Occupation as a key social determinant of health

Recent research, supported by a grant from the NIMHD, sheds light on the changing nature of employment in the United States and its effects on public health. Rapid technological advances, globalization, economic recessions, and demographic changes over the last few decades have fundamentally changed the nature of work and the labor market. There has been a shift away from maintaining a stable workforce towards more flexible and economically competitive employment practices which has resulted in a decrease in the number of workers in permanent, full-time, regularly scheduled work with secure wages and benefits; and concurrently, an increase in nonstandard arrangements. This study explores the health consequences and potential mechanisms that may underlie the health impacts of different types of employment in the U.S. labor market by measuring the multidimensional construct of employment quality. The researchers used data from the General Social Survey collected between 2002 and 2014 to construct a multidimensional measure of how self-reported health, mental health, and occupational injury were associated with employment quality among approximately 6,000 U.S. adults. Employment quality was conceptualized using seven dimensions: employment stability, material rewards, worker’s rights and social protections, standardized working time arrangements, training and employability opportunities, collective organization, and interpersonal power relations. They then used a typological approach to identify patterns of employment characteristics that holistically represent a worker’s experience. Using the Standard Employment Relationship (permanent, full-time, regularly scheduled work with secure wages and benefits) as a reference point, they characterized the experience of employment quality with differences in the pattern of employment conditions across the seven dimensions. The researchers found that employment quality was associated with self-rated health, mental health, and occupational injury. People employed in jobs where they may be well paid, but lack empowerment or opportunity, as well as those who work on short-term contracts and struggle to get full-time hours, were more likely to report poorer general and mental health and occupational injury when compared to people with more traditional forms of employment. Interestingly, people in careers that may be less stable (long or irregular schedules, insecurity, and lower pay) but have high empowerment (more control over their schedules, opportunities to develop, and involvement in decision-making) had similar health to those in standard employment. This study helps to expand the current occupational health research framework to consider the relational and contractual aspects of employment that affect health.

Citation: Peckham T, Fujishiro K, Hajat A, Flaherty BP, Seixas N. 2019. Evaluating Employment Quality as a Determinant of Health in a Changing Labor Market. RSF. 2019 Sep;5(4):258-281. doi: 10.7758/RSF.2019.5.4.09.

Persons with schizophrenia may process sound differently

Research supported by the NIMH, NCI, the Stanley Foundation, The Netherlands Organization for Health Research and Development, and the Brain and Behavior Research Foundation is shedding light on auditory hallucinations in schizophrenia. Auditory hallucinations, or “voices,” effect 80 percent of people with schizophrenia and are one of the most distressing symptoms of the disorder. These “voices” sound real to the individual and are often distracting and distressing in nature, and sometimes compel the person to become violent or suicidal. Determining the biological origins of auditory hallucinations is essential for improving the quality of life and reducing the disease burden of schizophrenia in these individuals. To investigate the biological origins of auditory hallucinations in individuals with schizophrenia, the research team used ultra-high field imaging (7 Tesla) to compare the auditory cortex of individuals with schizophrenia that had recently experienced auditory hallucinations (n = 16) with healthy controls (n = 22). Study participants listened passively to tones across a range of very low to very high frequencies (88–8000 Hz) while having their brain activity in the auditory cortex scanned to obtain high-resolution images. In people with healthy brains, the processing of sounds by the auditory cortex is very organized with each frequency activating a specific part of the auditory cortex, thus forming a tonotopic map. Using this technique, they developed tonotopic maps of the auditory cortex from the individuals with schizophrenia and control study participants. Results showed that the individuals with schizophrenia, who had recently experienced auditory hallucinations, had greater neural activation in the auditory cortex in response to the various sound frequencies, as compared to healthy controls. Additionally, these individuals had abnormal tonotopic organization of the auditory cortex. The tonotopic map is established during infancy and remains stable throughout life. These findings suggest that vulnerability for auditory hallucinations is linked to defects in the organization of the auditory system during in utero and early infant development, which precedes speech development and the onset of psychiatric symptoms. It may be possible to identify vulnerable individuals, such as the offspring of individuals with schizophrenia, much earlier than previously possible. Additionally, there may be implications for the auditory cortex as a therapeutic target area for novel neuromodulation techniques to help individuals who already have symptoms. More research is being planned to replicate and expand these findings in larger samples to determine if this is relevant to other disorders with auditory hallucinations and to quantify the association of tonotopic disruption to auditory cortical activation and connectivity during actual hallucinatory experiences.

Citation: Doucet GE, Luber MJ, Balchandani P, Sommer IE, Frangou S. 2019. Abnormal auditory tonotopy in patients with schizophrenia.  NPJ Schizophrenia doi:10.1038/s41537-019-0084-x.

Combining mindfulness with medicine may help reduce opioid cravings

Currently, the United States is experiencing an opioid use disorder (OUD) epidemic. In a recent publication, researchers funded by NCCIH and NIDA conducted a randomized clinical trial to investigate the use of mindfulness in people with OUD receiving methadone maintenance treatment (MMT), a commonly used form medication assisted treatment for OUD. Nearly half of people in ongoing MMT continue to use opioids during treatment or relapse within 6 months. Chronic pain, which affects more than half of people receiving MMT, contributes to continued opioid use and relapse. Further, traditional medication-assisted treatment, such as MMT, does not directly address the deficits seen in emotion regulation and reward processing that are characteristic of OUD. In order to address this gap, they examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on opioid craving, pain, and positive affective state by analyzing ecological momentary assessment (EMA) data from a Stage 1 randomized clinical trial. Participants with OUD and chronic pain (N = 30, female = 15) were randomized to 8 weeks of MORE or standard treatment that did not include a formal mindfulness-based intervention. MORE is an 8-session group therapy intervention involving training in mindfulness techniques to increase awareness, reappraisal skills to promote emotional regulation, and savoring of pleasant events and emotions to counteract deficits in natural reward processing. Each session was 2 hours, once a week, and led by a trained and supervised clinician. Participants were asked to engage in daily 15-minute mindfulness, reappraisal, and savoring sessions at home guided by an audio recording. Across 8 weeks of treatment, participants completed up to 112 random EMA measures (2 assessments/day × 56 days) of craving, pain, and affect, as well as event-contingent craving ratings. Therapist contact time was matched between study arms. Multilevel models examined the effects of MORE on craving, pain, and affect, as well as the association between positive affect and craving. The EMA analysis showed that participants in the MORE intervention had significantly greater improvements in craving, pain unpleasantness, stress, and positive affect than for participants in the standard treatment. Participants in MORE reported having nearly 1.3 times greater self-control over craving than those in standard treatment. Additionally, positive affect was significantly associated with a reduction craving for participants in MORE as compared to standard treatment. These results suggest that MORE may be a useful, non-pharmacological behavioral intervention adjunct among individuals with OUD and chronic pain in MMT.

Citation: Garland EL, Hanley AW, Kline A, Cooperman NA, 2019. Mindfulness-Oriented Recovery Enhancement reduces opioid craving among individuals with opioid use disorder and chronic pain in medication assisted treatment: Ecological momentary assessments from a stage 1 randomized controlled trial. Drug Alcohol Depend. 203: 61-65.