Health Research: Statistical tests, evidence, and peer-reviewed literature Psychological Health

Data Analysis: Statistical Significance

Statistical tests are used to determine the nature of a relationship between 2 variables
Is it a TRUE relationship or is it due to chance?

The p-value is often used as a cut-point for statistical significance

Probability value What is the probability that a particular value occurred by chance, assuming there is no relationship?

P<0.05 is standard cut-point this means there is less than a 5% chance the results are by chance

Statistical Significance
p-values come in all forms
0.05 is the cut off Often see 0.01, 0.001, .0000

NOTE: A smaller p-value does not mean a result is more significant or stronger
p <0.001 is just as significant as p <0.05 The chance that this is a random occurrence is smaller Approaching significance is NOT significant
See approaching significance p-values 0.06-0.08

Significance is significance

Data Analysis: T-tests and Group Differences

Examining differences between two groups T-tests (and F-tests) statistical procedures to compare two (or more) group means Statistical difference between two group means yields a p-value <0.05
Chocolate

CHOCOLATE

Data Analysis: Correlational Coefficient and linear relationships

Linear relationships
as X changes, Y also changes

Numerically quantify the relationship between the dependent (Y-variable) and independent (x-variable)

Data Analysis: Correlational Coefficient

Pearson product-moment correlation (r)
Measure of the strength of a correlation between variables Range: -1 to +1 Positive values=direct relationship
As one variable increases, related variable also increases

Negative value=indirect relationship

As one variable increases, related variable decreases

Steps of the Scientific Method: Drawing Conclusions

Drawing conclusions
CHOCOLATE INTAKE Body fatness

r= - 0.11 p-value=0.01
What can we conclude about chocolate and body weight?

Error in Research
No research study or researcher is perfect Measurement error
Incorrect use of measurement tools Measurement tools that dont measure what they are meant to measure

Researcher error
Recording results Implementing experimental procedures

Participant error
Memory bias (record incorrectly) Social desirability bias Misunderstanding of the questions

Steps of the Scientific Method

Observe a phenomenon and ask a question Form a hypothesis (is there a causal relationship; what do you think will happen?) Test hypothesis (research study) Analyze data and draw conclusions (statistical analysis) Communicate your results (informed literature publications, lab report)

Steps of the Scientific Method: Communication

Communicate your results
Publish in peer-reviewed journals Present at conferences Write lab reports (in this class)

Communications must be transparent and clear

Communicate purpose, methods, analysis & results Allow for critique and feedback Demonstrate reproducibility

Peer-reviewed Scientific Literature

Peer reviewed (aka refereed)
Submit research articles to journals for publications Expert review and critique research

Provides check on research promoting publication of only quality, systematic, and informative research

Peer-reviewed journals
Specific subject areas Experts on the editorial boards & as reviewers

Peer-reviewed (Informed) Literature

Caveat: All published research is not good research? It is still your responsibility as a good consumer to critically evaluate the evidence to form your own opinion
Methodological weaknesses
Design issues Sources of bias Analytical weaknesses

Data open to interpretation

Using Scientific Research

One study is generally NOT enough evidence to support a particular treatment or course of action at least not as a standard Compile findings from multiple studies of different types
Explain health and diseases Identify effective treatments and interventions

Evidence Based Practice

Applying the best available research results (evidence) when making decisions about health care. Health care professionals who perform evidence-based practice use research evidence along with clinical expertise and patient preferences. Systematic reviews (summaries of health care research results) provide information that aids in the process of evidence-based practice. - Agency for Healthcare Quality Research
http://effectivehealthcare.ahrq.gov/glossary-of-terms/?filterletter=e

Evidence Based Practice

Relies on scientific research studies Based on numerous and varied studies Standards of practice are NOT based on
One study Opinion Value what weve always done

Evidence Pyramid
Systematic Reviews Randomized controlled trials Cohort studies Case-control studies Case series Case reports Ideas, Editorials, Opinions Animal research In vitro (cell) research
Strongest Evidence

Weak Evidence
For more information (if you are interested) http://researchguides.uic.edu/ebm

Other sources of health information

Most of us arent reading peer-reviewed journals for health information Where do we learn about health (besides this class)?

How do you know when a source is reliable or credible?

Type of source Use of experts Use of research to back up facts Author/editor credited

Psychological Health
Reading: Chapter 2 Promoting and Preserving your Psychological Health, pg 2855

Announcements
Kresge Library Tutorial Lab 1
Topic: Stress Article posted on moodle Directions to come

Announcements
Suggestions for note-taking
Print or download notes prior to class
Print 4-6 per page and write on the those

Compare handwritten notes with the notes posted on line after class (if you dont print notes) Fill in the gaps with your book (or come to office hours)
If something is NOT in the book/readings I will almost always have it written out for you

CONTINUING WITH RESEARCH METHODS

Psychological Health
Mental dimensions of health
Includes social, emotional & spiritual aspects of wellbeing

Involves physical dimension of health

heart rate blood pressure digestive system weight immunity

Elements of Psychological Health

Feeling good about yourself (and your limitations) Feeling comfortable with others
Adequate expressions of respect and compassions

Controlling tension and anxiety

Consciously avoid irrational thoughts, excessive excuse making, or blaming others

Meet demands of life problem solve

Elements of Psychological Health

Curb hate and guilt Maintain positive outlook (more optimistic than pessimistic) Value diversity

Enjoy nature and/or conscious of place in universe

Positive Psychology
The scientific study of the strengths and virtues that enable individuals and communities to thrive. The field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play.

From the Positive Psychology Center (UPenn) http://www.ppc.sas.upenn.edu

Positive Psychology
Focus on emotional well-being, positive aspects of cognition
Conscious movement away from focus on abnormal psychology or mental disorders

study of happiness, resiliency, strength in character

ability to adapt to change and stressful events in healthy and flexible ways

Select goals of positive psychology:

How to promote happiness and well-being How to improve learning and productivity Understanding motivation Understanding strength and resilience

Positive Psychology
Recommended readings Happiness Hypothesis by Jonathan Haidt Stumbling on Happiness by Dan Gilbert

Psychological Health: Influences

Family
Encourage, support

Social Support (friends) Community

Psychological Health: Influences

Self-efficacy Self-esteem Learned helplessness Learned optimism

Psychological Health: Influences

Personality
Extroversion vs Introversion Agreeableness Openness to experiences (inquiring intellect) Emotional stability Conscientiousness Resiliency

Psychological Health: Influences

Life-stage
Adolescence vs adulthood Transitions Life events

Disruptions in psychological well-being

MENTAL ILLNESS

Mental Illness
Disorders that impair daily functioning by affecting Diagnostic Criteria
Diagnostic and Statistical Manual for Mental Disorders 5th edition (DSM-V) by the American Psychiatry Association

Diagnosing Mental Illness

Diagnostic and Statistical Manual for Mental Disorders V by the American Psychiatry Association
http://www.dsm5.org/Pages/Default.aspx

Sets criteria for

Diagnosis Treatment

Treating Mental Illness

Psychotherapy
talk-therapy

Goals of psychotherapy
Understand Provide

Examples
Cognitive-behavioral therapy Dialectical therapy
From: http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml

Treating mental illness

Medications

Anxiety Disorders
Characterized by persistent feelings of threat and worry Anxiety disorders
Generalized anxiety disorder Panic attacks Obsessive compulsive disorder Post-traumatic stress disorder

Generalized Anxiety Disorder

Level of anxiety Fight or flight symptoms unchecked Develops over time

Generalized Anxiety Disorder: Diagnosis

Exhibit at least 3 symptoms more days than not for at least 6 months

Panic Disorders
Panic attacks
Sudden onset-Anxiety
Severe physical symptoms: on- edge to heart attack

Panic Disorders
Causes:
Genetic Over-active sympathetic nervous system
fight or flight

Obsessive Compulsive Disorder (OCD)

Recurrent, unwanted thoughts and repetitive behaviors
Intrusive thoughts Rituals

Obsessive Compulsive Disorder (OCD)

Recurrent, unwanted thoughts and repetitive behaviors Knowledge of irrationality Diagnosis

Post Traumatic Stress Disorder (PTSD)

Responses to a previously experienced trauma that occur in absence of the event

Mood Disorders
Experience persistent emotional states
Sadness, despair, euphoria interfere with daily or usual functiongin

Major depression Dysthymic disorder Bipolar disorder

Post Traumatic Stress Disorder (PTSD)

Event associations Physical symptoms

Dissociation

More Information on Anxiety Disorders

National Institute of Mental Health
http://www.nimh.nih.gov/health/topics/anxietydisorders/index.shtml

Causes of Mood Disorders

Interaction of genes, environment, and personal history

Treatment

Major Depression
Most common mood disorder Women TWICE as likely to suffer from depression Depressed mood that interferes with work, relationships, daily functioning

Major Depression (DSM-IV)

Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks At least five of the following symptoms

Cause clinically significant impairment in social, work, or other important areas of functioning almost every day

Dysthymic Disorder
Chronic, persistent, mild depression Affects 1.5 million American adults (3%)

Dysthymic Disorder
Depressed mood most of the day for more days than not, for at least 2 years Presence of two or more of the following symptoms

Cause clinically significant impairment in social, work, or other important areas of functioning

Bipolar Disorder
Manic depression Severe mood swings
Highs to lows

Affects 2.6 % population (5.7 million Americans)

Bipolar Disorder
Symptoms of mania increased decreased need more talkative than usual flight of ideas distractibility psychomotor agitation excessive involvement in pleasurable activities

Recognizing Mood Disorders

Difficult to notice, attend, and talk about On-line screening available at Gannett
http://www.mentalhealthscreening.org/screening /?keyword=OAKLAND

Information on Mood Disorders

National Institute of Mental Health (nimh.gov)
Depression: http://www.nimh.nih.gov/health/topics/depressio n/index.shtml Bipolar: http://www.nimh.nih.gov/health/topics/bipolardisorder/index.shtml

American Psychological Association (apa.org)

Other Mental Health Issues

Self-injury Suicide

Self-injury
Self-harm, self-mutilation, cutting NOT a suicide attempt, but a coping mechanism Often associated with

Self-injury
Preventing behavior while developing coping skills
Identifying triggers Identifying plan of action for the trigger

For more information

www.selfinjury.org

Suicide
Third leading cause of death among 15-24 year olds 90% have a diagnosable mental condition Sex differences

Risk factors for Suicide

Risk factors Recent loss Inability to let go of grief History of depression
Expressed a desire to kill themselves

Previous suicide attempts

Common Signs
Change in personality Sexual dysfunction Expressions of Change in Preoccupation with A direct statement Indirect statement Final preparations

Suicide Prevention
What you can do:
Know warning signs Take threats seriously Let the person know how much you care about him or her. Ask directly. Do not belittle the persons feelings. Help come up with alternatives. Tell someone; do not keep your suspicions to yourself

Resources
National Suicide Prevention Hotline
1-800-273-8255
Suicidepreventionlifeline.org

International Suicide Prevention

http://suicideprevention.wikia.com/wiki/International_Suicide_Prevention_Directory

Veterans Crisis Hotline

1800-273-8255 (1) http://www.veteranscrisisline.net