UBC Pharm Sci PhD student Alyssa Howren on exploring the links between mental health and inflammatory arthritis
Julia Kreger: Let’s start from the beginning. What sparked your interest in health outcomes and epidemiology research?
Alyssa Howren: During my undergrad at UBC, I started working at BC Children’s Hospital in the department of pediatric orthopedics. The research program I worked with studied health outcomes in the areas of clubfoot and hereditary multiple exostosis. While I was there, I gained experience with conducting clinical research, writing papers and grants, and learning about health outcomes research. I was there for a few years and decided that I wanted to advance my career in health outcomes research. I enjoyed studying cell biology and genetics during my undergraduate training, but working in the hospital setting and research that helps improve patient outcomes just sparked something that I was even more interested in.
JK: You completed your MSc here at Pharm Sci before moving on to your PhD. What did you focus on for your Masters research?
AH: My MSc focused on individuals with gout using a qualitative research approach. I wanted to understand how patients experience managing their disease and also understand their experience with a multidisciplinary model of care that involved pharmacy, dietetics, and rheumatology.
JK: How about for your PhD?
AH: For my PhD thesis I am studying the epidemiology and treatments of mental health complications in individuals with inflammatory arthritis. I will be assessing trends in the burden and risk of depression and anxiety among individuals with inflammatory arthritis. I also want to study whether individuals with arthritis are receiving treatment for their comorbid depression and anxiety and to see if certain treatments for arthritis impact the onset of mental health complications.
JK: Are you still taking a qualitative approach to that?
AH: No, this project is going to be all quantitative and will be using administrative health data from Population Data BC.
JK: How far along are you with this project?
AH: I’m roughly six months in right now and we’ve done some preliminary research to inform my thesis. Together with two PharmD students working in Mary’s (Dr. Mary De Vera) lab, we’ve completed systematic reviews looking at the prevalence and incidence of depression and anxiety in different types of inflammatory arthritis. We’ve done this systematic review in four types of inflammatory arthritis – gout, less common systemic autoimmune rheumatic diseases, psoriatic arthritis, and ankylosing spondylitis. We recently presented three of these reviews as abstracts at the American College of Rheumatology Annual Meeting last October.
JK: What’s your hope for this research once you finish your PhD?
AH: Well, we’re starting to see that there is a higher burden of depression and anxiety in people with inflammatory arthritis. But we really don’t know if the burden or risk has changed over time or if persons with inflammatory arthritis are receiving adequate treatment for their mental health complications. I’m hoping that by answering these questions we can help improve mental health care for people with inflammatory arthritis.
JK: Do you have initial thoughts as to the link between mental health and inflammatory arthritis? For example, could the connection be related to chronic pain?
AH: There are a few thoughts on this. It could be the disability and the pain from the arthritis that is contributing to the increased prevalence of mental health complications. There’s also evidence for a shared inflammatory pathway being activated in both inflammatory arthritis as well as depression/anxiety that is contributing to this link.
JK: It’s an interesting problem and I imagine it would be rewarding to find a solutions that are directly applicable to patient’s lives.
AH: It is. We really want to make sure that the research that we’re doing is applicable to the patients. Mary has an appointment at Arthritis Research Canada where I’m also a trainee. Through Arthritis Research Canada we are connected with their patient advisory board and currently have two patient research partners involved in this project to make sure our research is informed by patients and addresses their needs.
JK: How have you found switching from working with qualitative versus quantitative data?
AH: It’s been a bit challenging. When I worked at BC Children’s Hospital I was conducting all quantitative research. Then I switched to qualitative and mixed methods research for my Master’s, which was difficult because it’s quite a different way of collecting and analyzing data. For example, my Master’s project relied on analyzing interviews that I conducted with individuals with gout, that I then analyzed with the support of a software called NVivo. It’s a valuable research approach and it helps you to answer questions that you can’t answer with quantitative data. I then decided that I wanted to round out my skill set and move back to quantitative research for my PhD. With all the switching back and forth I’ll now have both qualitative and quantitative research experience.
JK: Sounds like you’ve been well trained in both. So, you have two supervisors for your PhD training – Dr. Juan Antonio-Aviña Zubieta from the Faculty of Medicine and Dr. Mary De Vera from UBC Pharm Sci. How did you come to work with Dr. De Vera?
AH: Mary and I both worked as researchers for the same orthopedic surgeon at BC Children’s Hospital, but our paths actually never crossed. One of the projects I worked on was a randomized control trial and I later realized the original notes describing the trial design and protocol were actually Mary’s notes. When I was thinking about starting my Master’s, I spoke with the coordinator in our group who previously worked with Mary and was a good friend of hers. She introduced me to Mary, and we got talking about her research program and it just took off from there.
JK: How have you found working with Mary to be?
AH: She’s a very supportive supervisor and I’m very lucky to have worked with her for about four years now. What’s great is that she leaves room for you to pursue your own interests. For example, she knew I was interested in studying mental health and essentially said, “Well, okay. How can we incorporate this into my research program?” Then we came up with the research questions together. Similarly, with my Master’s we were originally going to do a completely qualitative project, but I was interested in learning about mixed methods and she helped me to pursue that research approach.
JK: What are your goals for when you finish your PhD?
AH: At the moment I want to pursue academia. My goal is to secure a post-doctoral fellowship position with a focus on mental health after I graduate. But I’m still early in my PhD and thinking about all of my career options.
JK: Do you have any advice for new graduate students?
AH: I think it’s really important to persevere through the challenges that you might face during your graduate training. You may encounter problems with data analysis or receive rejections from scholarship applications, grant applications, and journals. It can be a tough experience, but I think it is important to learn from these challenging experiences and keep pushing forward.
Graduate Student Conversations is an ongoing interview series designed to highlight our exceptional PhD and MSc candidates and their work, achievements, and experiences at UBC Pharm Sci.
Header photo: Alyssa Howren. Image by Justin Lee Ohata.