In this Papers Podcast, Maria Palma and Associate Professor Alice Goisis discuss their co-authored JCPP paper ‘Medically assisted reproduction and mental health in adolescence: evidence from the UK Millennium Cohort Study’ (https://doi.org/10.1111/jcpp.13877).
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- What the UK Millennium Cohort Study is.
- The differences in parental reports on adolescent mental health between MAR (medically assisted reproduction) adolescents and naturally conceived adolescents.
- The differences between adolescent self-reports and parental reports on adolescent mental health.
- The association between MAR conception and mental health outcomes in adolescents.
- Implications for clinical practice and researchers.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
#ListenLearnLike
Subscribe to ACAMH mental health podcasts on your preferred streaming platform. Just search for ACAMH on; SoundCloud, Spotify, CastBox, Deezer, Google Podcasts, Podcastaddict, JioSaavn, Listen notes, Radio Public, and Radio.com (not available in the EU). Plus we are on Apple Podcasts visit the link or click on the icon, or scan the QR code.
Maria is a Research Fellow at the UCL Centre for Longitudinal Studies working on European Research Council Grant to study the effects of Medically Assisted Reproduction (MAR) on children and adults (MARTE). She investigates the long-term associations between MAR and health and educational outcomes using the Millennium Cohort Studies and Finnish register data.
Maria is also studying a PhD in Social Sciences in the same department. Her supervisors are John Jerrim and Lindsay Macmillan, and her PhD works aims to build a better understanding of impact that educational policies have had on educational inequalities and highlight the potential of administrative data to lead to better informed policy decisions.
Alice Goisis is an Associate Professor in Demography and Research Director at the Centre for Longitudinal Studies located in the UCL Social Research Institute. Her research interests span a number of substantive areas in social demography and epidemiology. My research has examined the association between advanced maternal age and child well-being, with a particular focus on whether and how it varies across different groups of the population and time periods. Dr Goisis is currently the PI of an ERC Starting Grant investigating families the effects of Medically Assisted Reproduction on children, adults and families. More generally, I am interested in whether, and if so how, family processes are associated with children and adults’ well-being.
Transcript
[00:00:01.339] Jo Carlowe: Hello. Welcome to the Papers 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. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child & Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing Maria Palma, Research Fellow at the Centre for Longitudinal Studies, Social Research Institute, University College London, and Alice Goisis, Associate Professor of Demography and Research Director at UCL’s Centre for Longitudinal Studies. Maria and Alice are co-authors of the paper, “Medically Assisted Reproduction and Mental Health in Adolescence: Evidence from the UK Millennium Cohort Study,” recently published in the JCPP.
This paper will be the focus of today’s podcast. If you’re a fan of our Papers Podcast 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. Maria and Alice, thank you for joining me. Can you start with an introduction about who you are and what you do?
[00:01:18.490] Associate Professor Alice Goisis: Good morning. Thank you for having us. First of all, my name is Alice Goisis. I am a Family Demographer at the Centre for Longitudinal Studies at UCL. Over the past five years, I’ve been the PI of a project which aims to investigate different aspects of the life of families who are formed via medically assisted reproduction. For example, we have looked at the family’s mental health before, during and after the treatments, how it affects their relationships and whether the lives of children who are conceived through medically assisted reproduction are any different from those of the likes of children conceived naturally.
[00:01:54.700] Jo Carlowe: Brilliant, and Maria, could you introduce yourself too, please?
[00:01:58.090] Maria Palma: Of course. Hey, my name is Maria Palma. I’m a Research Fellow on our latest MARTE project and I am the Lead Author of the study and also a PhD student at the UCL Social Research Institute.
[00:02:09.300] Jo Carlowe: Great, thank you very much. So, today we are looking at your JCPP paper, “Medically Assisted Reproduction and Mental Health in Adolescence: Evidence from the UK Millennium Cohort Study.” Can you start with an overview of the paper? What did you look at and why?
[00:02:26.200] Maria Palma: The paper examines several mental health outcomes of adolescents conceived through medically assisted reproduction and whether they differ compared to those of adolescents who are conceived naturally. So, we are interested in MAR children, short for medically assisted reproduction children, because the number and proportion of children conceived via MAR has increased steadily over the last decades, and yet the evidence under mental health is inconclusive. So, we look at mental health outcomes reported by both the adolescents themselves and their parents to investigate if there are differences in the report.
[00:03:02.310] Jo Carlowe: Thank you. Can you tell us a little about the methodology used for this study?
[00:03:07.050] Maria Palma: Yes. The study uses data from the Millennium Cohort Study, a nationally representative longitudinal dataset that has followed around 18,000 babies born in the 2000s throughout their lives. This is important because it allows us to get informations on the children’s parents, such as education and other characteristics that might be relevant to explain differences in mental health by type of conception. And in our study, we focus on wave seven from MCS and altogether we follow almost 10,000 individuals up until they are aged 16/17.
We use linear and logistic estimations to investigate whether adolescents conceived through MAR are more or less likely than their naturally conceived peers to have mental health problems. So, to do so, we look at differences in different questionnaires, such as the SDQ, the Strengths and Difficulties Questionnaire, Kessler Psychological Distress Scale, and information that was self-reported by the adolescents on their antisocial behaviours, whether they have attempted suicide, have hurt themselves on purpose or have had substance abuse problems. So, we think that relying on several measures provide us with a comprehensive view on the cohort members’ levels of mental health and socioemotional wellbeing.
[00:04:29.060] Jo Carlowe: Thank you very much. What key findings from the paper would you like to highlight?
[00:04:32.880] Associate Professor Alice Goisis: We think that the main finding is that we find no differences by mode of conception in adolescents’ self-reported mental health. In other words, children who are conceived through medically assisted reproduction do not report to have more mental health problems than children who are conceived naturally. In contrast, when we look at the parents’ reports, we find small differences between adolescents conceived naturally and those conceived through medically assisted reproduction. In other words, based on the parental reports, parents of MAR adolescents report a slightly higher level of mental health problems than parents whose adolescents were conceived naturally.
[00:05:16.680] Jo Carlowe: What do you make of that discrepancy? So, what you’ve just highlighted is that based on parental reports, one might consider adolescents conceived through medically assisted reproduction to be at higher risk of suffering from mental health problems, but that was not supported by the adolescents’ own reports. How do you explain that? What do you – how do you interpret it?
[00:05:38.100] Associate Professor Alice Goisis: We think that this discrepancy might reflect differences in parental concerns, might reflect their underlying anxiety towards those children, since it was so difficult to conceive them and to have them, and possibly also, their relationship or closeness with their children. However, we think it’s important to highlight that the differences that we observe when looking at the parental reports are quite small and therefore, considering that the magnitude of the differences in the parental reports are small and we find no differences when we look at the cohort members’ reports, we interpret the findings as an indication of no meaningful, or clinically relevant, differences in MAR adolescents mental health outcomes compared to the mental health outcomes of adolescents conceived naturally.
[00:06:31.330] Jo Carlowe: What else in the paper would you like to highlight?
[00:06:35.000] Maria Palma: We think it’s relevant to highlight that before taking into consideration any of the parental characteristics that, for example, we know MAR children are – come from more advantaged families, we see that the unadjusted results show lack of differences in the association between MAR conception and the mental health outcomes for all of the outcomes. which means we observed no differences between children who were conceived via MAR or naturally. And then, when we adjusted for family sociodemographic characteristics, the results show MAR adolescents score slightly higher, but again, only when looking on three SCQ scales, which were reported by the parents, not by the adolescents themselves.
This suggests that the more selected and advantaged profiles of MAR families may protect against the risk of poor mental health outcomes. And the results did not change on adjustment for potential mediators, such as parental mental health, number of siblings in the household and parental household structure.
[00:07:29.099] Jo Carlowe: So, given your findings, what are the implications for clinical practice?
[00:07:32.230] Maria Palma: We urge that the finding of small long-term differences between MAR and naturally conceived adolescents should be part of the conversation between the Doctor and the couple when discussing the risks of fertility treatments. Also, they should be considered by Therapists when dealing with parents who conceived via this way and adolescent patients who were conceived via medical assisted reproduction. Still, the result suggest that the mode of conception is unlikely on average to play a major role in explaining mental health problems amongst adolescents.
[00:08:04.710] Jo Carlowe: Given that it’s not thought to play a major role, why does it still feel important then for Clinicians to ask?
[00:08:12.970] Maria Palma: We think it’s something that the Clinicians should have into consideration because – mostly because of the discrepancy in the report between parents and adolescents themselves. So, there could be that these parents have higher concerns, are more anxious and this could be affecting their relationships or their mental health, basically.
[00:08:31.150] Jo Carlowe: Right, thank you. Yeah, that’s very clear. What are the implications of your findings for Researchers?
[00:08:35.770] Associate Professor Alice Goisis: Previous studies looking at the mental health of children conceived by medically assisted reproduction have shown mixed results, with some studies finding an association and other studies finding a lack of an association. Based on our results, we hypothesised that this could be related to the fact that some of the previous studies have relied on the adolescent’s report and some of the previous studies have relied on the parental report. And so, the discrepancy in the responses between the adolescents’ reports and the parents’ reports suggest that future research should consider the views of different family members, but also that future research should evaluate a broad set of outcomes, if possible.
[00:09:13.860] Jo Carlowe: Maria and Alice, are you planning any follow-up research, or is there anything else in the pipeline for either of you that you would like to share with us?
[00:09:24.790] Associate Professor Alice Goisis: Another paper that we’re currently working on, which is aiming to shed light on why we observe that children who are conceived through medically assisted reproduction tend, on average, to come from highly advantaged families. So, the previous argument is that this might be related to differences in need for medically assisted reproductions. So, more advantaged women invest in their education and careers, postpone childbearing and therefore, are more likely to need medically assisted reproduction to conceive. But we challenged this assumption as there is evidence showing that less privileged women are less likely to access and undergo medically assisted reproduction, but actually, are not less likely to experience infertility.
Therefore, there could be barriers which prevent more disadvantaged women from accessing and succeeding in having a live birth via medically assisted reproduction. So, previous findings from our work support this hypothesis and this idea and show that amongst women who access and undergo medically assisted reproduction, the least advantaged, for example, women who have lower level of education, have a lower probability of having a live birth via medically assisted reproduction than women who are more advantaged. So, we argue that part of the social differences that we observe in medically assisted reproduction birth do not reflect, or are not fully explained by differences in needs between more and less advantaged women.
[00:10:44.350] Jo Carlowe: Sounds very interesting. What’s the timescale on the new study?
[00:10:48.110] Associate Professor Alice Goisis: Well, it’s difficult to tell. We are currently doing – we’re still in, sort of, analysis phase. So, we – and we are starting to write the paper, but we are hoping to submit it to a journal before the summer break and then the timeline is – that will be out of our hands after that, so – but several months.
[00:11:16.389] Jo Carlowe: Okay. Good luck with that.
[00:11:19.720] Associate Professor Alice Goisis: Thank you.
[00:11:22.570] Jo Carlowe: Finally, a question to both of you. What are your take-home messages for our listeners?
[00:11:29.720] Associate Professor Alice Goisis: Taken together, our research shows that most children who are conceived through medically assisted reproduction are healthy and develop normally. For outcomes such as education, we find that MAR conceived children have better outcomes than children who are conceived naturally, which is explained by the fact that MAR conceived children tend to grow up in socioeconomically advantaged families. And although the findings of this study looking at mental health could be a cause of concern, as highlighted before, the differences that we find are very small and this is reassuring evidence. At the same time, our research shows that the process of medically assisted reproduction can be highly stressful and can take a toll on women’s mental health, especially for those for whom the treatments are unsuccessful and do not result in a live birth.
[00:12:56.959] Jo Carlowe: Both of you, thank you ever so much. For more details on Maria Palma and Alice Goisis, 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.