For this podcast, we are delighted to interview aspiring academic psychiatrist Clara Faria, winner of the ACAMH 2021 Undergraduate Clinical Trainee of the Year Award and ACAMH’s first Young Person’s Ambassador.
Clara sets the scene by providing insight into what it meant to her to be recognised as ACAMH’s 2021 Undergraduate Clinical Trainee of the Year, as well as being named as the first ACAMH Young Person’s Ambassador.
Having been previously divided between doing paediatrics and psychiatric training due to her interest in working with children, Clara talks us through how she resolved this conflict and discusses how she became involved with research in mental health, her role as a research assistant at the Laboratory of Panic and Respiration, and how this sparked her interest in child and adolescent mental health.
Clara also explores how she balanced the combination of work, research, and study during her undergraduate studies, and shares tips for others who are following a similar path.
Clara talks to us about her current work on two different main projects. The first is a systematic review predicting factors in ADHD diagnosis at the University of Southampton, and the latter is a genome-wide association study of anxiety disorders in Brazil. Clara discusses what her role is in both projects and provides an insight into what each project entails.
Furthermore, as Clara’s research encompasses both the UK and Brazil, Clara explores what insights she has gained from this exposure to different demographic groups and different health systems, as well as why it is so important in the field of child and adolescent mental health to disseminate evidence-based science to the broader population.
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Clara is a junior doctor, graduated from the Federal University of Rio de Janeiro (UFRJ) working as a Research Assistant at the Laboratory of Panic and Respiration. She has presented her research at International Conferences numerous times, has active involvement in international research in translational neuroscience and joins advocacy efforts towards ending stigma against mental disorders on social media. Clara, alongside her studies, has been an active member of the Global Mental Health Think Tank within which she is now leading a new project on neurodevelopmental disorders. Clara has been described by her Research Mentor as a “lit candle of hope for global child and adolescent mental health in and from Brazil.
Jo Carlowe: Hello. 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 Clara Faria, the winner of the ACAMH 2021 Undergraduate Clinical Trainee of the Year Award and ACAMH’s first young persons’ ambassador.
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Clara, welcome. Can you give a quick introduction about yourself?
Clara Faria: I’m a final year medical student here at the Federal University of Rio de Janeiro, which is located in Brazil. And I’m very interested in child and adolescent mental health, especially neurodevelopmental disorders like ADHD, autism, and I hope I can become an academic psychiatrist one day in that area. And right now, completing medical school and for the next year, I want to apply for a master’s in that area too.
Jo Carlowe: Congratulations on winning the ACAMH’s 2021 Undergraduate Clinical Trainee of the Year Award and for being named as the first young person’s ambassador for ACAMH. You must be very proud. How was it to receive that recognition?
Clara Faria: It was actually the greatest honour of my life so far. It was very special to receive that prize. And actually, it was a complete surprise because my parcel got stuck in the Brazilian customs, and I only received it actually last week. So in the ceremony, at the time, I didn’t know what was happening, like it was really a big surprise to me. And also sometimes I have a bit of imposter syndrome. And I really didn’t think I was going to win, and it was 100% a surprise when Professor Cortese announced my name, so it was extra special because of that.
Regarding the young persons’ ambassador role, I was so thrilled when I received the invitation. It’s one of the things I’ve definitely most looking forward to this year. ACAMH has been around for over 60 years, and I truly believe there’s no other organisation like that in the world in the sense that it really encourages and tries to involve all relevant parties when it comes to promoting best evidence and best practise in child and adolescent mental health. And it’s a really, really huge honour to be able to promote the association’s values and missions in social media and try to make that its mission reaches more and more people. I really hope I’m up to the task, and I’m going to work really hard for that.
Jo Carlowe: Fantastic. I understand that you were divided between doing paediatrics and psychiatric training because of your interest in working with children. I imagine it’s quite a common conflict for many undergraduates. How did you resolve that conflict?
Clara Faria: Actually, it resolved itself quite naturally during medical school because my first rotation was in paediatrics and I loved it. I was completely in love with working with children and also with the routine. But at the same time, I have always been interested in and involved in research in mental health, but actually, I began working with adults. But I have always been involved in research in mental health since the beginning of the university. And after that, I started doing a bit of research in ADHD, and then I realised they could work with both children and mental health. And I started looking into ACAMH and the association and other resources I found for researching further into child and adolescent mental health. And I saw that a career in that area would be a possibility for me and that fitted my interests.
Jo Carlowe: Now early in your studies, Clara, you became involved with research in mental health when you joined the Laboratory of Panic and Respiration as a research assistant. What did this entail and how did it spark your interest in child and adolescent mental health?
Clara Faria: During my second year of university, I started working at first as a research intern then I became a research assistant at the Laboratory of Panic and Respiration. And there, I worked mostly with adults who suffered from anxiety disorders and/or depression. And in most projects I was involved in, I was responsible for interviewing patients and sometimes their families. And in the structured interviews, I realised that most adult patients who suffered from a mental health disorder in their adulthood, not all of the time but most of the times, they began struggling in their young years, in their childhoods, so I started to become interested for that particular period. And then I started doing reading on my own on this period and on disorders that are prevalent in children. And that’s how I became I’m interested because actually this laboratory, they don’t do research in children. They’re very focused on adults.
Jo Carlowe: How did you balance that combination of work, research, and study? And also if you have
any tips for others who are following a similar path, that would be great to hear.
Clara Faria: So I still struggle with that sometimes actually, to be honest. But basically, I think that well, first of all, I’m very lucky to have a really good support system from my family and from my friends. And secondly, I try to prioritise one area at a time because I really don’t think you can do all of them at the same time with the same intensity effectively. So for example, in this past year, I prioritised a lot of research because I was involved in really interesting projects and I was feeling really excited about it.
But in the year before that, I focused a bit more on my medical school workload because I wanted to improve my grades. But then this year, I knew, for most of the year, I had electives. So my finals had already passed, so I was not worried anymore about my grades. It was good because I was able to focus for most of the year on doing research and being more involved in projects I love. Yeah, I think basically, I try to prioritise one area at a time and also one day at a time. And usually, I’m more focused in one area, and then I tend to focus less on them. And also looking back, now that I’m graduating, I can see that I clearly focused more on research than on the other two, but I don’t regret it or anything like that. I just think that’s what I like most to do.
Jo Carlowe: Sure that gave you a clue of which direction to go into next. Let’s focus on some of your projects. So you’re currently working on two different main projects. The first is at the University of Southampton, and this is a systematic review predicting factors in ADHD diagnosis. Can you tell us about your involvement with this work and a little about the project itself?
Clara Faria: So this project is coordinated by Professor Samuel Cortese who is a professor of child and adolescent psychiatry at the University of Southampton. And he wanted to do a systematic review and meta-analysis on prediction algorithms for ADHD because in the last years, ADHD prevalence increased a lot in children and in adolescents. And sometimes there is a bit of diagnostic confusion with ADHD because sometimes diagnostic criteria change depending on the country. So there is a lot of discussion on that. And then some researchers, they have been doing some really interesting work in diagnostic algorithms. So they basically study factors and see if those factors are strong predictors of ADHD diagnosis. There are many factors that are involved. So for example, we have clinical features. There are also some studies that look at fMRI images and see if you can find markers of ADHD in those images.
So there are many, many studies that are trying to find ADHD predictors in children and adolescents. And basically, we are looking at all those studies and doing a systematic review and meta-analysis on that, which is basically trying to gather all this evidence and see where it points out. And there’s also another person involved in this project who is Holly Walker that is a higher trainee in child and adolescent psychiatry in Southampton. And she’s also great. So it’s been great working with them.
Jo Carlowe: Great. What’s the timescale on that project?
Clara Faria: So now we’re finishing. Because doing a systematic review is a lot of work and there are several steps, first we screened all the references and we’re finishing the screening now and deciding which articles to include in a preliminary analysis. We had, I guess, over 11,000 references and we finished screening those 11,000 now. And we are finishing to decide, which references we’re going to include in the project. And then after that, we will read these articles selected in full, and we’re going to extract data from them to see. And then the next step would be first organising all this data in a huge spreadsheet. And after that, we have to run the statistics. And then after that, we have to write the manuscript. So I believe that we will still be working on that for a while. But until the end of the year, we will have the final articles we are going to include sorted. And then in the next year, we will be doing the statistical analysis bit and also writing.
Jo Carlowe: I just look at your other project. So you’re also working in a genome-wide association study of anxiety disorders in Brazil. What does this project entail and what is your role?
Clara Faria: Basically, a genome-wide association study is looking for variations in the genome of lots of people to try to find if there is a particular variation in the genome that is associated with a certain disease. So in this study, we’re trying to look and see if there is a specific variation in the genome that is related to, specifically, panic disorder and also generalised anxiety disorder. So we sequenced the, not we because there’s a lab that does this part for us, but this lab sequences the genomes from a lot of people, and we are looking for these variations. It’s a really big project actually, and I entered in the middle. So when I entered, we were still collecting blood samples to sequence the genomes. But we were also interviewing patients that are volunteering for this project and also their families because we really need to be sure that those patients we are recruiting, they have the mental disorder. We are trying to see if there is a variation associated with it.
So we do lots and lots of diagnostic interviews with them and their families, if they agree of course, to see if there is the diagnosis we’re looking for and also to see if there are any other associated diagnoses. Basically, we need the patients that we are including to have an anxiety disorder, namely generalised anxiety disorder or panic disorder. And we don’t want them to have any other comorbid disorders
because that would mix up the results. So we do lots of diagnostic interviews with them to see if they have the disorder we’re looking for, and I’m responsible for this part. So it’s actually been, I really like talking to people. Sometimes they talk too much. And so I’m responsible for interviewing the patients
and also their families. But unfortunately, this study is coming to an end this year because we had problems with funding. So now we are going to do the analysis of the samples we already collected.
Jo Carlowe: It’s very clear that your research encompasses both the UK and Brazil. Clara, what insights have you gained from this exposure to different demographic groups and different health systems?
Clara Faria: One of the things I love the most about research is being able to work with people from different parts of the world and gaining insights from their cultural perspective. I think that’s one of the things that makes research great, and I’ve been really fortunate to be working with you guys from the United Kingdom and also in Brazil. Actually, in Brazil, we also have a public health system that we call SUS, and SUS was actually inspired by the NHS because you guys have the biggest public health system in the world. So there are some similarities in the way that had the health systems is structured. For example, we also have GP surgeries where patients are seen. And we also have many mental health demands that happen in GP surgeries, and we also reference the patients. The structure of the system is very similar, but I think that what’s really different is the demographic characteristics of each population. So for example, in Brazil, the inequality gap is bigger than in England.
So obviously, there’s also inequality in England, but when we look at the income gap from the most vulnerable groups in Brazil, it’s a larger gap. So when we go to work in vulnerable communities here in Rio, for example, we really see the difference in patients’ demands and patients’ need. So for example, right now I’m doing my elective GP surgery that is located in a very vulnerable community here. And we see lots of mental health demands related to violence and also when I say violence, I mean urban violence. It’s different in this way in this sense. Working in Brazil and working in these communities, one thing I realised and I started giving much more importance to is this determinants of health because we see mental health conditions that are very related to that. If we could improve the conditions where people live and the conditions of employment of people, we would certainly see an improvement in their mental health and their well-being in general.
Jo Carlowe: You graduate at the end of 2021, what are your plans post-graduation?
Clara Faria: Yeah. Here in the South Hemisphere, we have a different academic calendar. So we begin in January and we finish in December, so I graduate in December. And after that, I intend to work here in Brazil for a while. But as I told you, right now I’m applying to master’s in the UK. So if everything works out, I hope I can begin studying in October. Those are my plans for now as we speak.
Jo Carlowe: The very best of luck with that. Is there anything else in the pipeline that you’d like to mention?
Clara Faria: Well, one of the things I also hope to be able to improve next year that I actually started valuing because of ACAMH and because of Twitter is communicating science, especially when it comes to mental health. Mental health is such an exciting field of research to be working with, but at the same time, there’s still lots of stigma. So I think that it’s really important to communicate science and to involve patients and involve policymakers in our research. And I think that ACAMH does a brilliant work with Twitter and the website and also now The Bridge. So definitely, next year, I will try to improve in that part, and I’m trying to learn more about communicating science and speaking about mental health in the less technical and more accessible way, I guess.
Jo Carlowe: It’s really important. Can you say anything more about why it’s so important in the field of child and adolescent mental health to disseminate evidence-based science really to it to the broader population?
Clara Faria: I think that it’s significant and it’s important for several reasons. One of them is that there is still lots of stigma around mental health and I think that especially child and adolescent because many people still don’t think children and adolescents are so vulnerable as they are and also because especially when it comes to child and adolescent mental health, the role of family and the role of community is fundamental. So the more people we can involve and we can inform with evidence-based information is the best.
Jo Carlowe: Finally, Clara, what is your take-home message for those listening to our conversation?
Clara Faria: Well, I would like to thank ACAMH for the invitation today. This is my first podcast ever and it was a real honour. Also I think the Association does a brilliant, brilliant work in communicating mental health advancements regarding to children and adolescents. And well, it was a really, really huge privilege to be able to be a part of that. So thank you.
Jo Carlowe: Thank you, too. It’s been an absolute pleasure to speak to you. For more details on Clara Faria, please visit the ACAMH website, www.acamh.org and Twitter @acamh. ACAMH is spelled A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.