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Preference: Statistics, epidemiology and research design

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Volunteers needed to help unlock the genetics of depression

The Australian Genetics of Depression Study is the world’s largest genetic investigation into depression to date. It is surveying 200,000 people worldwide — including 20,000 Australians — in the hope of identifying the genes responsible for putting someone at risk of mental illness.

Interim data collated by the study has already revealed more than two-thirds of the participants have had to rely upon multiple antidepressants to treat their clinical depression – a trial and error approach that remains a major challenge in delivering more effective mental health care.

The interim data, published in MJA InSight in August, suggests the limit of our current knowledge of treating clinical depression has been reached, and a far more effective personalised and targeted approach is needed to optimise outcomes.

It has been just three months since the Australian Genetics of Depression Study began, and 10,000 Australians have already enrolled.

Research author, study co-investigator and co-director for Health and Policy, Brain and Mind Centre at the University of Sydney, Professor Ian Hickie, has now put out the call for the enrolment of another 10,000 adults into the ground breaking Australian Genetics of Depression Study.

One in seven Australians will experience clinical depression during their lifetime. The mental illness represents the top cause of non-fatal disability in Australia. Moreover, Australia has one of the highest antidepressant prescribing rates per head of all OECD countries – behaviour that delivers considerable benefits, but also forces many people to contend with ongoing, disabling and potentially life-threatening medication-related side-effects.

Professor Hickie said the interim data has revealed that a better targeting of existing treatments through individual genetic profiling before commencing medication would drive a major advance in clinical therapy.

“Given our lack of diagnostic methods to predict different responses to antidepressants, or forecast the potential for intolerable side-effects, we are exposing those battling clinical depression, to trial and error, which is often slow to deliver significant benefits,” he said.

The researchers also believe the interim data illustrates treatment has failed to move effectively from the general principles of treating clinical depression to much more personalised and targeted approaches that minimise risk to maximise benefit.

Participating in the Australian Genetics of Depression Study is simple and free. Volunteers complete a 15-minute online survey and, depending upon their responses, may be asked to donate a saliva sample. Study researchers will then analyse the saliva (DNA) samples to investigate and pinpoint specific genes that may be associated with clinical depression.

The Australian Genetics of Depression Study is being conducted internationally, with 200,000 participant samples required. Australia is aiming to contribute 10 per cent of the total study population.

To volunteer for the Australian Genetics of Depression Study, or to learn more head to: www.geneticsofdepression.org.au

MEREDITH HORNE

[Correspondence] Leonardo’s mistake: not evidence-based medicine?

Renowned as one of the most influential figures in many different fields, Leonardo da Vinci (1452–1519) was also a revolutionary anatomist. In his research on the human body and reproductive system, da Vinci devoted a series of drawings to conception and the fetus, in which the fetal membranes (chorion, amnion, and allantois) are represented for the first time.1 Additionally, when depicting coitus, da Vinci introduced two errors: a canal in the penis connected to the spinal cord, and a canal linking the uterus to the breasts (figure).

[Perspectives] Reinhard Busse: leader in Germany’s health-system development

As head of the Department for Health Care Management at the Technical University of Berlin, Germany, Reinhard Busse enjoys a varied, interdisciplinary academic life. “I run a department of around 20 researchers, crossing disciplines including medicine, public health, business engineering, political science, and economics, a vast array of talent that is needed in the projects we run in the field of health systems performance”, he says. Busse’s analysis of Germany’s health-system characteristics and performance is detailed in the first paper of the Lancet Germany country Series.

Perinatal suicide in Ontario, Canada: a 15-year population-based study [Research]

BACKGROUND:

Death by suicide during the perinatal period has been understudied in Canada. We examined the epidemiology of and health service use related to suicides during pregnancy and the first postpartum year.

METHODS:

In this retrospective, population-based cohort study, we linked health administrative databases with coroner death records (1994–2008) for Ontario, Canada. We compared sociodemographic characteristics, clinical features and health service use in the 30 days and 1 year before death between women who died by suicide perinatally, women who died by suicide outside of the perinatal period and living perinatal women.

RESULTS:

The perinatal suicide rate was 2.58 per 100 000 live births, with suicide accounting for 51 (5.3%) of 966 perinatal deaths. Most suicides occurred during the final quarter of the first postpartum year, with highest rates in rural and remote regions. Perinatal women were more likely to die from hanging (33.3% [17/51]) or jumping or falling (19.6% [10/51]) than women who died by suicide non-perinatally (p = 0.04). Only 39.2% (20/51) had mental health contact within the 30 days before death, similar to the rate among those who died by suicide non-perinatally (47.7% [762/1597]; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.40–1.25). Compared with living perinatal women matched by pregnancy or postpartum status at date of suicide, perinatal women who died by suicide had similar likelihood of non–mental health primary care and obstetric care before the index date but had a lower likelihood of pediatric contact (64.5% [20/31] v. 88.4% [137/155] at 30 days; OR 0.24, 95% CI 0.10–0.58).

INTERPRETATION:

The perinatal suicide rate for Ontario during the period 1994–2008 was comparable to international estimates and represents a substantial component of Canadian perinatal mortality. Given that deaths by suicide occur throughout the perinatal period, all health care providers must be collectively vigilant in assessing risk.

What’s your view?

A Survey seeking doctors’ views on medical student professionalism issues

Being professional can mean different things to different people. In particular, the public and professionals may place different values on the importance of various behaviours. For doctors, Good medical practice: a code of conduct for doctors in Australia, provides a comprehensive general guide. 

However, applying such guidance to particular issues and making judgements about the seriousness of unprofessional behaviours is often not straight forward.

In the case of medical students, the situation is even more confusing. 

They are developing professionals, but how important are their professional behaviours while a student? A national survey of Australian medical students in 2016* found that medical students have widely varying opinions on appropriate professional behaviours and students also commented on the inconsistencies in how medical schools address these issues.

We’re now interested in the views of qualified Australian doctors on the same scenarios that were posed to the medical students. You are teachers and role models for these students.

Are your value judgements different? If so, what are the differences? The survey asks you to assess issues such as: “If a behaviour is unacceptable, how unacceptable is it?” and “Does it matter if a student is first year or final year?”

The overall aim of the research program is to explore the variation in attitudes to professionalism issues for medical students, study the role of context in professionalism judgements and to identify areas of professionalism teaching that may require further development.

The views of qualified Australian doctors are simply essential to create a full understanding and we very much hope you will consider participating. The anonymous, online survey should take less than 10 minutes to complete; it can be accessed using the following link https://www.surveymonkey.com/r/AMA_doctors_survey.

If you have any questions about the survey, please contact Dr Paul McGurgan, paul.mcgurgan@uwa.edu.aupaul.mcgurgan@uwa.edu.au>

Dr Paul McGurgan is Professional and Personal Development Coordinator, Faculty of Medicine and Health Sciences, UWA. 

The research team includes Dr Kiran Narula  (Fiona Stanley Hospital), Dr Katrina Calvert  (KEMH) and Dr Christine Jorm (Hon. Assoc. Professor & Assoc. Dean [Professionalism] Medical Education, University of Sydney).

 

[Perspectives] Jeroen Bax: inspiring the next generation of cardiologists

A conversation with the eminent cardiologist Eugene Braunwald fuelled Jeroen Bax’s interest in nurturing aspiring cardiologists. “Braunwald told me that what really matters is developing the next generation of researchers and clinicians”, he recalls. By 2018, Bax will have mentored 60 international PhD students in his cardiac imaging research centre at Leiden University Medical Center (LUMC) in the Netherlands. “Jeroen’s students have achieved prominent positions at medical institutions throughout the world”, says Anthony DeMaria, Professor of Medicine at the University of California, San Diego.

[Hypothesis] Tachykinin neurokinin 3 receptor antagonists: a new treatment for cardiovascular disease?

Great progress has been made in reducing cardiovascular mortality over the past 50 years. Nevertheless, prevalence is rising in some settings and remains higher in men than in women, even with the same level of established risk factors. To gain new insights, researchers are now considering cardiovascular disease in relation to the well known evolutionary biology model of growth and reproduction trading off against longevity, with trials of calorie restriction underway. However, calorie restriction has not been as successful as expected in primates and it is increasingly realised that effects on the reproductive axis might also be important.

[Editorial] The rising north–south divide in health in the UK

The north–south divide in the UK, and in England in particular, is made up of economic and health-related disparities, among other socioeconomic factors. An article by Iain Buchan and colleagues, published on Aug 7 in the Journal of Epidemiology and Community Health, reported that in the past 20 years, age- and sex-adjusted excess mortality has increased by as much as 46 percentage points in people aged 35–44 years in the north of England compared with the south, and by 27 percentage points in people aged 25–34 years.

[Editorial] Nicotine addiction, reduction, and smoking cessation

Last week, the US Food and Drug Administration (FDA) announced a multiyear roadmap to begin regulating the amount of nicotine allowed in tobacco products. Researchers, including tobacco control advocates, have proposed nicotine reduction as a way of decreasing levels of tobacco use, and the USA may be the first country to seriously discuss using this form of regulation to produce a potentially less addictive form of tobacco. In the wake of the FDA announcement, it was widely reported that other countries, including the UK, Canada, New Zealand, and Finland, have suggested that they would consider nicotine reduction policies for manufacturers.