The prevalence of cancer is rising, as are the number of individuals who are cured of their cancer or are living with it as a chronic disease. This is partly due to the aging of the population and more effective treatments. As a result, many of these survivors face continuing problems due to cancer and its treatment, including a high prevalence of depression.

Mols and team examined whether depressive symptoms observed between one and ten years after cancer diagnosis were linked to an increased risk of premature death two to three years later. Their work focused on survivors of endometrial cancer, colorectal cancer, lymphoma or multiple myeloma, where little work looking at this potential link has been done to date.They analyzed data collected from several large population-based surveys in 2008 and 2009. A total of 3,080 cancer survivors completed questionnaires to identify symptoms of depression.

The authors found that depressive symptoms increased the risk of death: clinically high levels of depressive symptoms were more common in those who died than in those who survived. Overall, after controlling for treatment, type of cancer, co-morbidity, and metastasis, one-to-ten-year cancer survivors with depression were twice as likely to have died early.

The researchers conclude: “Paying attention to the recognition and treatment of depressive symptoms in this patient group is key. The next step is to investigate the possible mechanisms that might explain the association between depressive symptoms and death from cancer. We also need to better understand whether treatments for depressive symptoms in cancer patients have life-prolonging effects.”

Multiple factors can influence both the type and degree of neurocognitive abnormalities found during early abstinence, including chronic cigarette smoking and increasing age. A new study is the first to look at the interactive effects of smoking status and age on neurocognition in treatment-seeking alcohol dependent (AD) individuals. Findings show that AD individuals who currently smoke show more problems with memory, ability to think quickly and efficiently, and problem-solving skills than those who don’t smoke, effects which seem to become exacerbated with age.

Results will be published in the October 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Several factors – nutrition, exercise, comorbid medical conditions such as hypertension and diabetes, psychiatric conditions such as depressive disorders and post-traumatic stress disorder, and genetic predispositions – may also influence cognitive functioning during early abstinence,” explained Timothy C. Durazzo, assistant professor in the department of radiology and biomedical imaging at the University of California San Francisco, and corresponding author for the study. “We focused on the effects of chronic cigarette smoking and increasing age on cognition because previous research suggested that each has independent, adverse affects on multiple aspects of cognition and brain biology in people with and without alcohol use disorders. This previous research also indicated that the adverse effects of smoking on the brain accumulate over time. Therefore, we predicted that AD, active chronic smokers would show the greatest decline in cognitive abilities with increasing age.”

“The independent and interactive effects of smoking and other drug use on cognitive functioning among individuals with AD are largely unknown,” added Alecia Dager, associate research scientist in the department of psychiatry at Yale University. “This is problematic because many heavy drinkers also smoke. Furthermore, in treatment programs for alcoholism, the issue of smoking may be largely ignored. This study provides evidence of greater cognitive difficulties in alcoholics who also smoke, which could offer important insights for treatment programs. First, individuals with AD who also smoke may have more difficulty remembering, integrating, and implementing treatment strategies. Second, there are clear benefits for thinking skills as a result of quitting both substances.”

Durazzo and his colleagues compared the neurocognitive functioning of four groups of participants, all between the ages of 26 and 71 years of age: never-smoking healthy individuals or “controls” (n=39); and one-month abstinent, treatment-seeking AD individuals, who were never-smokers (n = 30), former-smokers (n = 21) and active-smokers (n = 68). Evaluated cognitive abilities included cognitive efficiency, executive functions, fine motor skills, general intelligence, learning and memory, processing speed, visuospatial functions, and working memory.

“We found that, at one month of abstinence, actively smoking AD [individuals] had greater-than-normal age effects on measures of learning, memory, processing speed, reasoning and problem-solving, and fine motor skills,” said Durazzo. “AD never-smokers and former-smokers showed equivalent changes on all measures with increasing age as the never-smoking controls. These results indicate the combination of alcohol dependence and active chronic smoking was related to an abnormal decline in multiple cognitive functions with increasing age.”

“These results indicate the combined effects of these drugs are especially harmful and become even more apparent in older age,” said Dager. “In general, people show cognitive decline in older age. However, it seems that years of combined alcohol and cigarette use exacerbate this process, contributing to an even greater decline in thinking skills in later years.”

Durazzo agreed. “Chronic cigarette smoking, excessive alcohol consumption, and increasing age are all associated with increased oxidative damage to brain tissue,” he said. “Oxidative damage results from increased levels of free radicals and other compounds that directly injure neurons and other cells that make up the brain. Cigarette smoking and excessive alcohol consumption expose the brain to a tremendous amount of free radicals. We hypothesize that chronic, long-term exposure to cigarette smoke and excessive alcohol consumption interacts with the normal aging process to produce greater neurocognitive decline in the active-smoking AD group.”

Cigarette smoking is a “modifiable health risk” that is directly associated with at least 440,000 deaths every year in the United States, Durazzo noted. “Chronic smoking, and to a lesser extent, alcohol use disorders are also associated with an increased risk for Alzheimer’s disease,” he said. “So, the combination of these modifiable health risks may place an individual at even greater risk for development of Alzheimer’s disease. Given the above, in conjunction with the findings from our cognitive and neuroimaging research, we completely support programs that routinely offer smoking cessation programs to all individuals seeking treatment for alcohol/substance abuse disorders.”

A study of how well college students adhere to these limits has found that female college student drinkers exceed national drinking guidelines for weekly drinking more frequently than their male counterparts.

Results will be published in the October 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Recommended drinking limits are lower for women than for men because research to date has found that women experience alcohol-related problems at lower levels of alcohol consumption than men,” explained Bettina B. Hoeppner of the Massachusetts General Hospital Center for Addiction Medicine, an assistant professor of psychology at Harvard Medical School as well as corresponding author for the study.

“It is always important to take gender into account when studying health or risk behaviors,” added Melissa A. Lewis, associate professor in the department of psychiatry and behavioral sciences at the University of Washington. “Even if you hold weight constant, there are differences in terms of how alcohol affects men and women. For example, men have more of an enzyme in the stomach – a gastric alcohol dehydrogenase – that lowers the amount of alcohol that makes it into the bloodstream. Also, women have less blood going through the bloodstream than a man at the same weight, so alcohol gets more concentrated in the bloodstream.”

For this study, Hoeppner and her colleagues asked 992 college students (575 females, 417 males) to report their daily drinking habits on a biweekly basis, using web-based surveys throughout their first year of college.

“We found that female college-student drinkers exceeded national drinking guidelines for weekly drinking more frequently than their male counterparts,” said Hoeppner. “Weekly cut-offs are recommended to prevent long-term harmful effects due to alcohol, such as liver disease and breast cancer. By exceeding weekly limits more often than men, women are putting themselves at increased risk for experiencing such long-term effects.”

“In addition,” said Lewis, “men’s weekly drinking declined over time whereas women’s weekly drinking did not. This finding is concerning. If women continue to exceed weekly drinking recommendations over time, it puts them at greater risk for health issues, such as liver or heart disease and certain forms of cancer.”

“These findings contribute to our understanding of how populations adhere to national drinking guidelines,” said Hoeppner. “Specifically, it examines college student drinkers, where adherence to weekly drinking limits has not been examined before. Generally, ‘binge drinking’ receives more attention when examining college student drinking, however, for long-term health, it is also important to examine the establishment of drinking patterns that may lead to long-term harmful effects, not just short-term effects.”

“These findings highlight the need for prevention efforts to focus on both daily and weekly limits to reduce harm from short- and long-term negative consequences related to alcohol use,” said Lewis. “Current preventative interventions often do not focus on weekly drinking recommendations, which is important and a warranted area of future research.

Hoeppner agreed. “Our results might motivate clinicians to address weekly drinking limits and the potential for long-term alcohol related harm with their patients,” she said. “The reasons that many college students exceed these weekly limits are unclear. It is possible that lack of awareness of the guidelines and possible consequences of exceeding them contributes to these high rates. If so, clinicians might reduce harm by educating their college-student patients about the guidelines and the harm they seek to prevent, especially their female patients. Similarly, researchers and clinicians designing prevention/intervention programs might find it useful to address weekly drinking limits in their programs, both to reduce incidence rates thereof, and to identify the reasons for exceeding these guidelines.”

Thus, age at first drink (AFD) is generally considered a powerful predictor of progression to alcohol-related harm. A new study shows that individuals who have their first drink during puberty subsequently have higher drinking levels than do individuals with a post-pubertal drinking onset.

Results will be published in the October 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Most teenagers have their first alcoholic drink during puberty, however, most research on the risks of early-onset alcohol use up to now has not focused on the pubertal stage during which the first alcoholic drink is consumed,” said Miriam Schneider, leader of the Research Group Developmental Neuropsychopharmacology at the Central Institute of Mental Health, University of Heidelberg, as well as corresponding author for the study. “Common thinking in alcohol research was that the earlier adolescents begin, the more deleterious become their drinking habits. However, a closer look at the statistics revealed a peak risk of alcohol use disorders for those beginning at 12 to 14 years of age, while even earlier beginners seemed to have a slightly lower risk. Since timing of puberty is not a simple function of chronological age, and also greatly differs between the sexes, the pubertal phase at first drink may therefore represent a stronger and better indicator for subsequent alcohol-related problems than simply the age.”

“Usually this type of research has to be done retrospectively, and those studies are not very reliable,” added Rainer Spanagel, head of the Institute of Psychopharmacology at the University of Heidelberg. “Prospective longitudinal studies like the one here … are able to provide reliable conclusions on such a clinically and highly relevant research question. Alternatively, animal studies can be very informative – and which the researchers have also provided.”

“Adolescents have their first drink at very different ages,” explained Schneider. “It would be unethical to make adolescents have their first drink in the course of a study, so this variable requires a longitudinal epidemiological study or experimental animal research to assess drinking behavior. Also, the determination of the pubertal stage at AFD is not trivial; even our study had to rely on estimations. Third, it takes longitudinal studies to assess drinking data in early adulthood. Fourth, both drinking behavior and pubertal development can be traced back to common factors such as psychosocial adversity. Finally, while puberty and adolescence are overlapping time periods, with puberty being a part of adolescence, the terms cannot be used interchangeably. ‘Puberty’ refers to the time period during which sexual maturity is achieved. ‘Adolescence’ refers to the gradual period of behavioral and cognitive transition from childhood to adulthood, where adult behavioral abilities are acquired, and the boundaries of this period are not precisely defined. Girls complete puberty much earlier than boys, indicating a difference in timing of neurodevelopmental processes.”

Schneider and her colleagues determined pubertal age at first drink in 283 young adults (152 females, 131 males) that were part of a larger epidemiological study. In addition, the participants’ drinking behavior – number of drinking days, amount of alcohol consumed, and hazardous drinking – was assessed at ages 19, 22, and 23 years via interviews and questionnaires. Furthermore, a rodent study concurrently examined the effects of mid-puberty or adult alcohol exposure on voluntary alcohol consumption in later life by 20 male Wistar rats.

“Both studies revealed that those individuals that initiated alcohol consumption during puberty tended to drink more and also more frequently than those starting after puberty,” said Schneider.

“In other words,” said Spanagel, “this study indicates that the period of puberty might serve as a risk window for AFD. Results also show a higher Alcohol Use Disorders Identification Test (AUDIT) score later in life in those individuals who had their AFD in puberty. A higher AUDIT score is indicative of a high likelihood of hazardous or harmful alcohol consumption. This information is of great relevance for intervention programs. Even more interesting, neither pre-pubertal nor post-pubertal periods seem to serve as risk-time windows. Therefore, intervention programs should be directed selectively towards young people in puberty.”

Both Schneider and Spanagel noted the influence of a high degree of brain development that occurs during puberty.

“Numerous neurodevelopmental alterations are taking place during puberty, such as maturational processes in cortical and limbic regions, which are characterized by both progressive and regressive changes such as myelination and synaptic pruning,” said Schneider. “Typically, an overproduction of axons and synapses can be found during early puberty, followed by rapid pruning during later puberty, indicating that connections and communication between subcortical and cortical regions are in a highly transitional state during this period.”

“Puberty is a phase in which the brain reward system undergoes major functional changes,” said Spanagel. “For example, the endocannabinoid and dopamine systems are at their peak and these major neurobiological changes are reflected on the behavioral level; reward sensitivity is highest during puberty. Therefore, during puberty the brain is in a highly vulnerable state for any kind of reward, and drug rewards in particular. This high vulnerability might also affect reward seeking, or in this particular case, alcohol seeking and drinking behavior later in life.”

“In summary,” said Schneider, “puberty is a very critical developmental period due to ongoing neurodevelopmental processes in the brain. It is exactly during puberty that substances like drugs of abuse – alcohol, cannabis, etc. – may induce the most destructive and also persistent effects on the still developing brain, which may in some cases even result in neuropsychiatric disorders, such as schizophrenia or addictive disorders. Prevention work therefore needs to increase awareness of specific risks and vulnerability related to puberty.”

The research will be discussed at the American Psychiatric Association meeting on Monday, May 20, 2013 at 12:30 pm in the Press Briefing Room at the Moscone Center in San Franscico.

Led by Dan Iosifescu, MD, Associate Professor of Psychiatry at Mount Sinai; Sanjay Mathew, MD, Associate Professor of Psychiatry at Baylor College of Medicine; and James Murrough, MD Assistant Professor of Psychiatry at Mount Sinai, the research team evaluated 72 people with treatment-resistant depression—meaning their depression has failed to respond to two or more medications—who were administered a single intravenous infusion of ketamine for 40 minutes or an active placebo of midazolam, another type of anesthetic without antidepressant properties. Patients were interviewed after 24 hours and again after seven days. After 24 hours, the response rate was 63.8 percent in the ketamine group compared to 28 percent in the placebo group. The response to ketamine was durable after seven days, with a 45.7 percent response in the ketamine group versus 18.2 percent in the placebo group. Both drugs were well tolerated.

“Using midazolam as an active placebo allowed us to independently assess the antidepressant benefit of ketamine, excluding any anesthetic effects,” said Dr. Murrough, who is first author on the new report. “Ketamine continues to show significant promise as a new treatment option for patients with severe and refractory forms of depression.”

Major depression is caused by a breakdown in communication between nerve cells in the brain, a process that is controlled by chemicals called neurotransmitters. Traditional antidepressants such as selective serotonin reuptake inhibitors (SSRIs) influence the activity of the neurotransmitters serotonin and noreprenephrine to reduce depression. In these medicines, response is often significantly delayed and up to 60 percent of people do not respond to treatment, according to the U.S Department of Health and Human Services. Ketamine works differently than traditional antidepressants in that it influences the activity of the glutamine neurotransmitter to help restore the dysfunctional communication between nerve cells in the depressed brain, and much more quickly than traditional antidepressants.

Future studies are needed to investigate the longer term safety and efficacy of a course of ketamine in refractory depression. Dr. Murrough recently published a preliminary report in the journal Biological Psychiatry on the safety and efficacy of ketamine given three times weekly for two weeks in patients with treatment-resistant depression.

“We found that ketamine was safe and well tolerated and that patients who demonstrated a rapid antidepressant effect after starting ketamine were able to maintain the response throughout the course of the study,” Dr. Murrough said. “Larger placebo-controlled studies will be required to more fully determine the safety and efficacy profile of ketamine in depression.”

The potential of ketamine was discovered by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, and Executive Vice President for Academic Affairs of The Mount Sinai Medical Center, in collaboration with John H. Krystal, MD, Chair of the Department of Psychiatry at Yale University.

“Major depression is one of the most prevalent and costly illnesses in the world, and yet currently available treatments fall far short of alleviating this burden,” said Dr. Charney. “There is an urgent need for new, fast-acting therapies, and ketamine shows important potential in filling that void.”

Dr. Murrough will present his research on Sunday, May 19, 2013 from 1:00 pm to 3:00 pm in the Moscone exhibit hall at the APA meeting.

Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or under-react in response to stressful tasks, such as recalling a traumatic event or reacting to a photo of a threatening face. Now, researchers at NYU School of Medicine have explored for the first time what happens in the brains of combat veterans with PTSD in the absence of external triggers.

Their results, published in Neuroscience Letters, and presented today at the annual meeting of the American Psychiatry Association in San Francisco, show that the effects of trauma persist in certain brain regions even when combat veterans are not engaged in cognitive or emotional tasks, and face no immediate external threats. The findings shed light on which areas of the brain provoke traumatic symptoms and represent a critical step toward better diagnostics and treatments for PTSD.

A chronic condition that develops after trauma, PTSD can plague victims with disturbing memories, flashbacks, nightmares and emotional instability. Among the 1.7 million men and women who have served in the wars in Iraq and Afghanistan, an estimated 20% have PTSD. Research shows that suicide risk is higher in veterans with PTSD. Tragically, more soldiers committed suicide in 2012 than the number of soldiers who were killed in combat in Afghanistan that year.

“It is critical to have an objective test to confirm PTSD diagnosis as self reports can be unreliable,” says co-author Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry and chair of NYU Langone’s Department of Psychiatry. Dr. Marmar, a nationally recognized expert on trauma and stress among veterans, heads The Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center.

The study, led by Xiaodan Yan, a research fellow at NYU School of Medicine, examined “spontaneous” or “resting” brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional MRI, which measures blood-oxygen levels in the brain. The researchers found that spontaneous brain activity in the amygdala, a key structure in the brain’s “fear circuitry” that processes fearful and anxious emotions, was significantly higher in the 52 combat veterans with PTSD than in the 52 combat veterans without PTSD. The PTSD group also showed elevated brain activity in the anterior insula, a brain region that regulates sensitivity to pain and negative emotions.

Moreover, the PTSD group had lower activity in the precuneus, a structure tucked between the brain’s two hemispheres that helps integrate information from the past and future, especially when the mind is wandering or disengaged from active thought. Decreased activity in the precuneus correlates with more severe “re-experiencing” symptoms—that is, when victims re-experience trauma over and over again through flashbacks, nightmares and frightening thoughts.

Key scientific contributors include researchers at NYU School of Medicine, the University of California at San Francisco, Mt. Sinai School of Medicine, and the Center for Imaging of Neurodegenerative Diseases at the VA Medical Center in San Francisco.

“Confrontational and violent reactions to infidelity have been observed throughout history, across cultures, and among a variety of species,” Jon K. Maner of Florida State University and his colleagues wrote in their study, which was published in Social Psychological and Personality Science. “The current findings offer novel insight into a physiological mechanism potentially underlying confrontational responses to infidelity.”

Maner and his colleagues found men and women exposed to higher levels of prenatal testosterone were more likely to approach potential romantic rivals. The study involved 58 undergraduate students who were asked to imagine their romantic partner flirting with another person and then completed a computerized task to measure their willingness to approach or avoid various people.

Exposure to testosterone in the uterus has been found to lead to permanent changes in brain structure. Researchers obviously cannot directly measure prenatal testosterone levels in adults. However, the difference between the length of the index finger to the ring finger has been found to be an indicator of prenatal testosterone. This ratio is known as 2D:4D — or second digit to fourth digit.

Those exposed to higher levels of testosterone while in the uterus tend to have a lower 2D:4D. In other words, the shorter a person’s index finger is compared to their ring finger, the more testosterone they were exposed to in the uterus.

“Prenatal testosterone may be associated with confrontational responses to threatening intrasexual rivals as an adaptation to environmental instability,” Maner and his colleagues explained in the study.

Maternal stress has been linked to increases in prenatal testosterone. Researchers believe the effect could be an evolutionary adaptation to prepare offspring for a dangerous environment where mates are rare, sexual competition is fierce, and life is short.

“Environmental instability during early development may incline offspring toward a faster life history strategy, which entails heightened intrasexual competition, aggression, and risk taking,” the researchers added. “High prenatal testosterone may prepare individuals to respond confrontationally to reproductive threats, and this propensity may persist into adulthood.”

The study was co-authored by Saul L. Miller of the University of Kentucky, Jacqueline M. Coyle of Stetson University and Michael P. Kaschak of Florida State University.

“Our study investigated whether participants’ spatial position has an influence on their reactions to being ostracized,” Christiane Schoel of the University of Mannheim and her colleagues wrote in the study.

“Drawing on embodiment research, we hypothesized that excluded participants would react less aggressively toward the perpetrators when positioned above (vs. below), and thus ‘aloof’ from the situation.”

For their study, Schoel and her colleagues had 40 university students play the computer game Cyberball. The 3-player game was developed by psychologists to study social exclusion and ostracization.

The game simply involves passing a ball among the three players, who are arranged in a triangle. The participant is led to believe he or she is playing the game with two other humans, but in reality the game is pre-programmed. The participant is passed the ball only twice near the beginning of the game, and has to sit and watch the two other players pass the ball between themselves.

The game also includes a control condition, in which every player is passed the ball an equal number of times.

When participants were positioned above the two other players, Schoel and her colleagues found they exhibited less aggression after being excluded compared to those positioned below the two other players. Being positioned above also protected the participants’ feelings of control and mood.

“[O]ur findings show that a high vertical position in space mitigates aggressive retaliation against the perpetrators of social exclusion,” the researchers concluded. “On a more general level, one may conclude that being in a position of power helps to buffer the effect of ostracism on threatened control and negative mood, thereby reducing the risk of aggressive retaliation.”

The study was co-authored by Jennifer Eck of the University of Mannheim and Rainer Greifeneder of the University of Basel.

In a 12-year Australian study of 10,547 women 47-52 years old, researchers found that depressed women had a 2.4 times increased risk of stroke compared to those who weren’t depressed. Even after researchers eliminated several factors that increase stroke risks, depressed women were still 1.9 times more likely to have a stroke.

“When treating women, doctors need to recognize the serious nature of poor mental health and what effects it can have in the long term,” said Caroline Jackson, Ph.D., study author and an epidemiologist in the School of Population Health at the University of Queensland in Australia. “Current guidelines for stroke prevention tend to overlook the potential role of depression.”

This is the first large-scale study in which researchers examined the association between depression and stroke in younger middle-aged women. The closest comparison is with the U.S.-based Nurses’ Health Study, which found a 30 percent higher risk of stroke among depressed women. However, the average participant’s age in the Nurses’ study was 14 years older.

Jackson and her colleagues analyzed survey results from the nationally representative Australian Longitudinal Study on Women’s Health. Participants answered questions about their mental and physical health and other personal details every three years in 1998-2010.

About 24 percent of participants reported being depressed, based on their responses to a standardized depression scale and their recent use of anti-depressants. Self-reported responses and death records revealed 177 first-time strokes occurred during the study.

The researchers used statistical software and repeated measures at each survey point to analyze the relationship between being depressed and having a stroke.

To distinguish the independent effects of depression, they factored out various characteristics that can affect stroke risks, including: age; socioeconomic status; lifestyle habits such as smoking, alcohol and physical activity; and physiological conditions including high blood pressure, heart disease, being overweight and diabetes.

Although the increased stroke risk associated with depression was large in the study, the absolute risk of stroke is still fairly low for this age group, Jackson said. About 2.1 percent of American women in their 40s and 50s suffer from stroke. In the study, only about 1.5 percent of all women had a stroke. That number increased to slightly more than 2 percent among women suffering from depression.

Similar results could be expected among American and European women, Jackson said.

“We may need more targeted approaches to prevent and treat depression among younger women, because it could have a much stronger impact on stroke for them now rather than later in life,” she said.

It’s still unclear why depression may be strongly linked to stroke in this age group. The body’s inflammatory and immunological processes and their effects on our blood vessels may be part of the reasons, she said.

The study, presented today at the Society for Academic Emergency Medicine’s annual meeting in Atlanta, that there is an interaction of the race and sex of the study assistant and the race of the patient.

Lead author Kimberly Hart says that her team found that black patients, both male and female, were about 15 percent less likely to be willing to participate in research when approached by a white male study assistant, compared to white patients.

However, black patients were about 15 percent more likely to be willing when approached by a white female study assistant. Conversely, black patients were about 50 percent less likely to be willing to participate in research when approached by a black female study assistant, compared to white patients.

The study builds on previous UC research reporting that black and female patients are less likely to agree to participate in research, despite being offered more frequent opportunities to participate.

“Social theories about relationships between medical providers or researchers and patients suggest that patients may have more trust in providers who are similar to them in terms of gender and race, but there are few research studies that directly address race and sex differences between medical researchers and patient participants,” says Hart, a research associate in the department of emergency medicine. “Our team hypothesized that when a patient was approached by a study assistant of the same race or sex, the patient would be more willing to participate than when race and sex were different.”

To test this, the team studied nearly 160,000 patients screened for clinical research by 89 different study assistants at the UC Medical Center emergency department and Jewish Hospital emergency department from January 2007 to December 2011.

The patient population was 60 percent white and 44 percent male, while the study assistants were 75 percent white and 44 percent male. Most patients, 89 percent, were willing to be approached for research.

“We found that willingness to participate in research is influenced by the race and sex of the study assistant, but the impact is different for different groups,” says Hart. “As researchers, we should be aware of the impact of race and sex on our relationships with study participants. The relationship is much more complicated than we thought it would be, and we hope to conduct further research to better understand the reasons behind our observations. It is important to ensure equal representation of all persons in clinical research and only by understanding the factors that influence willingness to participate can we begin to prevent bias.”

Co-authors of, “The Impact Of Race And Sex Of Study Personnel On The Decision To Participate In Research,” include Andrew Ruffner, MPH, Carla McTaggert and Christopher Lindsell, PhD.