Surely men should have their day too...

Posted by Shelina Visram, Senior lecturer in public health, Newcastle University (on behalf of the BoroManCan research team)

*Trigger warning: mental health and suicide

Unless you’re a fan of the comedian and writer Richard Herring, you may not have given much thought to International Men’s Day. For almost a decade Herring has raised huge sums of money for the domestic violence charity Refuge by spending International Women's Day (8 March) answering each person who asks on Twitter 'But when is International Men's Day?' He then follows up the enquiries on International Men’s Day (19 November) to raise money for CALM, the Campaign Against Living Miserably. 

It’s genuinely today. What are you going to be doing? Would you say the problem is that men are only interested in IMD when they think there isn’t one, but don’t want to do anything when it comes around? Genuine question. https://t.co/nAzbGtqBNE

— Richard K Herring (@Herring1967) November 19, 2019

Presumably, these people are under the illusion that there is no dedicated day to celebrate men, yet International Men’s Day was founded in 1999 to do just that. The theme for 2020 is ‘Better health for men and boys’ with the strapline ‘Laugh stronger, live longer’, but many have struggled to find reasons to be cheerful this year. Although women are more likely to suffer the social and economic consequences of the pandemic, being a man greatly increases the risk of death from COVID-19.^(1,2) Men tend to have many underlying health conditions that worsen coronavirus and generally contribute towards lower life expectancy. Our region (North East England) is likely to see high numbers of COVID-related deaths but also significant impacts in terms of poverty and unemployment, given that the North of England’s economy has been hit hardest by the pandemic.⁽³⁾

We don’t yet know what long-term impact the lockdowns will have on mental health and wellbeing, but early reports suggest an increase in suicide. Globally, men were almost twice as likely to die by suicide as women were before the pandemic.⁽⁴⁾ Harmful masculine norms – in other words, what it means to be a man – are a key driver of suicidal tendencies and encourage risk-taking behaviours like drinking and smoking. These norms often stop men from seeking medical help and have a knock-on effect on women’s lives, placing increased responsibilities on them to care for men’s wellbeing.⁽⁵⁾ They also affect women in other ways, for example, there have been reports of a dramatic increase in domestic violence during the pandemic.

Today is #InternationalMensDay, checking in on a mate only takes a few seconds, just a text, or a stupid tweet, or a quick call can make all the difference to a mate who may be going through a hard time. So give it a go! For more information there's Alan... pic.twitter.com/Vcnuxt2j71

— Dave (@davechannel) November 19, 2019

So, not much to celebrate this year then? Well, actually, there is some cause for optimism. Men’s health is starting to move up the agenda in policy and practice. I was involved in an evidence review and expert meeting to inform the first World Health Organization strategy on men’s health and wellbeing in Europe, which was published in 2018. World Health Statistics were separated by sex from 2019 so that we can better understand gender differences that affect health outcomes. There are also a number of initiatives that have adopted gender-sensitive approaches to actively address masculine norms, for example, through rugby or football.^(6,7) In the North East, the BoroManCan campaign aims to inspire positive behavioural, health and culture change in Middlesbrough, where four out of five suicides involve men and the rate of male suicide is the second highest in the country. Various activities have been developed in partnership with community groups, including Barbers for Health, young men’s workshops in schools, and a one-day training course to develop Men’s Health Champions. Many of these activities are on hold because of the pandemic but the BoroManCan website, podcast and social media pages continue to share stories from local men and services, as well as providing advice and links to further support.

To infinity... and beyond!

I’m working with a team from Newcastle, Durham and Teesside Universities to develop a programme of research around men’s health and wellbeing. We were recently awarded funding from the NIHR Applied Research Collaboration (ARC) North East & North Cumbria to conduct research that will help practice partners begin to understand what has worked so far in relation to BoroManCan and where improvements can be made. Findings and outputs will be shared widely so they can be used to inform the development of similar initiatives aimed at addressing gender equality. I’m looking forward to being part of efforts to change the conversation around men’s health and wellbeing, not least because my own little man celebrates his birthday the day after International Men’s Day. Hopefully by the time he’s older the phrase ‘man up’ will mean something quite different, like being comfortable with your emotions and having the confidence to ask for help when you need it. 

References

1. Burki T (2020). The indirect impact of COVID-19 on women. The Lancet Infectious Diseases, 20(8): 904-905.

2. Williamson EJ, Walker AJ, Bhaskaran K et al (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature, 584: 430–436.

3. Bambra C, Munford L et al (2020). COVID-19 and the Northern Powerhouse, Newcastle-upon-Tyne: Northern Health Science Alliance. https://www.thenhsa.co.uk/app/uploads/2020/11/NP-COVID-REPORT-101120-.pdf.

4. Dearden L (2020). Coronavirus: Mental health incidents rising during UK lockdown, police say. The Independent, 6 April 2020. https://www.independent.co.uk/news/uk/home-news/coronavirus-suicide-rates-ukmental-health-support-a9451086.html.

4. WHO (2014). Preventing suicide: A global imperative. Geneva: World Health Organization.

5. Marcos-Marcos J, Mateos JT, Gasch-Gallén À, Álvarez-Dardet C (2019). Men’s health across the life course: A gender relational (critical) overview. Journal of Gender Studies, epub ahead of print 18 December 2019.

6. Witty K, White A (2011) Tackling men's health: Implementation of a male health service in a rugby stadium setting. Community Practitioner, 84(4): 29-32.

7. Gray CM, Wyke S, Zhang R, et al. (2018) Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: The Football Fans in Training follow-up study. Public Health Research, 6(9): 1-14.

Supporting family carers of people living with dementia in a pandemic

Posted by Mark Parkinson, PhD in Health Psychology, Northumbria University

Social coping: offering family carers a lifeline in turbulent times

Despite our enduring efforts to battle COVID-19 and the headlines and attention the pandemic rightly warrants it is important not to lose sight of some of the separate public health issues which not only continue to grow apace in the background but may also be made worse by the social impact of the virus. Among the issues in danger of being overlooked is how the UK will respond to the growing number of people living with dementia which is set to reach one million by 2025.¹

Presently, family carers provide the bulk of care and reliance on family care is becoming even more essential given the lack of formal care available² and the Europe-wide shift away from reliance on formal care and towards ‘ageing in place’/ care in the community.³ However, a key issue is the high level of long-term stress family carers have to endure⁴ as a result of dealing with a combination of financial, social, mental and physical challenges over long periods of time and how this often leads to family care becoming unsustainable with reliance on formal care the only option. Family carers currently face a vicious cycle that threatens to derail family care itself-despite the wishes of carers and carees:

A key question is how this cycle can be avoided. Crucially, it is not the stress that threatens to derail family care, but how well family carers can COPE with stress. A critical coping strategy is carers’ capacity to seek out and receive effective emotional and practical support, particularly at times when they are most in need of it. This kind of coping strategy is called social coping (SC) and has been found to be effective in safeguarding mental health⁵ due to the positive interactions, support and assistance it can deliver.⁶

However, there is a pressing need to better understand what works to promote social coping. This calls for a deeper understanding of what helps or hinders SC and how this knowledge can be applied by providers of formal health and social services, together with the voluntary and charity sectors to promote social coping to make the family care of people living with dementia sustainable.

What we did

Our research, based on work carried out as part of a Fuse sponsored studentship, investigated ‘What works to support family carers of people living with dementia’. Coping⁷ and more specifically social coping⁸ was identified as important to ‘what works’ and this prompted follow-up post-doctoral research to investigate SC further. The findings (so far) can be found in our recently published article⁸ which highlights the need for formal providers to be aware of six key hindrances to family carers’ use of this important coping strategy:

Achieving a better balance between what helps and hinders the adoption of social coping is critical to promoting it and also pivotal to ensuring the long term sustainability of family care of people with dementia. The full report⁸ (briefly outlined here) was presented by the Chairman of Dementia UK to Helen Whately, the Minister for Care at Department of Health & Social Care, on 3 November. This is a work in progress and follow-up is already underway to reveal further insights into social coping theory. For example, how social coping might be used alongside other helpful coping strategies, the pinpointing of carer coping strategies that could be unhelpful in the long term, and the deeper exploration of how providers (health & social care, allied health care services and voluntary organisations) can put social coping into practice, including improving opportunities for carers and carees to socialise.

In the current climate it has never been more important to deepen our knowledge of coping and to separate carer coping strategies which are helpful, and lend themselves to making family care sustainable, from those that are unhelpful. Providing long-term family care for people living with dementia has never been easy, but the arrival of COVID-19 means family carers now need the additional lifeline of improved external support and the right incentives to accept this support⁹ if they are expected to navigate especially turbulent waters.



References

1. Prince, M., Knapp, M., Guerchet, M., McCrone, P., Prina, M., Comas-Herrera, A. & Rehill, A. (2014). Dementia UK: Update Second Edition. Report produced by King’s College London and the London School of Economics for the Alzheimer’s Society. Retrieved from: http://eprints.lse.ac.uk/59437/1/Dementia_UK_Second_edition_-_Overview.pdf 
2. Alzheimer’s Society. (2020). Facts for the media. Retrieved from: https://www.alzheimers.org.uk/about-us/news-and-media/facts-media
3. Glasby, J., & Thomas, S. (2018). Understanding and responding to the needs of the carers of people with dementia in the U.K., U.S. and beyond. Birmingham: University of Birmingham Press.
4. Fonareva, I., & Oken, B. S. (2014). Physiological and functional consequences of caregiving for relatives with dementia. International psychogeriatrics/IPA, 26(5): 725.
5. Norris, F. H., & Stevens, S. P. (2007). Community resilience and the principles of mass trauma intervention. Psychiatry: Interpersonal and Biological Processes, 70(4): 320-328.
6. Lee, C. Y. S., Anderson, J. R., Horowitz, J. L., & August, G. J. (2009). Family income and parenting: The role of parental depression and social support. Family Relations, 58(4): 417-430.
7. Parkinson, M., Carr, S. M., Rushmer, R., & Abley, C. (2016). Investigating what works to support family carers of people with dementia: a rapid realist review. Journal of Public Health. DOI:10.1093/pubmed/fdw100.
8. Parkinson, M., Carr, S.M. & Abley, C. (in press). Facilitating social coping-‘seeking emotional and practical support from others’-as a critical strategy in maintaining the family care of people with dementia. Journal of Health & Social Care, 00:1-12. http://dx.doi.org/10.1111/hsc.13159 
9. Egan, K. (in press). Digital technology, health and wellbeing and the COVID-19 pandemic: it's time to call forward informal carers from the back of the queue. In Seminars in Oncology Nursing. https://doi.org/10.1016/j.soncn.2020.151088

Changing the habit(s) of a lifetime: an intense body and mind affair

Posted by Fiona Ling, Senior Lecturer in Sport & Exercise Psychology, and Gavin Tempest, Senior Lecturer in Exercise Neuropsychology, Northumbria University

Many of us will be soon be thinking about making New Year’s resolutions, whether it’s to do with eating more healthily or doing more exercise. However, how many of us have actually managed to stick to our resolutions even though we know they are good for us? The question is – why is it so difficult to change our health habits?

While it’s well recognised that our environment does not help in encouraging a healthy lifestyle - from food and drink marketing to electronic devices promoting inactivity - could there be other reasons why we find it hard to change behaviour?

"Piled Higher and Deeper" by Jorge Cham www.phdcomics.com

What actually drives our behaviour?

Currently there exists many theories that try to explain why we do what we do, however, explanations are still lacking in regards to how our body and brain works together to directly drive our behaviour. When it comes to changing our habits, a key point to remember is that this involves stopping ourselves from doing things we consider pleasurable. For example, if you’re on a diet, every time you see an unhealthy snack, you have to tell yourself to STOP. Or, if you’re not a fan of exercising, why would you get off the sofa and slip on your running shoes? Making ourselves do things that don’t provide us with an instant reward can be stressful. These examples suggest that changing our habits can be stressful, that is, (the thought of) diet or exercise can become a source of stress (a stressor), and this makes our brain’s impulse control system work harder in order to adopt a new habit. Researchers have found that some of us can become stressed when seeing images of food, and are also not as good at controlling our impulses.¹ Food craving, especially from seeing foods that we like, is a known stressor and the stress experienced from having to control our cravings is likely to tire out the impulse control system that can lead us to give in to temptations.

We might be able to change our habits for a short time as we become vigilant towards our goals, that is, the need to stick to our diet or exercise. However, we all have our limits and if stress from restricting our behaviour continues it will sap our ability to control our impulses, and our behaviour will return to what we are used to (or our ‘normal’). We saw another example of short-term success in behaviour change during our research. When monitoring children’s physical activity, some showed a burst of activity level at the start, but before long, it quickly dropped.² These children were characterised by being hyper-vigilant towards stressors and they were generally more inactive than other children. We speculated that it was our monitoring of the activity that increased stress as the children felt that they had to show us they were more active which might spur on the initial activity spike, but as the children’s impulses for inactivity built up, it resulted in a considerable drop later on.

What’s next - how can we possibly take up, and keep up with, good health habits?

To influence health behaviour, it is crucial to understand the stress-impulse control mechanisms that DIRECTLY drive the behaviour. To use an analogy, if a person has a fractured arm, a direct treatment would be fixing the bone, rather than taking painkillers which would help to relieve the pain but not fix the problem. Similarly, if it is the stress from behaviour change and its influence on impulse control that directly causes us to succumb to temptations, we ought to target psychological interventions that reduce stress, or the brain’s impulse control system. Being able to manage our stress-impulse control system is particularly vital in the current environment where we are constantly exposed to temptations that lead to an unhealthy lifestyle. It is important to note that other factors, such as motivation and intentions, are also influential in changing our behaviour, however, this stress-impulse control process may more directly dictate the way we behave within split seconds and without our conscious awareness.

A possible psychological intervention is mindfulness training which can increase awareness of the stress cues, so that self-control can be executed before the brain’s impulse mechanism takes over. So next time we have a craving for an unhealthy snack or we are getting worked up about going for a run, we can potentially cope by containing and managing stress and impulses.

We believe that more research needs to be invested in the stress-impulse control mechanisms as it can potentially enhance the effectiveness of future individual health behaviour interventions and public health messages in getting us live a healthier lifestyle, and crucially, it can revolutionise the way we think about health behaviour change.


References

1. Spitoni, G.F., Ottaviani, C., Petta, A.M., Zingaretti, P., Aragona, M., Sarnicola, A.,. & Antonucci, G. (2017). Obesity is associated with lack of inhibitory control and impaired heart rate variability reactivity and recovery in response to food stimuli. International Journal of Psychophysiology, 116, 77-84. https://www.sciencedirect.com/science/article/abs/pii/S0167876016307310?via%3Dihub
2. Ling, F.C.M., Masters, R.S.W., & McManus, A.M. (2011). Rehearsal and pedometer reactivity in children. Journal of Clinical Psychology, 67, 261-266. https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20745

The views expressed here are those of the authors and do not necessarily reflect those of Fuse (the Centre for Translational Research in Public Health) or the author's employer or organisation.