For this podcast, we are joined by Dr. Catharina Hartman, Associate Professor of Psychiatric Epidemiology at the Interdisciplinary Centre of Psychopathology and Emotion Regulation (ICPE) at the University Medical Centre, Groningen, and Deputy Editor-in-Chief of our Open Access journal, JCPP Advances.
Catharina’s research team aims to advance the understanding of the onset, and course, of childhood onset psychiatric disorders and uses data from longitudinal studies to explore the interplay between genetics, behavioural and environmental factors.
Catharina has (co-) authored over 200 peer reviewed papers, and in this podcast, highlights some of the studies and findings that have had the greatest influence or are especially important to her, as well as provides insight into what barriers exist when translating research into practice.
Catharina talks us through some of her recent work with the CoCA (Comorbid Conditions of ADHD) project, and discusses what CoCA is, its overall goal, and why it is important for researchers and clinicians, who work in CAMH, to also think about prevalence and comorbidity in adults.
Furthermore, Catharina also discusses our Open Access JCPP Advances journal and details the importance of Open Science and rapid publication for the research community, in particular for those working in child and adolescent mental health.
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Dr. Catharina A. Hartman is Associate Professor of psychiatric epidemiology at the Interdisciplinary Center of Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen (UMCG), the Netherlands. The overall objective of her research team’s work is to advance mechanistic understanding of the onset and (long-term) course of childhood-onset psychiatric disorders. The leading hypothesis in her work is that childhood psychiatric disorders accelerate the onset of other psychiatric and somatic disorders, throughout the lifespan and across generations. The aim of her work is to unravel such transactions -at the genetic, neurocognitive or behavioral level, and in relation to environmental exposures. Catharina Hartman’s team uses data from longitudinal studies, partly run under her own supervision. Catharina has (co-) authored over 200 original peer-reviewed papers and has a broad international research network.
[00:00:30.550] – 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 Dr. Catharina Hartman, Associate Professor of Psychiatric Epidemiology at the Interdisciplinary Centre of Psychopathology and Emotion Regulation, the ICPE, at the University Medical Centre, Groningen, the Netherlands. Catharina’s research team aims to advance the understanding of the onset and course of childhood onset psychiatric disorders. Catharina is also Deputy Editor-in-Chief of JCPP Advances, one of the three journals produced by the Association for Child and Adolescent Mental Health. ACAMH also produces the JCPP and the CAMH.
[00:01:21.340] If you’re a fan of our in-conversation series, please subscribe on your preferred streaming platform. Let us know how we did with a rating or review, and do share with friends and colleagues. Catharina, welcome. Nice to meet you. Can you start by introducing yourself?
[00:01:36.430] – Dr. Catharina Hartman: I’m an Associate Professor in Groningen, based in Groningen University of Groningen, University Medical Centre Groningen. My work is obviously on child psychiatry, and what I do is mostly epidemiological work. That is large samples. Hopefully if we can do that, longitudinal research, if we can do that, and to study associations between different psychiatric disorders, risk factors, protective factors between psychiatric disorders and somatic diseases. I also do sometimes other studies, like, for example, intensive measurements for diary studies, but that is more occasional. The main thing is epidemiological work.
[00:02:17.230] – Jo Carlowe: Catharina, what prompted your interest in child and adolescent mental health?
[00:02:21.710] – Dr. Catharina Hartman: My background is psychology. I’m a psychologist from origin and it was my second study and I started this with the idea that I would be a clinician in the future. Of course, I failed at the first study, art school, I failed, but I stopped that. I had really read up on the next study, but also did volunteer work to see if I would like it to be a clinician. So I worked with youth who ran away early from home and had to be placed in other families, and that suited me. It went fine. I thought, okay, this is the study I’m going to do. So that is the background in children and psychology, psychiatry, but then when I started my studies it turned out that I didn’t like the clinical psychology one bit at all.
[00:03:11.140] This was about learning how to do IQ tests and interviews and all kinds of skills, and it didn’t keep my brain occupied at all. It was very practical, but the other thing which was unexpected is that I was very good, actually among psychology students, I must say, in statistics and methods and I loved that because it was a new area and for me and I hadn’t envisioned this as part of psychology.
[00:03:39.130] But then, in fact, I loved it. So that became my specialty. So away from the ideal of youth and mental health, but then this was a route into science and then when I finished my master the opportunity was there to do a PhD with all these knowledge about methods and statistics in child psychiatry. That fitted. That was an old interest on youth and mental health with the new skills, and that was the basis and it has remained with me.
[00:04:12.590] – Jo Carlowe: Catharina, you hypothesise that childhood psychiatric disorders accelerate the onset of other psychiatric and somatic disorders throughout the lifespan and across generations. Is this view widely supported through longitudinal research?
[00:04:29.590] – Dr. Catharina Hartman: My first answer is yes. Yes we have indications that this is the case, but there is a big part, and that is also where I’m doing my research. There’s way too little research on this. When you think of, for example, about the lifespan, obviously we have no studies that run from baby to old age. We don’t have that, and if we have long standing studies, psychiatry is generally not a topic in the early childhood years, which are way back. So many conditions have been studied more. So this is just to show that this is the area where I’m working, but I feel passionate about and we are working on studies doing this and whether or not my hypothesis will be true or not, but this is the front line say. So, yes, there are indications and yes every study will inform us on this.
[00:05:25.770] – Jo Carlowe: Your team uses data from longitudinal studies to explore the interplay between genetics, behavioural and environmental factors. Catharina, you authored or co-authored over 200 peer reviewed papers. Can you highlight some of the studies and findings that have had the greatest influence or that you feel are especially important?
[00:05:48.250] – Dr. Catharina Hartman: As an explanation, we say that over 200, very few papers, it could also have been 300, because that is also true. But it is just the way of saying I am a scientist who is very actively contributing. It’s certainly not the case that all those 200 or 300 have my personal signature there. Yes, I contributed to more than 200, 300 papers, and that is how we do it these days. So we work in groups. So we try to work together and then every scientist has a small contribution. The other comment I want to make that all papers are, of course, small pieces of the big puzzle, as to why some people are more vulnerable to develop mental health problems and others are not, and why some have a higher chance to have a beneficial course even though they have a mental disorder. That as others become sicker and sicker, that is the main question that we are looking at.
[00:06:43.210] This is bit by bit by bit by bit. So that said, when I think about important papers my PhD time, for example. I was very much focusing on measurements of child psychiatric disorders and how we can differentiate with the best possible signs and symptoms between different child psychiatric disorders.
[00:07:03.820] That is still very important, even though that is more than like 30 years ago. Measurement is almost everything. If we cannot assess syndromes, then you get messy results. Here the cross-diagnostic theme and that is actually I guess that will be important to emphasise. I was in the opportunity to already work on different disorders very early back then, through this measurement thing because it’s very good that you have the overview of what is going on in other psychiatric disorders and with measurements. If you have each group, one group is working on depression, the other is on anxiety, and you will get overlapping measures.
[00:07:45.380] The anxiety group will develop a measure of anxiety that accidentally also have some depression symptoms in them and so on. So just as an example of the PhD time, very important to have good measures that differentiate the symptoms that we want to know all about. My post doc was on anxiety and depression very much and there again the cross-diagnostic thing that’s very important. So we did studies on the transference from parents to children. The parents had anxiety disorders or mood disorders, so maybe depression, [inaudible]. We wrote a lot about the risk, the high risk of offspring and also that this is not a one-to-one relation.
[00:08:29.240] So if one of your parents has depression, it can very well be the case that for example, the child is more at risk for ADHD. Again, a theme that is still very much acknowledged has gained momentum. So through genetics, the scientific community has also discovered how many genes are actually not specific for specific disorders. This is also a theme that is still going on and has a big interest. Maybe more recently when I was an Assistant Professor I started to work more on ADHD and autism spectrum disorders. These are neurodevelopmental disorders. So for example, for ADHD, we started to explore the social problems of ADHD. That is not particularly a core criteria, that there are social problems like for example, problems with peer relations, children who do not accept, a kid who has been diagnosed or has ADHD and we wrote a review on this, and this was also quite an influential paper because we are the first to look at this social, to get all this information together in a paper.
[00:09:40.270] From that I also started to think a lot about the comorbidity with autism spectrum disorders. We did quite some review papers on that as well. So that is more extreme. These are more extreme social problems, not understanding other people, for example. That is a core characteristic of autism, and also there we did a lot about the overlap between ADHD and autism spectrum disorders. So this is also quite influential, highly cited papers, still an important theme very much.
[00:10:12.930] Maybe that is maybe my biggest passion right now. So at some point we moved on towards the adult part, and if you look at this theme for the neurodevelopmental disorders, there is such a huge gap there in knowledge. So as if ADHD or autism spectrum disorder would stop at age 18, which is obviously not the case. So my passion there is also to have more knowledge about adults with neurodevelopmental problems.
[00:10:45.840] – Jo Carlowe: Catharina, what are the barriers to translating research into practice and how have you managed to be successful at this?
[00:10:53.820] – Dr. Catharina Hartman: I noticed that because very simple questions that have already been answered in science are often not known in practice. I think implementation of knowledge is really a different job and I would not know how to do really implementation. So for me it is about knowledge. How can we get sound knowledge from our research and then indeed let the world know about this? So we are writing and of course, we have always been writing because that is the more the journal kind of stuff but yeah, more recently we are talking more. We are making videos or small movies. We do online courses and actually I’m learning a lot still.
[00:11:43.620] So I’m from the generation that simply wrote scientific publications. In my recent like six, seven years I’ve been involved in multiple European grants in [inaudible] and there the dissemination and the co-creation more and more is obliged and there is somebody there who gets all our knowledge out of our head safe, from the scientists who are not used so much or not as much as should be used to spread the news. So that is how I learn a lot and how I teach my group, but the interesting thing is actually that the young generation is actually very eager to spread the knowledge. So I also learned from young generation.
[00:12:30.140] – Jo Carlowe: It’s really interesting to hear about the intergenerational input. You have the experience and perhaps the younger generation have the know-how about dissemination of ideas. Catharina, can we turn to some of your recent work with the ADHD Comorbidity Project, CoCA? What is CoCA and its overall goal?
[00:12:50.540] – Dr. Catharina Hartman: The CoCA Project stands for Comorbid Conditions of ADHD and we know quite a lot about this again in childhood. So in childhood, aggression is often comorbid, some early onset anxiety disorders and I also mentioned already the autism spectrum problems. CoCA was about adults. So for the first time for me I was able to start participating in a group of experts, adult ADHD. We wanted to know exactly how prevalence comorbidities are, psychiatric comorbidities mostly in CoCA, but also obesity and we wanted to know why. So how come that these comorbidities are so frequent that we knew, suspected but from smaller samples? We wanted to do this in a big way, but also understand the mechanisms and also treat and learn more about the genetics of comorbidity and so on and so forth.
[00:13:58.610] So CoCA is a multidisciplinary consortium that is very much appreciated by the EU and that is the kind of grants that are provided that you learn to talk to other disciplines and then get the best out of this, and my role was the epidemiology part, obviously. So what we were able to do is based on very large samples, so in the 30-40,000, and these are cohort samples or based on registries, for example and that is the whole population.
[00:14:34.770] For example, in Sweden, Denmark, or based on claims data from insurance companies. Again, hundred, thousands of people to really show how comorbid multiple psychiatric conditions are with ADHD, and in particular also the adult onset psychiatric disorders. So the common adult disorders like depression, anxiety, substance use disorders, because that is actually the translation from child psychiatry ADHD towards the lifespan, potentially meaning that ADHD if you can treat ADHD properly some of these comorbidities may be avoided.
[00:15:16.400] – Jo Carlowe: I’m just wondering why is it important for researchers and clinicians who work in child and adolescent mental health, why is it important for them to also think then about prevalence in adults and comorbidity in adults?
[00:15:34.890] – Dr. Catharina Hartman: If ADHD can be treated, meaning that for a particular person there are less failures, failures at work, for example, or at school. It starts already at school, of course. Failures in social relations that might prevent onset of later comorbidities. So if you have this knowledge, I guess as a condition, you’re more inclined to look very closely at how it can be treated in the best possible way. If you think this will go away with age 18.
[00:16:05.770] – Jo Carlowe: Yeah. I imagine it completely increases motivation if you think you can change the trajectory.
[00:16:11.670] – Dr. Catharina Hartman: Yeah, that is the point. Obviously, that has not been shown to a large extent. That is why the work is to show this, that it helps to treat, but first you need to make sure that the problem is known and that is my work.
[00:16:28.500] – Jo Carlowe: Fantastic. Thank you. Catharina, I want to turn to your role as Deputy Editor and Chief of JCPP Advances. JCPP Advances offers innovative approaches to publication and research. What is the importance of Open Science and rapid publication for the research community and in particular for those working in child and adolescent mental health?
[00:16:51.750] – Dr. Catharina Hartman: Yeah. Open Science is obviously very important right now, but it is also very broad term. So let me talk about some aspects of this in relation to JCPPA. So JCPPA has open access publications, so that is at least one part secured in the Journal and it’s part of Open Science. Open Science would also ideally, for example, have the raw data available so that people can access it, but here there is a complication. We cannot demand it by the Journal because there are obviously rightly so all kinds of privacy regulations there.
[00:17:27.630] So not every raw data set can be put on the Internet, but what we can encourage is that we share scripts for our findings and scripts meaning statistical, analytics scripts, so that people can see exactly what decisions were made. Other examples are of pre-registration. So you want to do a study and you think it through from the very beginning, towards the end, including all the decisions and the primary outcome measures, the secondary, and that means that you cannot anymore, even unconsciously fish in your data. So as a researcher when something beautiful comes up, a finding, even if it was not planned to be your main interest, you might get overly enthusiastic about this and describe this as this was your aim all along, not even consciously.
[00:18:17.750] But yeah, it can also be a chance finding and we know already very well that this gives strong biases in the literature. So pre-registration helps to stick to your protocol and of course you can write all about your new finding that was unexpected and not planned for, but then at least you are explicit in saying so this was the post [inaudible] finding, so that others know, okay, this needs replication, rather than this was planned all along and you find it and this is solid evidence.
[00:18:46.290] So this is another aspect that we can encourage and actually JCPPA has banners for different parts that are currently seen as important assets of open science. So you can see for every paper that we publish the extent to which different open science principles were followed. So that is an incentive. So it doesn’t go unnoticed. If you make these commitments as individual scientists to work according to open science principles, then this banner shows you that you did. So that is an important thing to change potentially to motivate people. So that was your question actually. You said, okay, what is the importance of being able to get soon to the new knowledge, which is also an open science principle.
[00:19:30.640] And here I’m not sure if we should adopt it in JCPPA. So let me explain this a bit as soon as possible obviously but we only publish after photo peer review and peer review obviously takes some time. We do that as fast as possible. That is our task also as Editors but if you would not do that, then everything will be published, whether it is trustworthy or not and actually that was one of the reasons when I was asked to join as a Deputy Editor I was thinking, yeah, okay, my main interest is in sound knowledge.
[00:20:07.090] So let me make sure that with this new Journal we will not publish nonsense. So yeah, here is an open science principle that I think rightly so JCPPA has not welcomed yet. So first very few, then the knowledge. Whereas others make another choice, but for me it’s important because when you’re not completely knowledgeable about all these science practises, you cannot make the difference between solid knowledge and simply something that was put on the internet without a solid base. The fun thing of JCPPA is that there are a lot of young editors and we have this new start.
[00:20:47.740] So we are building together on the Journal. We have no tradition. So we do not have to fight for things to change, but rather we can make it ourselves. It was also one of the incentives for me that I thought, okay, a new group of people sitting together doing this in the best possible way. That should be very important and also refreshing and I’m the older person, so I may sometimes be more conservative, but that is also not particularly bad. So we balance the decisions.
[00:21:24.430] – Jo Carlowe: What content is coming up in JCPP Advances that particularly excites you? So what can readers look forward to?
[00:21:33.010] – Dr. Catharina Hartman: Can I turn this around first? I am pretty sure that listeners have not read the three issues that we have done within the year, and can they read them first before looking at the future? I’m saying because we have been able to get very good research papers in editorials, reviews, and that within the year. So, yeah, I want to advertise what we’ve already done and please read these papers from beginning to end and you will have a pretty good idea of where the research field of child psychiatry and [inaudible] is at this point. It’s already a very good overview, but then for the future there is a special issue on gender differences, so you might want to look out for that as well.
[00:22:24.690] – Jo Carlowe: What else is in the pipeline for you?
[00:22:27.000] – Dr. Catharina Hartman: Currently, next week we will have the results back from one very large grant in the Netherlands. So this will be scary because we worked in a multidisciplinary group very long and hard on this grant. That means that I’m already very committed to the content. So I’m hoping we get positive reviews. It is something that is very near now and there is another European grant, and that will also come back in I think, two months. So what I hope is and again multidisciplinary group, a big, great group. So I’m hoping at least one of the two make it but that is potentially hopefully future work.
[00:23:11.680] – Dr. Catharina Hartman: One is on depression and ADHD, one is on positive functioning and ADHD. So the benefits of having features that we count as ADHD but I’m not sure if this will go, if this will fly, of course. Then currently I’m working on a relatively new project on the development of ADHD starting in pregnancy. That is the [inaudible] studies. So this is a lot of work because we’re doing the study right now, but also very exciting. We have also other recent grants on intellectual disability, which is a very much neglected area in child psychiatry.
[00:23:52.900] So also that has my strong interest right now and obviously there are the smaller day to day things. So very soon I have two PhD students who will defend their thesis, and they have done an excellent job. So, yeah, I’m also very happy about that kind of stuff.
[00:24:10.230] – Jo Carlowe: Finally, Catharina, what is your take home message for those listening to our conversation?
[00:24:15.430] – Dr. Catharina Hartman: I think my take home message is that child psychiatry is a very, very important field. Knowledge is accumulating and accumulating. It is a rather recent field child psychiatry but that also means that we have a lot to learn there and it goes fast, really fast. My take is that most of the mental and part of the somatic conditions have their origin in childhood and then potentially this means also that the change with the largest impact can be in child. So please follow the science in child psychiatry and then DCPA, of course is a new outlet that tends to be very important in this.
[00:24:52.270] – Jo Carlowe: Brilliant. Catharina, thank you so much and good luck with the outcome of your grant submissions.
[00:24:58.580] – Dr. Catharina Hartman: Yeah. Thank you.
[00:25:00.310] – Jo Carlowe: For more details on Dr. Catharina Hartman please visit the ACAHM website www.acahm.org and Twitter at @acamh. ACAMH is spelt is A-C-A-M-H and don’t forget to follow us on your preferred streaming platform. Let us know if you enjoy the podcast with a rating or review and do share with friends and colleagues.