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Gatt-Rutter T, Forrest L, Sexton A, Isbister J. Consumer attitudes and preferences toward psychiatric genetic counselling and educational resources: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 123:108229. [PMID: 38461792 DOI: 10.1016/j.pec.2024.108229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The etiology of psychiatric disorders is multifactorial including genomic and environmental risk factors. Psychiatric genetic counseling is an emerging field that may promote processes of adaptation to, and the management of, psychiatric disorders. Many countries lack dedicated services leading to a gap in care. This scoping review will inform the development of psychiatric genetics-based educational resources. OBJECTIVES To explore individuals with a psychiatric disorder and their relatives' attitudes and beliefs toward psychiatric genetics, genetic counseling, and genetics-based education. To evaluate how best to convey education to consumers. METHOD Database literature searches occurred on May 2nd, 2023, using PubMed, Medline, and PsycINFO. Reviews, letters to the editor, case reports, and publications before 2003 were excluded. RESULTS Twenty-four papers met the inclusion criteria. Results suggest individuals with a psychiatric disorder and their relatives tended to overestimate risk, and express concern about reproductive decision- making. Genetic counseling and educational resources were perceived to be useful and empowering. CONCLUSION Affected individuals and relatives are interested in gaining greater insight into their own and/or their relative's psychiatric disorder, management strategies, and understanding familial risks. PRACTICE IMPLICATIONS The evidence from this review may inform the development of genetics-based educational resources or guide future research.
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Affiliation(s)
- Tessa Gatt-Rutter
- Department of Paediatrics, University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - Laura Forrest
- Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Adrienne Sexton
- Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia; Genetic Counselling Service, Epworth Freemasons, East Melbourne, Australia; Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Joanne Isbister
- Department of Paediatrics, University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia; Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia.
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Perceptions of causal attribution and attitudes to genetic testing among people with schizophrenia and their first-degree relatives. Eur J Hum Genet 2022; 30:1147-1154. [PMID: 35577937 PMCID: PMC9553941 DOI: 10.1038/s41431-022-01116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/28/2021] [Accepted: 04/28/2022] [Indexed: 12/15/2022] Open
Abstract
Rapid advances in the genetics of psychiatric disorders mean that diagnostic and predictive genetic testing for schizophrenia risk may one day be a reality. This study examined how causal attributions for schizophrenia contribute to interest in a hypothetical genetic test. People with schizophrenia and first-degree relatives of people with schizophrenia were recruited through a schizophrenia research bank and mental health organisation. Semi-structured telephone interviews were conducted with 13 individuals with schizophrenia and 8 first-degree relatives. Transcripts were subjected to a qualitative analysis using the thematic analysis framework. Five themes were developed: (i) "It is like a cocktail", with most participants aware that both genetic and environmental factors contributed to causation, and many mentioning the positive impact of genetic causal explanations; (ii) "Knowledge is power" (i.e., in favour of genetic testing); (iii) Genetic testing provides opportunities for early intervention and avoiding triggers, with participants citing a wide range of perceived benefits of genetic testing but few risks; (iv) Views on reproductive genetic testing for schizophrenia risk with a few participants viewing it as "playing God" but not necessarily being against it; and (v) "It snowballs", whereby participants' understanding of genetics was sophisticated with most believing that multiple rather than single genes contributed to schizophrenia. In conclusion, many individuals had a sound understanding of the role of genetic testing if it were to become available, with evidence of insight into the role of multiple genes and the contribution of other risk factors that may interact with any inherited genetic risk.
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Pavarini G, Yosifova A, Wang K, Wilcox B, Tomat N, Lorimer J, Kariyawasam L, George L, Alí S, Singh I. Data sharing in the age of predictive psychiatry: an adolescent perspective. EVIDENCE-BASED MENTAL HEALTH 2022; 25:69-76. [PMID: 35346984 PMCID: PMC9046833 DOI: 10.1136/ebmental-2021-300329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Advances in genetics and digital phenotyping in psychiatry have given rise to testing services targeting young people, which claim to predict psychiatric outcomes before difficulties emerge. These services raise several ethical challenges surrounding data sharing and information privacy. OBJECTIVES This study aimed to investigate young people's interest in predictive testing for mental health challenges and their attitudes towards sharing biological, psychosocial and digital data for such purpose. METHODS Eighty UK adolescents aged 16-18 years took part in a digital role-play where they played the role of clients of a fictional predictive psychiatry company and chose what sources of personal data they wished to provide for a risk assessment. After the role-play, participants reflected on their choices during a peer-led interview. FINDINGS Participants saw multiple benefits in predictive testing services, but were highly selective with regard to the type of data they were willing to share. Largely due to privacy concerns, digital data sources such as social media or Google search history were less likely to be shared than psychosocial and biological data, including school grades and one's DNA. Participants were particularly reluctant to share social media data with schools (but less so with health systems). CONCLUSIONS Emerging predictive psychiatric services are valued by young people; however, these services must consider privacy versus utility trade-offs from the perspective of different stakeholders, including adolescents. CLINICAL IMPLICATIONS Respecting adolescents' need for transparency, privacy and choice in the age of digital phenotyping is critical to the responsible implementation of predictive psychiatric services.
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Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, UK
- Ethox Centre, Department of Population Health, University of Oxford, Oxford, UK
| | - Aleksandra Yosifova
- Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Keying Wang
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Benjamin Wilcox
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Nastja Tomat
- Department of Philosophy, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Jessica Lorimer
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Leya George
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Sonia Alí
- Department of Psychology, University of Sussex, Brighton, UK
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, UK
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Blasco D, Stortz SW, Grivel MMR, Dishy GA, Samuel SS, Pilla D, Crump FM, Lieff SA, Williams J, Phoummavong P, Guo X, Brucato G, Girgis RR, Yang LH. Naturalistic conceptions of genetic optimism and precision psychiatry among those at clinical high-risk for psychosis. Early Interv Psychiatry 2021; 15:742-745. [PMID: 32478479 PMCID: PMC9848423 DOI: 10.1111/eip.12983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/09/2020] [Accepted: 04/28/2020] [Indexed: 01/21/2023]
Abstract
AIM Fuelled by genomics advances, recent emphasis on the concept of "precision medicine," and public optimism towards genetic advances, it is important to understand how those who are considered to be at clinical high-risk for psychosis (CHR) perceive possible benefits of genetic testing to inform future stakeholder education efforts. METHODS Semistructured interviews were completed with 20 participants who met CHR criteria. Coding for genetic optimism was completed. RESULTS Participants endorsed many conceptualizations of the link between genetics, the development of psychosis, and the benefits of genetic testing. Specifically, themes emerged surrounding how genetic testing may lead to greater genetic knowledge and tailored treatment. CONCLUSIONS Our results demonstrate that CHR participants generally endorse several precision psychiatry concepts, including how genetic testing may lead to tailored treatment advances. This knowledge may aid development of best communication practices regarding forthcoming genetic advances in diagnosis and treatment among CHR.
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Affiliation(s)
- Drew Blasco
- School of Global Public Health, New York University, New York, New York, USA
| | - Saige William Stortz
- Clinical and Counseling Department, Teachers College, Columbia University, New York, New York, USA.,Psychology Department, The Graduate Center at the City University of New York, New York, New York, USA
| | | | - Gabriella A Dishy
- Clinical and Counseling Department, Teachers College, Columbia University, New York, New York, USA.,Department of Translational Imaging, New York State Psychiatric Institute, New York, New York, USA
| | - Shana S Samuel
- Clinical and Counseling Department, Teachers College, Columbia University, New York, New York, USA.,Clinical Psychology at Queens College, The Graduate Center at the City University of New York, Queens, New York, USA
| | - David Pilla
- Clinical and Counseling Department, Teachers College, Columbia University, New York, New York, USA.,Department of Counseling and Counseling Psychology, Graduate School of Education, Fordham University, New York, New York, USA
| | - Francesca M Crump
- Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA.,Department of Psychology, Rowan University, Glassboro, New Jersey, USA
| | - Sarah A Lieff
- School of Global Public Health, New York University, New York, New York, USA
| | - Jourdan Williams
- Clinical and Counseling Department, Teachers College, Columbia University, New York, New York, USA
| | | | - Xufei Guo
- Clinical and Counseling Department, Teachers College, Columbia University, New York, New York, USA
| | - Gary Brucato
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York, USA
| | - Ragy R Girgis
- College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, New York, USA.,Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York, USA
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Preliminary investigation of public perspectives towards psychiatric genetics in Japan. Asian J Psychiatr 2021; 55:102519. [PMID: 33360704 DOI: 10.1016/j.ajp.2020.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022]
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Meiser B, Guo XY, Putt S, Fullerton JM, Schofield PR, Mitchell PB, Yanes T. Psychosocial implications of living with familial risk of a psychiatric disorder and attitudes to psychiatric genetic testing: A systematic review of the literature. Am J Med Genet B Neuropsychiatr Genet 2020; 183:277-288. [PMID: 32369270 DOI: 10.1002/ajmg.b.32786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 01/12/2023]
Abstract
The aim of this systematic review was to synthesize the existing evidence documenting the psychosocial implications of living with a familial risk of an adult-onset psychiatric disorder. Six databases were searched systematically to identify qualitative and quantitative studies, which explored perspectives of those at increased risk for psychiatric disorders, as well as the general public. Thematic analysis was used to identify major themes. Thirty-five articles met the eligibility criteria and reported on the views of 4,896 participants. The literature demonstrates strong interest in psychiatric genetic testing of adults as well as children, whereas attitudes toward prenatal testing were much less positive. Predictors of interest in testing, as well as perceived advantages and disadvantages were identified. Very few studies are available on anticipated and actual reactions to receiving results. Studies show that the majority of participants feel that having a genetic explanation would alleviate some of the stigma associated with mental illness. This review shows that interest in, and predictors of attitudes toward, psychiatric genetic testing are well researched, but the extent to which attitudes will translate into actual testing uptake is unknown. Future research also needs to assess the actual behavioral and psychological impact of genetic testing.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Xin Y Guo
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Sophie Putt
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, UNSW, Sydney, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, UNSW, Sydney, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Tatiane Yanes
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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Moldovan R, McGhee KA, Coviello D, Hamang A, Inglis A, Ingvoldstad Malmgren C, Johansson-Soller M, Laurino M, Meiser B, Murphy L, Paneque M, Papsuev O, Pawlak J, Rovira Moreno E, Serra-Juhe C, Shkedi-Rafid S, Laing N, Voelckel MA, Watson M, Austin JC. Psychiatric genetic counseling: A mapping exercise. Am J Med Genet B Neuropsychiatr Genet 2019; 180:523-532. [PMID: 31222934 DOI: 10.1002/ajmg.b.32735] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 11/08/2022]
Abstract
Psychiatric genetic counseling (PGC) is gradually developing globally, with countries in various stages of development. In some, PGC is established as a service or as part of research projects while in others, it is just emerging as a concept. In this article, we describe the current global landscape of this genetic counseling specialty and this field's professional development. Drawing on information provided by expert representatives from 16 countries, we highlight the following: (a) current understanding of PGC; (b) availability of services for patients; (c) availability of training; (d) healthcare system disparities and cultural differences impacting practice; and (e) anticipated challenges going forward.
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Affiliation(s)
- Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kevin A McGhee
- Faculty of Science and Technology, Bournemouth University, Poole, United Kingdom
| | - Domenico Coviello
- IRCCS Istituto Giannina Gaslini, Research Institute and Children Hospital, Genova, Italy
| | - Anniken Hamang
- Department of Medical Genetics, St. Olavs Hospital, Trondheim University Hospital
| | - Angela Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Mercy Laurino
- College of Medicine, Department of Pediatrics, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Lauren Murphy
- University of Texas Genetic Counseling Program, UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Milena Paneque
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CGPP - Centre for Predictive and Preventive Genetics, Institute for Molecular and Cell Biology (IBMC), Universidade do Porto, Porto, Portugal
| | - Oleg Papsuev
- Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Eulàlia Rovira Moreno
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.,Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Barcelona, Spain
| | - Clara Serra-Juhe
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Barcelona, Spain.,Medicine Genetics, VHIR, Barcelona, Spain
| | - Shiri Shkedi-Rafid
- Department of Genetics and Metabolic Diseases, Hadassah Medical Center, The Faculty of Medicine, The Hebrew University, Jerusalem
| | - Nakita Laing
- Division of Human Genetics, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | - Melanie Watson
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, United Kingdom
| | - Jehannine C Austin
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW Genetic testing for mental illness is likely to become increasingly prevalent as the science behind it is refined. This article identifies anticipated ethical challenges for patients, psychiatrists, and genetic counselors and makes recommendations for addressing them. RECENT FINDINGS Many of the ethical challenges of psychiatric genetic testing are likely to stem from failures to comprehend the nature and implications of test results. Recent studies have identified gaps in the knowledge base of psychiatrists and genetic counselors, which limit their abilities to provide patients with appropriate education. A small number of studies have demonstrated the value of counseling in empowering patients to deal with relevant genetic information. Psychiatrists and other health professionals must be able to assist patients and families in making informed decisions about genetic testing and interpreting test results. Filling their knowledge gaps on these issues will be a critical step towards meeting these responsibilities.
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