Genetically informed family research, and anti-racism in mental health research – In Conversation with Dr. Yasmin Ahmadzadeh

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In this podcast we talk to Dr. Yasmin Ahmadzadeh, post-doctoral research associate at the Institute of Psychiatry, Psychology and Neuroscience, King’s College, London.

We hear how Yasmin helped to set up the Twins Early Development Study, CoTEDS, her research on genetically informed methods to examine the intergenerational transmission of psychopathology, and her advice for those considering a part-time PhD.

Yasmin also talks about anti-racism in mental health research, how categories of race and ethnic group are outdated and inadequate, what scientists can do to correct their vocabulary, and what researchers should think about in order to prevent or break cycles of racism in research.

Yasmin Ahmadzadeh

I joined King’s College London as a Research Assistant in 2015, helping to set up and run the Children of the Twins Early Development Study (CoTEDS). I started a part-time PhD in 2016, supervised by Dr Tom McAdams and Prof Thalia Eley, alongside my role on CoTEDS. My PhD is focussed on investigating associations between parent internalising and offspring behavioural and emotional outcomes, using genetically sensitive research designs. I have an undergraduate degree in Neuroscience with Industrial Experience from the University of Manchester. (Bio via King’s College London)

Transcript

Interviewer: Hello and welcome to the In-Conversation podcast series for the Association for Child and Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology Today, I’m interviewing Dr. Yasmin Ahmadzadeh, a post-doctoral research associate at the Institute of Psychiatry, Psychology and Neuroscience, King’s College, London. Yasmin helped to set up the children of the Twins Early Development Study, CoTEDS. She researches how common mental health problems run in families and advocates for anti-racism in mental health research. We’ll focus on these interests in today’s podcast.

If you’re a fan of our In-Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating review or and do share with friends and colleagues. Yasmin, thank you for joining me. Can you say a little about yourself by way of an introduction?

Yasmin Ahmadzadeh: Thank you for inviting me. I’m a post-doctoral researcher at King’s College London, and I’ve been working at King’s for almost six years as a research assistant, a PhD student and now as a research associate, and before that I did my undergraduate degree in neuroscience at the University of Manchester.

Interviewer: What prompted your interest in the field of genetically informed family research?

Dr. Yasmin Ahmadzadeh: It was a series of slow steps over the years, I think, prompted mainly by being really lucky that I had opportunities for learning and jobs in this field. I can talk you through that journey. When I was at school and I decided to apply to study neuroscience at university and I was really inspired by the work of Camila Batmanghelidjh and Kids Company at that time and how this charity were funded and collaborating with neuroscientists at universities, and at that I thought that science seemed like a really powerful tool for supporting social change.

And then as I transitioned from school to university I started to pay more attention and care more about mental health topics as most of my friends and I kind of navigated first hand experiences of mental health, and we hadn’t really had education about mental health at school. I knew about depression, but I didn’t even know that anxiety problems existed, and I really wanted to work on something that did something about that lack of knowledge. Then during my degree I did a placement year in mental health research with families in Manchester, and that was really crucial in helping me to understand the structure of academic research and knowing that it’s something I could do as a research assistant and that I enjoyed.

So when I graduated, one job that came up was with Dr Tom McAdams and Professor Thalia Ely to work on genetically informed family research at King’s, and I read some of their research in preparation for applying and I remember thinking this is so thorough and I didn’t really understand what behavioural genetics was or genetically informed research at that point, but I was really taken by the approach of trying to meticulously untangle the different ways in which mental health problems can develop.

Actually I recently heard that they offered that job to someone else before me. So I was really lucky that that person turned it down and I got the opportunity to be trained in this field. I’m here now and I subscribed to the belief that it is really important that we use robust research methods to account for the role of both genes and environments in families to understand how they shape young people’s mental health, and also said that young people and parents can be better informed about what’s going on and how mental health problems can develop for them.

Interviewer: Yasmin, you completed your PhD examining familial risk for anxiety and depression and you’ve had a number of papers published on this, can you highlight some of the key takeaways from this work?

Yasmin Ahmadzadeh: We know that mental health problems run in families, so the children of parents who experience anxiety and depression are at higher risk for experiencing similar problems themselves, but we don’t have a great understanding of how that happens and we know that as both genetics and environments that are involved, nature and nurture, but most mental health studies just report correlations between parent and child mental health. So we don’t get information on what actually caused these correlations in the first place. In genetically informed family research the aim is to kind of work out to what extent parents and children are similar in their mental health because they share the same genes and once you know how much it’s being driven by people’s genetics the rest must be due to something causal in the environment.

So this is what I focussed on during my PhD specifically in relation to anxiety and depression, and I guess there are kind of three key points that I think are worth talking about from my research so far. So the first one, when you look at pregnancy before the child is born, results show the mother’s anxiety during pregnancy is only associated with child mental health outcomes after birth because the mother and child are genetically related. So the child is inheriting the same mental health associated genes that the mother has, and there’s no evidence to suggest that mother’s anxiety is causing the child’s emotional problems during pregnancy.

Once you account for the fact that they’re genetically related, and then after pregnancy there is evidence to suggest that anxiety symptoms and parents could be causing emotional symptoms in children, but we don’t really know whether they cause changes in child mental health that’s lasting across time because most researchers just looked cross-sectionally, so at parent and child mental health at the same point in time. So we don’t know if parent anxiety is causing long term changes in mental health, and I’ve shown that in a systematic review of the literature.

And then finally, I’ve written about how child anxiety can predict future changes in mother’s anxiety. So it’s possible for child mental health to be influencing parent’s mental health over time, and that’s really important to consider because it moves us away from just thinking about the effects that parents have on children and we need to take a more holistic view and think about the influence of all family members on one another.

Interviewer: Alongside your PhD you worked as a research assistant setting up and managing the children of the twins early development study CoTEDS. We’ll look at CoTEDS in more detail, but before we do, what was it like studying for a PhD while managing such a large project?

Dr. Yasmin Ahmadzadeh: Well, I think I really enjoyed it, but it’s always easy to say that in hindsight once you’re finished, but when you do a PhD and a research assistant job you really get to be involved in all aspects of research, and especially in my field, because we need such large data sets most PhD students work with data that’s already been collected. So they don’t have input on what’s collected and how and all the other jobs that go along with running a study, and I think that a PhD can be very lonely and isolating and you could end up doing it all on your own from home, which wouldn’t really suit me well. I was going in every day and I was part of a team with an office job and I had purpose and a routine and that suits me. So I felt like I had the best of both worlds and could mix and match jobs when one got hard you could just go and do the other one.

But you do have to be really organised, and there were some things that I couldn’t do that other people did. So students often do teaching and collaboration, bigger collaborations and research exchanges, but I had to be there to do my job, so I couldn’t get too segwayed, and I think I realised quite late on maybe everyone comes to realise that every PhD is so different and you can’t really compare your experience to other peoples because you will have different pros and cons of your set up.

So I think maybe you feel like you’re being a bit unproductive when you’re part-time, but really there’s loads of reasons why other people feel unproductive too.

Interviewer: I was going to ask what advice you have for others who were considering a part-time PhD. So what are the pros and cons for this, and do you have any tips for maintaining a healthy work life balance?

Dr. Yasmin Ahmadzadeh: I mean, I think I do have some advice. I think that you have to really enjoy both roles because both of your roles will eat into the time for the other one and you don’t want to end up resenting one of them. So you have to want to be doing your job and your PhD and maybe think about whether your supervisor and your line manager or boss will be the same person, because I was lucky that I had that. So my supervisor always knew everything that I was being asked to do.

And I guess lots of people take different approaches to time management, but it really is all about managing competing priorities and staying on top of deadlines and to do lists. You’ve just got to stay calm and manage expectations because research is just really slow and never work at weekends.

Interviewer: Great advice. Let’s turn now to CoTEDS. This is a twin study that includes information on both twin parents and their offspring from birth. Can you tell us about the aims of CoTEDS and the highlights so far?

Dr. Yasmin Ahmadzadeh: Just for some context, TEDS is a longitudinal cohort study involving around 10,000 families who had twins born in England and Wales in 1994, 1995 and 1996. So TEDS have been running for 25 years as those twins grew up and now they’re in their mid-20s and lots of them are starting to have children. So CoTEDS has been designed to study the children of those twins who’ve been taking part in research for their whole life, and it’s really cool because we have the same data on the twins as they grew up, as we have on their children as they grew up.

So we can look at trajectories of the twins growing up and becoming children and the transmission of traits from the twins to their children and change and how generations develops. So if the twins grew up in the 90s and now their children are growing up from now. So what’s different? Maybe everyone who works on a longitudinal cohort finds this, but it’s just so nice to work with participants who are really invested in the study and who feel part of the study.

So it’s been so easy to recruit their children to Co-TEDS because it’s already part of their lives and the majority of the twins that I speak to want their children to be involved too. So I think seeing the new generation coming through and joining the study has been really great. Maybe given me a full sense of an idea of what it’s like to recruit to a study.

Interviewer: Your research group specialises in genetically informed methods to examine the intergenerational transmission of psychopathology. You’ve touched on this a bit, but what are you working on currently, and can you share any interim findings?

Dr. Yasmin Ahmadzadeh: I finished my PhD last year and I’ve started a new project since then. I talked a bit about the importance of considering the influence of children on parent’s mental health, and recently I’ve turned my focus to the prenatal period. So wondering during pregnancy to what extent is mother’s mental health influenced by her child? Is the developing foetus, so the child’s influence on the mother before the child is born, and we know that loads of pregnancy related traits are influenced by both the mother and the child, like gestational age and foetal size and birth weight?

So perhaps the foetus is influencing mother’s anxiety and depression during pregnancy too, and it would be really cool to understand the real causes of mother’s symptoms of poor mental health during pregnancy so that mothers can understand what’s going on and we can offer better support that’s more likely to work.

Interviewer: For the early stages or is there anything…?

Dr. Yasmin Ahmadzadeh: Yeah, so I’m working with data from Norway. It’s an amazing data that we have around 32,000 families where we have DNA from the mother, the father and the child. So you can look and see the extent to which genetic variation and the foetus can explain variation in mother’s mental health. Actually, I’m still trying to get these analysis to run, so I can’t share any findings yet, but I think that the child will to some extent be influencing the mother’s symptoms.

Interviewer: That sounds fascinating. I’m going to turn to some of your other work. You’ve been focussing on anti-racism in mental health research. Race, ethnicity and ancestry are among the most commonly used variables in human research. In a recent blog you describe the measurement protocol for these variables as murky and in some cases unacceptable. Can you elaborate on this and the harms that have occurred?

Dr. Yasmin Ahmadzadeh: In research that information or the variables that we measure have to be valid? So if we’re measuring the height of people in our sample, we want to do it in a way that we know the data is as correct as possible and it makes sense, and people spend a whole careers designing accurate measurement of all kinds of human traits and characteristics, and one thing that we wanted to know and most human research is the diversity of our samples. So who’s in our sample and to what extent do they represent other people in society, or to what extent can their results be generalised to other people and often, as you say, we report on participants race or ethnicity or ancestry. I was actually asked to do this in one of my recent papers and I realised way too late that I actually didn’t know how to do this because I didn’t really know or understand what race, ethnicity and ancestry mean.

And lots of people combine race and ethnicity and is that okay?  I don’t know. Could you give me a good definition of what you mean because most people can’t even in research and this time last year I couldn’t, and maybe I had more interest in thinking about this more and take it more seriously because I have mixed heritage. So already a bit of a confusing identity. I mean, most researchers are like so maybe we’ve gone along with not really understanding these variables very well because it’s harder to consider and remember the lived experiences of other groups.

But I don’t think that this kind of apathy would be tolerated for any other type of variable that’s used so much in research, and I could maybe just talk through what race, ethnicity and ancestry. Race and ethnicity are both socially constructed terms. So race terms were invented in the heyday of colonialism during slavery to categorise people typically by what they looked like, so black and white or to do with hair texture and they were invented by eugenicists to legitimise unequal treatment of different groups, and race terms are still really relevant today. They still affect people today and then ethnicity, it’s related to race, but it’s different because it refers to individuals’ cultural identification.

So relating to the language or religion or traditions or customs of people and again, same as for race, there are no fixed categories of ethnicity. No one has agreed these are the ethnic groups or these are the race groups, and with ethnicity it’s subjectively meaningful to the person involved. So only really, I can tell you what I think my ethnicity is, and ancestry relates to where your populations come from geographically.

So it’s kind of the most objective of all these terms, but it’s still not without flaws because ancestry isn’t categorical. So people from China are not categorically different from people from Mongolia, for example, and genetic diversity across populations is continuous. It doesn’t sit within categorical geographical boundaries that we’ve made. So to an extent ancestry is also socially constructed, and I think that there’s lots of ways that scientists have misused these terms by confusing and combining them and using words that are derived from the eugenics era, like, for example, Caucasian.

Many people still use that thinking it’s a more sciency way of saying white, but it’s a pseudo-scientific term that was developed by eugenicists and it doesn’t mean white. Also using categories that don’t fairly represent everyone. So, for example, when you’re measuring race you might group everyone from Asia into one category. Whereas other people might have more nuanced categories that they can identify with. I think that we don’t really understand these terms properly and we’re not thinking well about how we measure them.

Interviewer: And you’ve described the sort of apathy really amongst the research community, and I assume also a fair level of sort of ignorance, people not really realising that they’re not getting it right. Can you elaborate a bit on the harms that have occurred as a result of this?

Dr. Yasmin Ahmadzadeh: I think that lots of groups are currently being misrepresented and excluded from research. So, for example, if we think about during the Covid pandemic, we’ve had headline after headline in 2020 about the risks experienced by people in the BAME group and this BAME label basically lumps everyone who is not white British into one category. So personally, when I was looking at these headlines last year saying that that was much higher risk of transmission and death amongst people from BAME groups I was thinking, well does that mean that my family are at a higher risk?

What does that mean for me, and basically this label doesn’t represent anyone. There’s no nuance in this clumping of this other group of this group that are non-white British. So the harms really are that our findings it’s the same in mental health research. I mean, that was a physical health example, but findings are really specific to white groups because a combination of research being conducted by white scientists who are performing in the experiences of white groups and then mainly white participants taking part in research and all aspects of this really complex system, meaning that marginalised and racialised groups are being left out of research and not helped by the findings.

Interviewer: And you’ve described the categories, as you said before, race and ethnic group as outdated and inadequate. You’ve made a call for scientists to correct their vocabulary and that of others. Can you say more about this? What should scientists be doing to get this right?

Dr. Yasmin Ahmadzadeh: Yes, so I think that the crucial question is thinking about what data do you actually need to know for your research question. So, for example, ancestry will be more important for geneticists exploring the role of population stratification, while racial terms will be more important for psychologists and social scientists who are exploring the influence of racial inequality, and which one do you need to know about, and then how valid is your measure and do your response options or categories represent everyone fairly and equally?

So did everyone have a chance to report that identity in a way that reflects how they perceive themselves? For example, in the UK government categories for measuring ethnicity, I actually have no idea how to define my identity on these categories because I’m half British and half Iranian and I end up selecting mixed white Asian. So my mother’s side are categorised by their skin colour white and my father side by the whole continent of Asia, which many people don’t even think includes the Middle East and similarly, people who are racialised as black they can only categorise themselves by their skin colour. While some Asian groups can identify their nation, so Bangladesh or India and then other Asian groups are categorised by the whole continent and these categories just weren’t designed, so rigorous research.

Interviewer: So are researchers better to not categorise at all or do these categories need to be better?

Yasmin Ahmadzadeh: I think this is the million dollar question because we do need categories in research, but I think that we need to be really thinking about making them as fair as possible and designing them for what we actually need to know, and then also just being really open about the limitations of our measurement as we are with all other variables that we measure. We know we’re never doing a perfect job and yet identity is really complex. I don’t think we need to obscure that.

We just need to be more open about it, and we are working in a system that was built on a racist structure and we just have to treat this as an active learning process where we’re constantly reflecting and challenging our assumptions that are really deeply ingrained in our practice and institutions.

Interviewer: Is there anything else that researchers should think about when collecting and using data and research in order to prevent or break cycles of racism in research?

Dr. Yasmin Ahmadzadeh: Thinking about the fact that we are working in a racist system. So researchers, mental health research is conducted mostly by white researchers with white participants and white majority countries, and we have little to no nuanced evidence about mental health and other groups. So I think we just all need to be constantly aware of this and emphasising the limitations of our work.

And I don’t think we can say it enough and most people aren’t saying it at all, but there are limits to what we’re doing at the moment and most of us are working with samples that are comprised mostly of white participants. So thinking about, as I was saying before, not grouping everyone who is non-white into this other category and being really open about who are they and who’s represented in your data, and then when we’re making suggestions for evidence based policy and practice we need to think about what do we know about the generalisability of results and who might be being excluded.

So I don’t think we can solve these problems overnight, but we could start to be much more aware and honest about it and that’s the only way we’re going to start to make change I think. We’re all in positions of power, so we’re the ones generating the knowledge and influencing policy. So even young early career researchers we’re in control of what we write and what we apply for.

Interviewer: Are there any good resources you can recommend for scientists who want to learn more about anti-racism in mental health research?

Dr. Yasmin Ahmadzadeh: Yeah, so the more time that passes, the more resources I’m finding that date back decades and I’m realising that people have been trying to raise this alarm for so long. So there’s resources going back 20 years and longer that are all still really relevant, but in the past year, especially since 2020 some great new resources produced by the mental health, they had a webinar called Mental Health Research is Racist. So what are we going to do about it, and you can still watch the recording of that on YouTube. Then I also read two really good books by science journalist Angela Saini’s book The Return of Race Science and Adam Rutherford’s book How to Argue with a Racist. I learnt a lot from those two.

Interviewer: That’s really helpful. Yasmin, what else is in the pipeline that you’d like to mention?

Dr. Yasmin Ahmadzadeh: I’m really keen having spent the past year learning and thinking and talking about racism and mental health, I’m really excited to apply for new funding to do some more concrete action. So my research, as we’ve talked about, is focussed on how mental health problems run in families and because most of this research has been conducted with white families, we don’t know much about how experiences of racism and marginalisation might be influencing mental health and families in other groups. So I’m really keen to collaborate with people from different backgrounds, and I’ve been working with a charity called the Centre for Mental Health who are already working a lot on racial inequality and mental health risk.

I’d just like to talk to more groups and get more people involved in research to start to extend what we’re already doing in mental health research but other communities and start to think about how can we change how we’re doing things and involve more people in research and what research do other communities want to help support their mental health and help them to understand the processes that may be more specific to their communities and families.

Interviewer: And finally, what is your take-home message for those listening to our conversation?

Dr. Yasmin Ahmadzadeh: I think research is slow and it takes time and there’s still so much to do and there’s so many unanswered questions and I think for early career researchers we’re all in control of what we write and what we apply for, and I think we can try to get involved in research that’s more equitable and try to challenge everything that doesn’t sit right and that’s wrong in science that’s gone before. Then also in terms of the research that we’re producing I think it’s really important to remember that genetics is involved in mental health and that we should refrain from assuming causality from correlations. So remember that child mental health can be influenced by genetics and children can influence their parent’s mental health. So it’s not all about how parents are moulding their child’s mental health. We have to think about all the different causal pathways.

Interviewer: Brilliant. Yasmin, thank you so much. For more details on Dr Yasmin Ahmadzadeh please visit the website www.acamh.org and Twitter at ACAMH. ACAMH is spelt ACAMH and don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review and do share with friends and colleagues.

 

Discussion

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Dear Dr Ahmadzadeh, Thank you so much for this interesting podcast..

I work in Child and adolescent mental health and it has been a source of discomfort and irritation for some years that our referral forms and other ways of identifying people have been couched in terms of ethnicity and race often on the same form with no differentiation between them, which as you indicate is at best confusing for many people, and at worst inaccurate and disenfranchising.. Unfortunately, as you say this language is used as an identifier so widely in many areas if life, as if it carries a high degree of truth likeness when it often dies not except at the crudest level. Research can be really powerful tool I think and I very much hope you’reWork and the work of early career researchers takes this forward and makes a difference on the ground.

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Dear Ferelyth, thank you so much for your comment and support, I really do hope that research can spark some change in this area and it will be so important for us to do so with practitioners such as yourself. Many thanks again for your comment, Yasmin

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