes during childhood and adolescence.
First, billions of new connections are made between neurons as we take in information, and our amazing, flexible brains change according to our experiences.
The most frequently used paths then start to get stronger, and a process called pruning removes unnecessary connections. This helps us become multitasking experts and makes it harder (though not impossible) for our brains to change.
At the same time, myelin, or the white matter that surrounds our neurons, protecting them and making them more efficient, grows rapidly.
This process occurs at different speeds in different areas of the brain.
Our visual system finishes pruning and reaches full adult maturity by age 11. But other areas take much longer, and the last to finish developing is the prefrontal cortex, located behind the forehead, which isn’t fully mature until our mid-twenties.
More so
In adults, the prefrontal cortex helps regulate our emotions by controlling our reactive limbic system (the emotional part of the brain). It allows us to control our mood and ignore that little voice that tells us that everyone is looking at us.
Adolescents’ limbic system is fully developed and responsive to their environment, but it is not controlled by the calm, rational prefrontal cortex.
This may be one of the reasons why teenagers are very susceptible to mental health conditions, especially depression and anxiety.
In fact, researchers have found that teenagers whose myelin grows more slowly in their prefrontal cortex are more likely to struggle with their mental health.
Of course, many other factors occur during our teenage years that can contribute to this risk profile.
“We have a lot of societal and environmental influences that play an important role. You have to become more independent, find a job, get along with your peers, and your family no longer makes all the decisions for you,” says Tobias Hauser, professor of computational psychiatry at the University of Tübingen and University College London.
“And then there’s puberty, which is a huge change in your body and has a big impact on your brain and mental health.”
Your “brain fingerprint” can identify you
Back on the Sunshine Coast, the researchers decided to look at the “functional connectivity” of the teenagers in the database.
It’s a measure of how different regions of the brain work together, in this case, when people are at rest. Previous research has shown that adults have unique functional connections; each of our brains is wired slightly differently, so you can use this ‘brain fingerprint’ to identify people from their brain scans.
This study showed that even in 12-year-old participants, all the brain connections were already unique, and the uniqueness increased with age. The authors believe that this process of our brains becoming more individualized is a vital sign of maturity.
The researchers not only looked at the brain as a whole but also examined brain networks.
They found that some of these, including what is known as the cingulo-opercular network (CON), were less coherent, and, crucially, adolescents with low contemporaneous levels of CON uniqueness were more likely to score high on measures of mental functioning. . the next time the data is collected.
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Cognitive flexibility and its relationship to mental health
The CON is a group of areas that run from the frontal lobes deep into the center of the brain. Its function is still not fully understood, but it appears to play an information-processing role, helping us focus and directing actions to help us achieve our goals.
Shan believes that the fact that it is less developed than other networks in our teenage years may explain some common teenage behaviors. “If the uniqueness of their CON is not yet developed, teenagers cannot focus and concentrate for long periods of time.
This network is also related to cognitive flexibility—the ability to change our behavior and thinking. And that may explain why it has been consistently linked to a range of mental health conditions, from depression and anxiety to obsessive compulsive disorder (OCD), all conditions that have an element of inflexible or stuck thinking.
For example, anxious people worry too much; depressed people may ruminate, thinking negative thoughts about their lives; and OCD sufferers have intrusive thoughts and compulsions to perform repetitive actions. A problem with cognitive flexibility may underlie each of these problems.
Thus, if the uniqueness of CON is a marker of healthy brain development during adolescence, and problems with this network can lead to reduced cognitive flexibility and higher risk of mental health disorders, it is not surprising that individuals with slower development of CON are at higher risk of mental health disorders.
The researchers say we could use this fact to screen people and detect those at risk before they show symptoms. Then we might be able to prevent their deterioration.
What are the practicalities?
Prevention, not treatment, of mental illness can save a lot of people from a lot of suffering.
However, this requires an upfront cost, especially when it comes to expensive fMRI scans, which can be a difficult sell for governments.
Fortunately, evidence is emerging that early detection of mental health problems can save money in the long run.
The £15.5 billion spent on treatment each year pales in comparison to the economic toll of mental illness in other ways, such as people being too unwell to work or needing time off to care for sick family members.
in 2022 A report has found that mental health problems cost the UK economy at least £117.9 billion every year.
A detailed analysis would be needed to determine whether this particular intervention would reduce the burden of mental health disorders to provide a financial benefit, but it is clear that, in general, prevention is not only better, but also cheaper than treatment.
For example, a review paper found that for every £1 invested in mental health interventions in the workplace, companies saved £5 in costs.
Hence, brain fingerprinting researchers think it’s an idea worth pursuing. “You can think of it as breast cancer screening,” says Shan. “We should think about monitoring adolescent brain development if we want to prevent mental health problems.”
But there’s a big hurdle: brain scans aren’t the most accessible way for us to do this, as one of Shan’s colleagues, Professor Daniel Hermens, admits: “Since there hasn’t been much progress in predicting mental illness, a reliable and objective way to do this would be of great benefit to society.”
“While many hospitals (and other facilities) have fMRI brain scanners, their cost remains high, requiring government subsidies. Linking brain fingerprinting techniques with other technologies, such as electroencephalograms (EEGs), will help address issues of accessibility and affordability, as well as enable the use of “wearables” that people could use to monitor changes in their brain patterns that correspond to changes in mental health. and well-being’.
Games for mental health
One group working on an alternative is the Developmental Computational Psychiatry Laboratory, led by Prof. Tobias Hauser.
The group’s Brain Explorer app collects data as people around the world play games that test their cognitive abilities. The team found that this produced similar results to lab-based tests, while giving them access to a much larger and more diverse population.
Like games, the app asks questions about the mental health of players, and the researchers behind it are beginning to unravel the links between game performance and mental illness.
This would be a very interesting development, because asking people to play a game is much easier (and cheaper) than doing a brain scan.
Smartphone apps could be used to track and identify people at risk
“I don’t see a future where we put every teenager in a brain scanner. It would be a huge effort financially and logistically,” says Hauser.
“So I think you need to have indexes or markers that are easier to apply. And a smartphone app would be the way. You can do this in schools and we can use the results to identify people who are more at risk.
Instead, Hauser considers the brain scan to be a second-line test, used in conjunction with other factors such as the patient’s history and symptoms. They can be used together to improve clinicians’ understanding of that individual and predict their outcomes.
He compares it to a blood pressure test. “Your family doctor measures your blood pressure. They don’t make a diagnosis based on that, but if you have high blood pressure, you get more detailed tests… Only then can you get a diagnosis with these more accurate assessments,” he says.
Regardless, it’s clear that preventing mental health problems before they occur can make a difference. With the current crisis in youth mental health, we need to make a difference.
I hope that a future where we better understand the factors that cause mental illness, both brain and environment, will provide more opportunities and ways to provide support to those who need it most.
About our experts
Dr. Tobias Hauser is Professor of Computational Psychiatry at the University of Tübingen and University College London. His research has been published in journals including Cognitive, affective and behavioral neuroscience, European Journal of Neuroscience and Journal of Experimental Psychology.
Dr. Zach Shan is the Head of the Neuroimaging Platform at the University of the Sunshine Coast’s Thompson Institute. He is a biomedical engineer specializing in brain imaging and brain image data analysis.
Professor Daniel Hermans is the Deputy Director of the Thompson Institute at the University of the Sunshine Coast. Directing the Youth Mental Health and Neurobiology Program, his research tracks brain development during the most dynamic phase of adolescence.
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