The role of genes and environment in psychiatric disorders: perceptions and beliefs of people with lived experience of eating disorders and mental health professionals in the uk

Individuals with psychiatric illness and their families often experience negative emotional responses, such as shame, guilt, or a heavy burden of personal responsibility, which are tied up with misconceptions about the cause of their illness. Developing effective methods of communication that offer both accurate and accessible information about the causes of psychiatric disorders is of great importance. Genetic counsellors offer one such method of communication, however there are limited numbers of them in the UK (n=310), and psychiatric genetic counseling is not widely available. Therefore, there is a need for alternative or supplemental methods for communicating about genetic and environmental risk with families, and for other mental health professionals to contribute to having these conversations. Broadly, our study sought to: 1) evaluate the effectiveness of an animated video on perceptions, feelings, and health-related behaviours of participants with an eating disorder, and 2) explore to what extent UK-based mental health professionals understand and feel confident discussing genetic and environmental risk with patients. For our first aim, we surveyed 983 adults with eating disorders (98% female; 95% white; mean age = 35) at three time points: baseline, two weeks from baseline, and four weeks from baseline. At baseline, participants were randomly assigned to one of two groups: 1) the intervention group who were shown our animated video and 2) the comparison group who were shown an animated video that discussed mental health more broadly without mentioning genetic risk. For our second aim, we surveyed 155 UK-based mental health professionals (68% female; 83% white; mean age = 34) on their perception of the genetic and environmental contributions to 12 psychiatric disorders and their confidence in discussing risk with patients. Preliminary results for our first aim indicate that a significantly greater proportion of the intervention group than the comparison group showed feelings of hope (38% versus 29%, p < 0.001) and that they had learnt something about themselves (34% versus 21%, p < 0.001) immediately after watching the video, however these differences were not maintained at the later follow ups. We found no evidence of a change in health-related behaviours across the two groups, however we found significantly lower levels of environmental determinism (i.e., attributing ‘only environmental factors’ to their disorder) in the intervention group in the immediate follow-up (7.2% at baseline versus 0.8% at immediate follow-up, p < 0.001), whilst the change within the comparison group was not significant (4.5% versus 4.3%). Preliminary results for our second aim indicate that 10% of mental health professionals believed that at least one of the psychiatric disorders we assessed was caused by ‘only genetics’ or ‘only the environment’. A greater proportion of mental health professionals felt confident discussing environmental risk (85%) than genetic risk (31%) and only half (54%) would recommend psychiatric genetic counselling for their patients. Alternative methods of communication, e.g., animated videos, show some benefits and may be a useful tool as people wait for an appointment with a genetic counsellor or mental health professional trained in psychiatric genetics. Increased training in psychiatric genetics for other professionals is needed to improve knowledge and confidence in discussing genetic risk with patients.