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and the and associate Professor Adrian Zerbu, and also a Ph. D. Student Kosmin, get so based at Babbage by University, the university where I'm based as well. So screen time, development, screen time and development of internalizing and externalizing problems among Romanian urban high schoolers.

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Something about the context of our research. First, before going into the actual results. Children and adolescents are now living in a complex media world, that, besides its opportunities, also creates a unique set of risks for them

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and portraying to remain in context. remain in adolescence as remaining all over the world, are frequent user of electronic devices

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with more than half of uranium's age, 1115, spending more than 2 h per day on screen and doing the covid restriction when everything or almost everything moved online, this time increased to 4 h per day during the week, and to 3.5 h per day during the weekends for children, aged 6, 18.

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But even without taking into consideration the pandemic impact on screen time exposure, we noticed an increase from 2,012. We're watching TV using the telephone, and the computer accounted in average for 1.7 h per week days and 2.8 h per weekend for children, age 1318.

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So, considering these numbers, we asked ourselves whether the amount of time one spends navigating on different electronic devices is harming youth

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and research so far has been more or less inconsistent. In terms that some studies have found negligible effect on screen time, on adolescence, well-being, or even some positive effects. But other studies have found that excessive screen time for atolescence has been associated with a range of psychosocial disturbances. Behavioral and health issues.

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Increased. Time spend in front of screen has been found to have a small yet consistent impact on adolescent mental health as well. In addition to internalizing problems like depression and anxiety screen time has also been previously linked to different externalizing pro behavioral problems, like bullying for academic performance, due to inattention or skipping classes, substance abuse on

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and and how they different eating habits. So, starting from this assumption, starting from this previous research, we hypothesize that increased screen time is associated with heightened display of internalizing and externalizing symptoms.

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So in starting from this, we we carry this empirical, it empirical research. we have used a lot of instruments.

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this research is part of a larger study. But for this presentation we we are only focusing on this internalizing and externalizing symptoms. So for internalizing symptoms, we use 13 items from symptom checklist 19. So 3 items for anxiety and 3 items for depression.

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aggressive behavior was measured using C 6 items and was, was evaluating behaviors like heating, slapping, strangling, threatening, while delinquency measured the frequency on which, during the past year, the respondents engage into a different criminal behavior, such as stealing, break into a car or house vandalizing

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for a screen time. We use a series of 4 questions measuring the average daily time, spending, watching TV, playing video games, navigating social media and navigating Internet. The responses were range from one to 8, almost not at all to 6 h or more per day.

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E C.

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 control variables were assessed as at the individual level, at a family level, at individual level. We were interested in gender

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male female in family structure. Here we categorize our responses into a dicotomous variables, a family of children who lived together with 2 parents. So both parents were present and alternative family structures. As we defined all the other family arrangements, where, where a child could leave like one parent being present, they were a divorced or one parent or a that were in

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He or she was living with a different family member. a change in residency and school measure. During the past year the child has changed the city where he lived and or changed the school where he studied and the family. We were interested into 3 variables, family support, family rule and family monitoring. Family support is a

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cumulative is an added score of from 5 items, measuring different forms of support, care, and worm, discussing about personal issues, receiving advice about own studies, or receiving help when dealing with different problems and higher score indicated a higher level of support from parents.

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Parent rule. Again, it's It's a cumulative, cumulative score, based on responses to 3 items, including the degree in which parents set strict rules regarding different activities at home

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activities performed outside the home and time curfew. So it was. Rules in general and not specific rules for trained to electronic device usage and monitoring again, 3 items measure, the degree in which parents know with who and how evenings and free times are spend. And again, a higher score. We present a lower level of parental monitoring

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In total, we have nearly 25, 100 students. they are 10 great students, meaning 1516 years old.

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From Bucharest, the capital city of Romania. certain class, a certain number of classes and high schools. Colleges were randomly selected, and an anonymous questionnaire were administrated, then to all 10 graders that were present in the classroom at the time of selected at the time of the Sarvey

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and before data collection there were more than 3,500 informative letters were sent to parents. asking for their consent.

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We use the passive consent, procedure, and students who returned the letter signed by their parents. The students who returned the letter signed by parents were included in

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in the study And they filled in the questionnaire. So they filled in the questionnaire in the classroom, and then send The answer in the sealed envelope. And you know, then the procedure. The procedure.

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you know, carried.  okay, so results some descriptive results. First, so regarding the screen time

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exposure. boys are more exposed to screen time activities and are also more engaged into active screen time. We we try to differentiate between active and passive screen time, because, as I said before, our screen time variable

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was composed by 3. By 4 measures, different activities. They could carried online. and we use the general screen time score. But then it's interesting. And it was becoming, while doing, performing our analyzes was becoming interesting, that there is an active screen time

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like doing something on the Internet like reading, something, commenting, being on social media and passive screen time like it's watching till it watching television. So boys are more engaging to active screen time exposure

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screen time activities. Sorry compared to girls and living in other family arrangements, is also associated towards screen time exposure compared to traditional 2 parent families and also active screen. Time is more frequent in these non-traditional families, which

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may be explained by the lack of other activities or the lack of supervision. The lack of monitoring in terms of mental health, so internalizing and externalizing symptoms. girls significantly displayed more internalizing problems, boys significantly display more externalizing problems, so more engagement, more frequent engagement into aggression or delinquent behavior, respondents belonging to other family structures, some non typical family structure displaying or internalizing problems.

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A in school contributed to height and depressive more than engagement into delinquent behavior while changing residency contributed to height and depressive mood and

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and and aggression. But more interesting is the model we tested. So we wanted to see how all these variables contribute to the development of this internalizing or externalizing

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problems.

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we use a 3 step. multiple linear regression, analysis that identify the combination of factors associated with this development of internalizing and externalizing problems.

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and in in summary aside from family structure and changing the school environment. All the other factors have shown to be significant contributors to the model for internalizing problems. Therefore girls tend to display more depressive and anxiety. Symptoms compared to boys

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changing the city leads toward depressive symptoms, while a family environment, characterized by low support and less restriction, leads to both heightened depression and anxiety, while low monitoring is associated with depression only

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and consistent with our and so assumptions screen time exposure is significantly associated with the development with the display of depressive symptoms suggesting that more time spent, one spends on different electronic devices and performing different activities, while online is associated to more frequent display of internalizing problems while controlling for other individual and family factors.

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As for externalizing problems, we found similar correlates, similar variables contributed to the model. But in this.

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In this model, boys experiencing change in residency during the last year. Low perp, parental support and monitoring are associated with more frequent engagement in aggressive and delinquent behavior. Frequent media use was significant only for aggression, and partially supporting, thus partially supporting our

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assumption. So we we concluded that, controlling for all the other predictors. More total screen time exposure is associated to more engagement into into aggressive.

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into aggressive behavior.

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So in summary upon controlling for all this individual, like gender family structure, certain environmental changes and family variables, like parents, support rules and monetary. More screen time exposure indicates heightened depressive and anxiety, symptoms and elevated aggression.

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So now, delinquency, delinquent behavior, engagement into the liquid behavior was not a significant, variable. acknowledging that current generation of teenagers is growing up in a world saturated with electronic media. This conclusion will.

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however, I need further exploration, as we did not examine for specific types of devices and the level of interaction, but only accounted for a general screen time exposure

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and previous research also shows that it's not a matter of screen time exposure, but also what counts. What matters? It's the device used and what they are doing on that specific device. So the timing we use a general construct of time. But time

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it's not to say, we acknowledge that the time is not the only variable that might be significant. or we cannot just based our explanation on general time.

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As adolescents are more susceptible to opportunities and risk of emerging new technologies, additional studies, exploring and clarifying the role of active and passive screen time in adolescent mental health outcomes also becomes critical. As I was mentioned before.

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when when discussing about our our variables, we had 4 items, and we average those items, and we did not necessarily make the distinction between active and screen time

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screen time exposure. Nevertheless. We, we consider that with all these limits that we would not go into details. Now, this study contributes to the field in bringing new and contextualized evidence regarding the association between individual family environments, screen time, exposure and development of certain emotional and behavioral problems for adolescence.

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and we consider that our results may help to clarify some underlying relationships contributing to negative health outcomes and also supporting development of targeted prevention or supportive programs for adolescence and their families. One when relating to

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to media exposure. So briefly. That was it. I I tried to to keep up in time, and this is still an ongoing research and some

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firsthand the first time. The results. Oh, thank you for taking your time to listen to to the presentation, and if you have other questions or comments, I or my colleagues are happy to to address them. Thank you and enjoying the rest of the conference.

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 all right. And our 6 s presentation

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will be made by Felicia. And.

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oh.

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are you there

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Felicia Boma Lazaridou: in here. Yeah. yeah, we will stop

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just a second. I will stop sharing here to you. Share your presentation.

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Felicia Boma Lazaridou: Okay? Perfect. Right? Thank you. So yeah, my name is.

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and I will get the first.

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Felicia Boma Lazaridou: The the sound is not clear here. Sorry. Just a second.

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Try again.

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Felicia Boma Lazaridou: Can you hear me?

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That's enough.

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No.

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Now, because your your son is in owning the computer here, not not in the

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there, in the sound system and in the room.

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Just a second

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try again, Felicia.

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Felicia Boma Lazaridou: Okay, is that better?

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My Sue is still in the in the computer, not in the system.

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Just a second. I just called the

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Felicia Boma Lazaridou: support.

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So

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she

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her her presentation. It's only in the computer that nothing that helps the some system.

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It's too time.

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Now let's just check. If the audio is coming through properly.

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It's working.

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Yeah.

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go in there. It lets you change the speed. I don't

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I? There we are. Try one more time.

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Felicia Boma Lazaridou: Okay, can you hear me. Now.

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Felicia Boma Lazaridou: there we go.

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Okay. Thank you. Bit more.

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Okay, perfect.

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Felicia Boma Lazaridou: Thank you.

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Felicia Boma Lazaridou: So yeah, my name is and I will talk about a project on racism, clinical psychosis, and some clinical psychosis, symptomatology. The role of ascribed migrant status and post migration sets.

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Felicia Boma Lazaridou: So the first question is.

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Felicia Boma Lazaridou: what is racism? So typically my zoom is understood in many different ways. we do know that it creates hostile and exclusionary environments.

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Felicia Boma Lazaridou: that it leads to divisions, animosity, and feelings of alienation that it reinforces systematic inequalities and perpetuates disparities. normalizes discriminatory behavior

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Felicia Boma Lazaridou: leads to fragmentation and around trust.

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Felicia Boma Lazaridou: And it's based on categorizations generalizations and hierarchies that both over time and the continued to to persist as a system of power.

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Felicia Boma Lazaridou: So we conducted a systematic review.

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Felicia Boma Lazaridou: looking at all international studies for the past 5 years among children and adolescents and their experiences of racism and mental health.

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Felicia Boma Lazaridou: And one of the questions that we asked was looking at how the different researches of conceptualized racism. So this is just a little map

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Felicia Boma Lazaridou: of some of the different ways that racism is conceptualized in these studies.

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Felicia Boma Lazaridou: So the studies looked at bullying and victimization. So that was looking at racist insults and versus descriptions, also looking at societal level. So in the neighborhood schools, as historical and structural oppression. Nowadays online is coming an important

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Felicia Boma Lazaridou: the format for understanding racism also thinking about things like microaggressions and demeaning messages.

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Felicia Boma Lazaridou: So in the study, we decided that we were looking at racism and not race. And this is quite an important distinction. The question remains as to why, then we would look at one concept and not the other

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Felicia Boma Lazaridou: specifically.

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Felicia Boma Lazaridou: And the answer would be that that because we believe there are no human races as such. But there is racism.

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Felicia Boma Lazaridou: however.

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Felicia Boma Lazaridou: what remains, despite this kind of shift in science, to not consider race, especially as a biological construct, but to think of it only as a social construct, and then thinking about the ramifications of that is that they persist to be a racist world view.

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Felicia Boma Lazaridou: So if we take this as an example we do have. I mean, there are literature where you can. you know explicitly. See this race as well if you still being perpetuated.

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Felicia Boma Lazaridou: But

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Felicia Boma Lazaridou:  Some time ago in science we would look at race, and we would make particular assumptions. So certain types of races have certain happy brain size which is then associated with by IQ, which is then associated with the individual or national success.

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Felicia Boma Lazaridou: And on the other side we would say. certain races are associated with the high levels of To to the right that's associated with violence regression, which is that's associated with rape.

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Felicia Boma Lazaridou: So what happened was, we said, Okay, we're not. We're not going to talk about race anymore, or the race is no longer a valid construct for our study. So we'll take that out.

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Felicia Boma Lazaridou: But what still remains besides of this are these particular assumptions within science? And we can see that in terms of the types of scientific publications that are still prevalent today

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Felicia Boma Lazaridou: that make assumptions about brain size, about IQ and about individual and national success. and on the flip side

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Felicia Boma Lazaridou: still make assumptions about testosterone aggression and rate.

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Felicia Boma Lazaridou: So what we've done is actually replace race with this idea of population differences. Now, now, we don't talk about race. But we'll talk about population differences. So we might talk about male to female differences. We might talk about cultural differences. for example, again, these same

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Felicia Boma Lazaridou: associations or the same Ideas are still being perpetuated.

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Felicia Boma Lazaridou: and we did it. Small sort of literature review, where we put in the

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Felicia Boma Lazaridou: search terms race and genetics into pubmed

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Felicia Boma Lazaridou: And we did the same for race and social construct. And it seems that there are a lot more publications

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Felicia Boma Lazaridou: on race and genetics than there are, and on race as a social construct which suggests that, despite this popularized idea, that race is no longer a biological construct. There seems to be a lot more money going into this type of research. and a lot more of these types of research are being published even today.

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Felicia Boma Lazaridou: So for those reasons, we focus on racism, and not race, because we don't want to perpetuate the idea that place is a valid construct.

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Felicia Boma Lazaridou: So in terms of the current state of the the research.

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Felicia Boma Lazaridou: What we know about racism, mental health is that racism causes negative effect and impacts cognitive functionality. So experiencing racism can lead to negative emotions which can negatively impact cognitive functioning, including memory, attention and decision making.

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Felicia Boma Lazaridou: It also contributes to allostatic load. which is a concept

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Felicia Boma Lazaridou: covering the prolonged and continued exposure to racism or to to stress in general that can lead to physiological changes, such such as increased levels of cortisol, which is the the stress hormone and inflammation we can contribute to a cumulative burden

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Felicia Boma Lazaridou: braces and reduces in engagement in healthy behavior, so it makes it difficult for people to have a good quality of sleep with good duration of sleep, for example.

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Felicia Boma Lazaridou: and it can lead to direct physical injury in the sense of violence, of police brutality and other forms of racialized harm.

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Felicia Boma Lazaridou: So just to give it a conceptual understanding of how racism then leads to mental health issues. So we start at a structural level. First of all. So thinking about you know, systematic in exclusion or integration, let's say, a company by system, exclusion. And this is fairly paradoxical, but at the same time

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Felicia Boma Lazaridou: if you think about, for example, migration and the the

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Felicia Boma Lazaridou: the social demands for integration and at the same time, you know various types of exclusions that take place, for example, in health care system in the education system. It's easier than to understand.

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Felicia Boma Lazaridou: And at the same time you then have this kind of skate voting and colonial imagination disseminated through media, for example.

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Felicia Boma Lazaridou: which create moral panics and the withdrawal of belonging. You know. the idea that people should.

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Felicia Boma Lazaridou: you know, go back when it when I came from, and things like this which can lead to social pain and learned helplessness. And in the end you then

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Felicia Boma Lazaridou: you're at this social identity last connected to the connectedness, loss, and disintegration of the body. And this is where we're focusing on all we thinking about mental health.

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Felicia Boma Lazaridou: So from a structural level, there are various potential remedies at various steps within mental health within psychiatry. so the first point we're understanding. Okay, so if we're saying that racism impacts mental health. Of course, we're looking at social factors.

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Felicia Boma Lazaridou: what social factors are in play when people are experiencing racism and the potential remedies for that. Our social societal transformation, form and revolution.

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Felicia Boma Lazaridou: And in the next step you then have biological and psychological factors. So as I mentioned earlier, thinking about things like anesthetic load

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Felicia Boma Lazaridou: thinking about things like sleep, quality, and how do all of these things are affected? And a potential refugees here would be classical public health. So this might be things like medication, psychiatry, psychotherapy. Sorry. counseling and things like this.

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Felicia Boma Lazaridou: and if you know all of these

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Felicia Boma Lazaridou: other than you might end up with people being considered at risk. So this is prior to any clinical state. But you know the the accumulation of symptoms. even people are putting people in an at risk situation and potential remedies here. I think that it's screening and early detection.

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Felicia Boma Lazaridou: And if they go through this stage, then you'll end up in this kind of sickness and illness stage. And here potential remedies are hospitals and doctors.

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Felicia Boma Lazaridou: And if not, then we're thinking about things like social death. And

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Felicia Boma Lazaridou: so the idea here is really to think about where at which level racism impacts this institutional structures and and where we can sort of intervene to really be thinking about providing the best level of.

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Felicia Boma Lazaridou: So then, coming back to the focus of racism, clinical psychosis and subclinical psychosis symptoms.

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Felicia Boma Lazaridou: So in we did 2 things. So in method. One, we did an umbrella review of Meta, analytical studies. Looking at the incident rates of clinical psychosis among migrants

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Felicia Boma Lazaridou: so clinical psychiatrist as far as to a severe mental health condition characterized by a loss of contact with reality, leading to significant disruptions and thinking perceptions, emotions, and behaviors.

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Felicia Boma Lazaridou: So in terms of the scope we gathered and synthesized existing systematic reviews and meta analyses that have investigated the covalence of psychotic disorders among various migrants across different countries and regions.

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Felicia Boma Lazaridou: those who migrated to Western countries.

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Felicia Boma Lazaridou: and we looked at the the strength of evidence available, the quality and reliability to provide a comprehensive evaluation of the evidence.

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Felicia Boma Lazaridou: and in terms of implications, the findings of a number of you can inform mental health, help, mental health care, professionals, policymakers, and researchers about the current state of knowledge. And everyone.

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Felicia Boma Lazaridou: Okay. So in terms of findings.

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Felicia Boma Lazaridou: our first finding, was looking at region of origin of the migrants, and we found that Caribbean migrants, followed by black migrants of African descent, have the greatest psychosis with

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from all migrant groups.

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Felicia Boma Lazaridou: In terms of country arrival, we found that migrating to Great Britain, the Netherlands and Southern Europe shed the greatest like this race.

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Felicia Boma Lazaridou: and in terms of development status of the country of origin, we found that migrants from developed countries have a smaller risk of psychosis.

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Felicia Boma Lazaridou: whilst migrants from developing countries. an increased risk of.

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Felicia Boma Lazaridou: So in the second plot.

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Felicia Boma Lazaridou: we cannot. We noted a qualitative study on the development of stuff, clinical symptoms and racist contexts. In Berlin, in Germany

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Felicia Boma Lazaridou: I'm so clinical psychosis refers to symptoms that populate a threshold of illegal diagnosis. But still so in terms of the research objective. The objective of the study was to gain a deep insight into the experiences of people who have experienced racism and examine the potential impact of these experiences on the development of sub clinical psychosis symptoms

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Felicia Boma Lazaridou: in terms of data collection. our method of interviewing one on one. Interviews allow participants to share their personal experiences, perceptions, and emotions relating to encountering racism, and any potential associations with sub clinical psychosis symptoms.

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Felicia Boma Lazaridou: and in terms of the implications the results could inform intervention, support services and policies aimed at addressing the mental health needs of people experiencing.

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Felicia Boma Lazaridou: And so what we found

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Felicia Boma Lazaridou: were for something cool. psychos like that that were experienced by the participants in relation in direct relation to their experiences of racism.

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Felicia Boma Lazaridou: So the first point was a sense of different, a sense of differentness. and this is emotional alienation and a lack of confidence between actual self and forced ideal self.

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Felicia Boma Lazaridou: Negative self-awareness, which is intense public and private self-consciousness as a result of racism.

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Felicia Boma Lazaridou: paranoid ideation regarding general prosecution, so stress-based hypervigilance in a distinct sense of physical physical psychological and emotional and safety

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Felicia Boma Lazaridou: and self question, self questioning on self-esteem, instability. So the reduction of self concept, clarity, experience this confusion, but distorted reality and self perception.

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Felicia Boma Lazaridou: So then what is the role of prescribed migrant status and post migration?

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Felicia Boma Lazaridou: So we had 2 sets of participants. So one set of participants were what we would call as well given this ascribed to migrant status. So they were actually second generation. So born in Germany, but with one at least one parent who was born abroad, so they were not actually migrants themselves, yet they were perpetually seen and treated

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Felicia Boma Lazaridou: and talk to you as though they are migrants. And so this ascribed migrant status referred to refers to a label of being seen as a migrant based on being seen as not from here.

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Felicia Boma Lazaridou: I, irrespective of generation.

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And so they talked about how my at the subscribed migrant status can contribute to a feeling of otherness.

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Felicia Boma Lazaridou: also that it hinders a sense of belonging, and contributes to a sense of exclusion and marginalization as it creates these divisions between us and in them.

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Felicia Boma Lazaridou: And then we had a second group of migrants who were migrants first generation migrants who had arrived various different time points. But nevertheless, you directly had arrived at some point in Germany themselves.

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Felicia Boma Lazaridou: and together they you know, they talk about a collective process of adapting to a new country and the various stresses in relation to the mental health, including language, barriers, acculturation, and social isolation. But they also talked about how their experiences of racism and discrimination contributed to that overall stress.

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Felicia Boma Lazaridou: So

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Felicia Boma Lazaridou: the bringing all of those findings together. it's really important to talk about into cultural competence, but also to talk about structural competence. Right? And so the ethics of structural competence. are emphasized here. And this is the use of mental health, diagnosis and treatment as tools.

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Felicia Boma Lazaridou: as we know right? That the the The use of mental health, diagnosis and treatment as tools of depression have been well documented throughout history with many marginalized groups, experience and discrimination and mistreatment within mental health services.

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Felicia Boma Lazaridou: And so this is a good example. of how

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Felicia Boma Lazaridou: diagnosis has been used. As for political genders in order to sign people.

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Felicia Boma Lazaridou: And so racism and stigma have historically been personally in the mental health sciences. And these biases often were influenced by political vendors to label and stigmatize people who are resisting oppression, such as enslaved people and high profile civil rights after this

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Felicia Boma Lazaridou: and it equity and access to the

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Felicia Boma Lazaridou: the delayed seeking delayed help seeking and greater like, we had a first contact by emergency services among racialized communities. It's not an issue of lack of knowledge, and it's usually depicted as such.

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Felicia Boma Lazaridou: Rather it is a consequences of consequence of a great deal of knowledge about the systemic issues that need to be addressed if we are to move towards a more equitable and accessible mental health system.

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Felicia Boma Lazaridou: And this paper that I'm referring to is published already. so if you want it to to read it. You can find it in the European archives of psychiatry and clinical neuroscience.

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Felicia Boma Lazaridou: Thank you for your attention.

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Felicia Boma Lazaridou: I can't hear you.

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Agata Krasowska: We can hear you

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now. She can hear you

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today.

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My name is Chihuahua.

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Before I start my presentation I would like to acknowledge what Felicia said now about the history of film.

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the relationship between Eugenics

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and Mental Health in South Africa. Can you hear me now?

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Okay.

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all right. My presentation is entitled, Exploring the Effectiveness of mental health.

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First, it program for young people in South Africa. And this

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this research project is embedded in the history of mental health care

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in South Africa before 1,994,

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mental health and mental health care? Was you weaponized by the appetite government

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and a lot of political dissidents and people who were opposed to the appetite. Government government

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were in prison, and some of them were institutionalized in mental health facilities.

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and because of that, most people from previously marginalized communities in South Africa are not quite open to psychotherapy.

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So that's the background to my research.

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All right. So

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my talk will focus on the following key points, I would look at the objective of the research.

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and I would give an overview of some relevant health indicators within South Africa.

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I talk about the demographics and social determinants of health amongst young people in South Africa.

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A look at the research design, the methods, results, and then conclusion.

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Now this was a pilot study that was for caused on mental health. First aid.

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Why mental health? First aid? Because in South Africa black Africans make up 82% of the population.

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But with regard in terms of access to health care, most of them are not able to afford health care because we do not have our national health

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insurance and the bulk of payment within the South African health care system is, I think, about 80 95% is out of pocket.

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So we can't talk about psychotherapy

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in a generalized form, because not a lot of people can afford it.

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Then, on the other hand, we have the issue of acceptability of mental health care with mental health care

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has been weaponized in South Africa, and as a result of that

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we still have. There seem to be an intergenerational

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on transfer of the social construction or the construct of mental health in South Africa. So, as a result of that, a lot of young people in South Africa are not predisposed to any form of intervention from the public health.

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So this study, this pilot study set out to examine the effectiveness of a peer-to-peer. Mental health. First Aid intervention, named as the the Sentinel Project, where we designed a mental health app, and it was embedded, and the the

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the study was

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on the Sc. By the a couple of studies that are embedded in what is known as an asset-based approach to mental health care

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where we looked at communities that have been described as

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as low resources, and those who do not have access to public health facilities

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and decided that they could be. There could be some form of assets within those communities that can be leveraged to increase access to mental health care, and 2 of the things that came up was that people forecast more people, valued the relational aspect of life, and most of them.

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but based on the needs assessments we did. The relationship they had with each other

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was something they their social capital. Yeah, that's the word. Their social capital was considered a Major. a major asset that could be leveraged. So we embarked on this pilot study.

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Now, before I talk about the research design, I would like for us to just take a look at the specific health indicators in South Africa.

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Now, South Africa has a population of over 60.40 million people and More than half of them are mostly female.

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and with regards to medical insurance, only about 16.1%

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are, in short, and when we talk about the people who are. In short, here we're talking about it from the general population. Not just black Africans now. So life expectancy at birth in South Africa. For females seem to be higher than that of meals.

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The percentage of individuals who have access to the Internet are just about 41%. And I specifically inserted this because it was relevant to this study

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and also the second indicator we're looking at, which is alcohol and heavy episodic drinking

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which applies to the agenda was around 59%. Again, it is relevant to this study

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when we look at the fact that a lot of people in South Africa.

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So when we consider the fact that a lot of people in South Africa, especially people from previously marginalized communities, are not predisposed to

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seeking to seeking mental health care

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because of systemic

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discrimination and because of cultural in inappropriateness of some of the that has provided. Then we begin to understand why some studies have shown that the most

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commonly known coping mechanisms for most South Africans is alcohol, especially young people.

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Now, again, the data from the statistics are African mental health care indicators. This is the 2,016. Data also points to the fact that

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the mental health care space in South Africa is not quite nice at the moment. Now, with regards to Bates in the We in mental health hospitals we have just about 16.1. Then mental health care units in general hospitals is just about 0 point 8%. And this is for the entire country. Bet for mental health in general, hospitals is about 4.3%. And if you, if you compare this to the general populace, you will understand why people are predisposed

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to drinking and other forms of cooking mechanisms.

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Then, when we look at mental health, outpatient facilities, it's just about 0 point 1%.

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And then you compare that to a standardized suicide rates for both mills and of females. then it's around 24.4%. But for mills it seems quite higher.

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and the overall spending, which is about the the

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recognized and total spending for health care and household is around 10%. But in South Africa, if you look at it, it's only 1.4% can afford to pay for their health care.

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I keep going back. Sorry.

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Now, let's look at social gradients and help the variations in held across and within specific species. In South Africa.

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in South Africa we have the suburbs, and then we have the locations. The locations are the

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the shanty towns, and a place. We have a place like that in Cape Town.

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A child born in Kailica. Calicia is one of the sharks there, and Limpopo is a a province there. But Limpopo is a low-income province, so a child born in Kaleisha Limpogo.

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it's likely to die of HIV aids compared to those born in the southern suburbs or the Western key.

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A child born there is twice more likely to suffer from malnutrition 2 times less likely to have access to clean water and sanitation 3 times more likely to die of injuries 4 times as likely to live in a neighborhood with high number of fast-food restaurants and liquor stores

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5 times more likely to experience domestic violence 5 times as likely to use wood.

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a paraffin in cooking 6 times, very likely to drop out of school, or become incarcerated

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7 times more likely to have unemployed parent, and 10 times already likely to be born into poverty.

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And I think here this here speaks to the demographics. The sample from which our project was piloted. Now in terms of socioeconomic status, the emergence we seem to have a new crop of black African middle class in South Africa.

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But if you look at that, most of them still remain at the lowest from of the South African society. 70% of them earn 17% of the total annual income within South Africa. And I'm talking about people from previously marginalized communities. Here.

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10 million of them live on less than one dollars a day on the lies around eating grants. Now in South Africa, if you control for inflation

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and 45% on less than $2 per day. And if you look at well, this, most of these people, the the people from which this sample was drawn from there. You understand that?

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most of them are likely to die from HIV aids are likely to be exposed to violence, injuries, diabetes, and non-communicable disease

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and data from the satellite, from statistics of Africa indicates that the disability I just said is lost to alcohol. Alcohol use high body mass index, high blood pressure and unsafe sex is quite high compared to that of other countries.

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So this research project was a seven-week randomized control trial following the launch of our mobile app known as Sentinel Apps sentinel App had an app mobile app that was designed to help these young people

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maintain that manage their mental well-being. Why? Because most of them had reported, and these are the students. They withdrawn from a university from a a public university in South Africa. Most of them had complained that the the waiting time to be able to access psychotherapy was long, and some of them had also complained that because of or reported that because of cultural issues they were unable to access. they were not predisposed to seeking help

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mit

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the design was served as a tool to examine and the course and effect relationship between the introduction of the sentinel mobile app

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and I improve mental welding outcome among the participants.

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So we had a total number of 303 undergraduate students of all genders between 18 and then 35 years, and they were recruited and assigned to the sentinel mobile app

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and the Sentinel project, integrated Journaling. It had about 3 features. It had journaling and mood, coming features that were supposed to be used, or daily.

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And then the

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participants were also asked to include Am. Sessions, to have personal individualized sessions which included a 15 min walk daily and 5 min

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mit ctl, and to listen to a daily aff affirmation. So they were provided with affirmations and bin, or else so, and then we, the control group, were required to refrain from walking and from listening to affirmation. So one.

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and at the end of the project participants completed a short, open-ended questionnaire at pre-intervention, and then with 3, they they had a post intervention. At week 4 we had a follow up.

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so the study was supposed to be part of a physiology of Health classroom project where they were recruited from a second-year cohort. And while other assessments in the course we graded, this task was not graded, if and were

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because students were who were recruited for this this particular project, had some of them had reported that they have had a history of mental health

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breakdowns, but they could not access medical care. Now there is a different context to this 2 which was also part of the sociology of health class.

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In one of my classes, and this is just a digression from my original.

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It's like, in one of my my date, my my writing retreats as a Phd. Students. We had about 8 Phd. Students who were in odometry. All of us were in a dometry, and

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we hadn't we? It was this morning where we woke up

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to find to one of our colleagues living on the floor.

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We were at that writing clinic for about sorry we had that writing retreat for about 7 days, and for the 7 days throughout the Seventys we would wake up, sure that the

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at the bottom bunk

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and she will find her on the floor. So day 3 came. Everybody became worried.

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Then we moved her up and they would find her on the floor. So on further inquiry, we found out that she was having what I got to realize were panic attacks, depressive symptoms.

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but the interpretation and her own construction of what she was experienced, for of her symptoms was actually what led to this, and because I realized that when I started teaching, I invested that it had become quite common to find people who were experiencing depressive symptoms to claim that it was a spiritual calling. So when we inquired for that, we found out that most of them thought that she thought it was a spiritual calling.

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So, and I gave a task in my sociology of health class, and most of the students reported that their understanding of me, most of them were not familiar with mental health symptoms, or depressive symptoms, and others said did when we showed them the symptoms of depression or anxiety. Most of them said no, that they had experienced that. I think about 80% of the students

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in the post post intervention. Survey reported that they had experienced some of those symptoms, but they had interpretations of those symptoms. We're quite different from what we thought it would be. Most of them said it was a spiritual calling. It was a sign that they had spiritual calling.

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and while others said that they had that they they thought they were being. They were bewitched. Now, when we looked at the the variations, the racial variations in those constructs, we realized that the bulk of the the majority of the people, who said

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that their mental health our depressive symptoms with signs of spiritual calling, were black Africans, and it had nothing to do with socioeconomic status. Most of them could afford psychotherapy, but they had a different. It had

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their cultural definition of mental illness was completely different. And then we also had those who thought that they were bewitched. And there were also others who thought that psychotherapy Based on the experiences of their grandparents with the appetite government. That psychotherapy was a form of was always would always be reponized against black Africans in South Africa.

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So the study was a taking week trial of various mental health. First-state interventions for mental health and participants were allocated to either the control group, about 100 of them or the mental health condition, where we had about 200

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and 3 of them using their students, numbers participants in both study conditions were invited for briefing and consent, and individuals in the mental health. First, a condition was shown how to use the Sentinel Mobile app

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with specific journaling, peer affirmations and breathing exercise prompts and orders in the control group was shown how to dial up a peer accountability partner for a matrix supports. We had people in a different group who who also believed because we had the study, was theoretically framed with social capital theory. So we thought that most of them and Saudi have shown the role of social capital in managing mental well being among young people. So we had recruited peer accountability partners, and

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most of them were assigned to this pay accountability partners, and this feature was embedded within the sentinel app, and all they needed to do when they experienced depressive symptoms was to just dial someone and talk to the person. So we created a brief An open-ended question here, which consists of questions that were related to the effectiveness of the sent in a mobile app, and one of the questions we asked them was, Why does the mobile, the sentinel mobile app offer a good or bad user experience for you.

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but not to other group. Who do you think is most likely to use it? Do you think that the features meet your mental health needs? What were your pinpoint while you were using the mobile app and where you and where were you emotionally when you were using the app? And where were you also physically, in terms of access, and in what situations? So when we we also wanted to find out from them, they are so. The economic status, their financial status.

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and whether they would recommend the mobile app to their friends.

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And this is what the move the mobile app looks like. So it has the breath, the focus

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feature, it has the journaling feature. The journaling was the one that was mostly used by most by the participants, and then It also has where they dial for support here, so they could do a coming for exercise, breathing, exercise. They could talk to someone that they could write in their journal.

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So where all responses were hand-coded, and they reflected broad categories in their perceptions of the user experience and their state of mind during the program.

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So at pre-intervention, 56% of the participants in the control group

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described their mental well-being as improved compared to 90% of those in the Mental Health

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First Aid group who claimed that their mental health had not improved

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at post intervention. 7% of the control group continue to perceive the emotional well being in a positive manner compared to the other people who were in the mental health. First, Mental Health First Aid Group

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43% of the people in the control group, and 87% of those in the Mental Health first group maintained a positive outlook on their mental well-being during the follow up.

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But overall participants did indicate that they they enjoyed a significant optimism and positive outlook on life, and that their depressive symptoms had lowered at the end of the 18 weeks.

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and most people who were most of the participants who were exposed to positive, affirmative words from pay supporters demonstrated

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a significantly higher perceive social support than those who were not at the We at the with 3, because we had introduced it at with 3, and those at the control group at Week 4. Now based on the overall quality qualitative data. While journaling daily walks and reading exercises, health participants, affirmative words from payment was made the most significant difference. Thank you.

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Well. now, we have one more pre-recorded

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 presentation

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greetings.

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greetings. My name is Harold, Neighbors. I have the honor of introducing today's topic. Each member of the research team will make remarks during this presentation.

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The title of our presentation is black-white differences in goal-striving stress and depression. The Nashville Stress and Health Survey.

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When I started as a doctoral student in 1975, I had but one seemingly simple research question, and that question was, which group has the higher rate of mental illness, black Americans, or white Americans?

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The answer seemed obvious, because the minority status argument argued that blacks were thought to lead more stressful lives due to racism. That stress in turn was sought to damage mental health

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goal striving looked like a good indicator of the stressed black Americans face in their quest for the American dream. However, even though it was assumed that mental disorder should be higher for black Americans, the literature finds that mental disorder, especially depression, is higher for whites compared to black Americans

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in 2,008, sellers and neighbors wrote their first paper on goal, striving, stress. Focusing solely on black Americans, they found that high goal striving stress was associated with poor mental health.

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In a second paper, neighbors and sellers. 2,011 explored the relationship of goal-striving stress to mental health in both black and white Americans

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they found in contradiction to the minority status argument that high goal. Striving stress led to more psychological distress for whites than for black Americans.

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Similarly, the Angelus in 2020 found that, compared to their black peers, whites with high goal, striking stress reported more depressive symptoms.

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In this presentation we revisit these findings by replicating the analysis for blacks and whites with a more serious mental health outcome, major depressive disorder.

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goal-starting stress assesses the degree to which individuals feel they have achieved their ideal life. The goal striving stress measure employs the metaphor of a ten-step ladder to measure the subjective discrepancy between aspirations for and achievement of a hypothetical best life.

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Prior research shows that large discrepancies between the aspirations and achievements are associated with unhappiness, low self-esteem, and higher depressive symptoms

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based on our previous research, and a scoping review of the literature. The study hypotheses are one black of Americans will display, display a lower ambulance of major depressive disorder compared to white Americans. To the higher goal striving stress will be significantly related to Higher

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and Md. For both black and white Americans. and 3, the relationship between goal striving stress and Mvd. Will be stronger for white Americans than for black Americans.

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and we trusted our hypotheses with cross-sectional data from the national stress and health study. This is a probability sample of us born non-hispanic black and white working age adults who lived in Davidson County, Tennessee, between 2,011 and 2,014

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Mit. Ctl. And and our key outcome is lifetime major depressive disorder. Mdd. So during the in-home interview, researchers determine whether each respondent met clinical criteria for Mtv. Using the who city structured diagnostic interview, one.

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So the Who city is a computer-assisted, fully structured interview with pre-coded skip patterns that can be easily and quickly administered by survey interviews without clinical training.

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now focal, independent, variable is goalstreaming stress or Gss. And so we first calculated scaled scores with the formula shown on the slide, which basically waits the subjective gap between aspirations and achievements by the perceived likelihood of goal attainment and a level of disappointment.

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And we also test an alternative measure that collapses the scaled scores into ordinal groups of low medium and high.

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and in our multivariable analyses we also include controls for age, sex education, marital status, employment, status, household income and scales for major life events daily and lifetime discrimination. And I'm having to answer any specific questions you might have about our measures via email

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in these next 3 slides summarize our findings. So here in figure one, we first show that percentages of Nbb diagnoses are nearly twice as high for whites and blacks, or 39% versus 29 or 39% versus 20% respectively. So this finding supports hypothesis one, and is consistent with a large body of research on the so-called black, white, Mental health paradox which Alexis will discuss in more detail the following.

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and here, in Figure 2, we show percentages of black and white respondents who score low medium and high on goal striving stress. And very briefly, this figure basically shows that more white than black respondents score low on Gss. Which can be seen in those top 3

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bars, while more black than white respondents more high on Gss. Which can be seen on the bottom.

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Mr. And this third figure is our main finding. So this figure depicts the marginal probabilities of Mdd. On the Y-axis at varying levels of goals that I stress on the X-axis.

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and we also include separate slopes for black and white respondents. So this is essentially a figure for Mdd. Regressed on an interaction turn between race and goal striving stress, holding our covariance constant.

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and the left panel shows results for scale Gss. Scores, while the right panel depicts the same for the ordinal scores. So basically, this figure shows that while gold starving stress predicts Mdd. For whites and blacks, it's a stronger predictor of Mdd. For whites, and this is especially true at high levels of Gss. Which can be seen on the right panel.

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And so these patterns are also robust to our control measures as well as different regression techniques, including binary logistic and linear regression.

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Our analyses supported each of our 3 research hypotheses. Here Dr. Sellers and I are briefly going to situate our findings within the broader sociological literature.

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and while our study was descriptive, we will also suggest some possible mechanisms that could drive these relationships that should also be studied in future research. Our first finding that black Americans display a lower prevalence of Mdd. As compared with white Americans, aligns with prior research on the black, white Mental Health paradox, this body of literature was generally found that black people tend to report higher levels of psychological distress, but lower rates of mental disorder than whites.

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At the same time, when black people are diagnosed with mental disorders, their conditions are generally more severe and more persistent than those of whites. Scholars are still working to understand the black, white, mental health paradox. But one possible explanation is that there are methodological challenges to appropriately capturing the construct of depression across Rachel groups, making this paradox an artifact of measurement error.

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Our second, finding that higher Gss. Scores are significantly related to higher risk of Mdd. For black and white Americans aligns with stress theory which suggests that the combination of greater exposure to stressors and a lack of coping resources to mitigate those stressors will be associated with worse mental health outcomes.

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Since the 1970 S. The Us. Economy has undergone several major structural changes which have made it more difficult for individuals to complete their education, obtain well-paying jobs, purchase a home, and achieve the American dream.

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It is possible that the increased difficulty in meeting these milestones could contribute to the levels of goal striving stress and related poor mental health for the black and white respondents in our sample

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future future research in this area could explore the relationship between such structural changes, goals-driving stress and Mdd. And whether race moderates these relationships.

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Our third, finding that the relationship between gulf striving stress and Mdd. Is stronger for white Americans than black Americans aligns with mallet and colleagues. Framework of the relationship between the ideology, acquaintance and health.

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The Us. Is a racialized social system, and historically, social policies, economic conditions and social norms have systematically benefited whites over other minoritized racial groups prior to scholarship shows that the ideology of whiteness facilitates white people's expectation that they will achieve more social and economic success

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than people of color, and this expectation, combined with the long history of reaping the benefits of white privilege, may have inhibited white people from developing the same types of coping mechanisms and psychological resilience that minoritized racial groups are able to employ in the face of adversity. Indeed, prior scholarship shows that white people experience more emotional distress

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than they are more socially disadvantaged peers when exposed to the same stressors. Future scholarships should continue to investigate how the ideology of whiteness may contribute to white people's enhanced vulnerability to Mdd. In the wake of goal striving stress.

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So by way of our conclusions, we want to state that the impact of goal striving stress may be more painful for white Americans, due to higher expectations that their status goals should be achieved

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for black Americans. On the other hand, the pervasiveness of racism may result in developing a psychological outlook that protects against the damaging effects of blocked opportunity.

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Alternatively, our findings may stem from the challenges of measuring depression, using a questionnaire that eliminates completely clinical judgment. A highly structured instrument like the CD. Has no ability to adjust for cultural differences in vocabularies of distress

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to conclude structural determinants like racism play an important role in a development mental disorder. Among black Americans, however, just as important are the cognitive processes used to assign importance to structural exposures.

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It is this subjectivity of of personal experience, contextualized by racial identity, that provides a deeper understanding of black, white differences in mental health.

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Our findings disrupt popular narratives that too easily assume universal black disadvantage in comparison to whites. Thank you very much.

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So is the

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the distributed papers outers here.

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No.

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we can. They left the the handout available here. I'll give you.

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and I would like to

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 invite Christina to

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the the discussion. Please, Christina.

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come, come to?

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Yeah.

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if you have some questions.

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thank you very much for your wonderful presentations.

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And if the public have some questions, comments

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about the works presented here.

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 no.

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There are some. Then someone in the shadow. maybe

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any questions.

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No.

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Felicia, do you have some questions or comments?

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Hmm.

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no.

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No. One, have questions.

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So maybe I can have. So I don't have a question. I can make, maybe some comments.

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Okay.

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so, Felicia, I think that it's very interesting that you are so 1 min I will take my

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notes.

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It would be a discussion of the public, because

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and

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maybe about the last one.

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I was thinking in the morning in our table, that maybe the explanation for some results of the the the studies where that black people has more lower, lower level of

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mental illness, mental illness. Maybe it was due to the lower respectances that was the result of the last one. No, and white people have higher expectances about their future about their

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and about the careers.

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and black people in general have low expectancy. So it would be an explanation, and I think that the last

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study confirmed it. No, and Felicia has the advantage that she is comparing the results about race with all racism, also with migration, because migration is linked also with a stress situation when you are living in another country.

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No, you are a new one, and you can.

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and be never fixed it with this new situation, where it's a stressing, stressing situation. So I think when we are only black living, your country is different when you are a black person living in another country, mainly in Europe, where people are predominantly white, so that this is a general comment, and maybe more ever than 150.

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Then the spectac is lower and and higher. I thought that maybe a Africa and the same that could be. What do you think about? Could you have a tiger resilience

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also that protect them from stress

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as they are suffering daily discrimination. They we developed some resistance.

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some resistance already is resilience. So

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so we to have a protection against this continuous, its position

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of aggressions and violence, and also a subtle discrimination. I don't know. What do you think about? You are the researchers.

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Maybe, if you can comment it.

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Felicia Boma Lazaridou: Yeah, I think you're absolutely right. I think that this concept of resilience not as an individual psychological construct, but as a collective

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Felicia Boma Lazaridou: endeavor has been

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Felicia Boma Lazaridou: something that has been necessary for a long time, and so I think that marginalized groups have

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Felicia Boma Lazaridou: take it as a as a given. You know, it's it's become quite normalized that people don't even think about resilience anymore. Even if we're talking about just recognizing racism for what it is. that can also be part of this resilient

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Felicia Boma Lazaridou: process as well with that.

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Felicia Boma Lazaridou: Naturally, it's like in that social support. community structures and and things like this.

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Felicia Boma Lazaridou:  yeah, I think also, one of the issues is also about trust. Why, I mean.

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Felicia Boma Lazaridou: And my colleague spoke about the the apartheid situation and the weaponizing of mental health.

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Felicia Boma Lazaridou: and the way in which then, you know, South African young people don't necessarily

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Felicia Boma Lazaridou: trust services to provide the care that they say they're going to provide, and that the same issues occur in the Us. Context in the German context.

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Felicia Boma Lazaridou: in the British context, and many various contexts whereby.

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Felicia Boma Lazaridou: even if you are experiencing mental health issues, even if you are experiencing mental illness issues. And you know that that's what you're experiencing. So you're not saying that it's a spiritual issue. But you know full well that it's a mental health issue. And you know if you had the privilege to be able to go to services and use them, that you would.

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Felicia Boma Lazaridou: But then you just don't trust that they're gonna treat you in the way that you will get better then that keeps you away, and may also account for

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Felicia Boma Lazaridou: why? Why, people do have in some cases greater levels of diagnosis. I wouldn't agree that that's

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Felicia Boma Lazaridou: in all cases, I think major depression is a bit of an a an in in the certain aspect.

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Felicia Boma Lazaridou: because it's

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Felicia Boma Lazaridou: one of those disorders that is

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Felicia Boma Lazaridou: I would argue, is is not as stigmatizing as some of the other disorders. So, for example, schizophrenia?

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Felicia Boma Lazaridou:  so you have. You do generally have

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Felicia Boma Lazaridou: higher rate of schizophrenia diagnosis a month.

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Felicia Boma Lazaridou: black people, for example, in comparison to white people.

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Felicia Boma Lazaridou: and the reasons for that. I mean, it's there are many

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come, come here. Otherwise she can. She can read and listen. You.

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Okay.

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I really enjoyed all of the presentations and giving me lots of things to think about. Even in terms of my own research. I actually had a question for the presenter who focused on South Africa.

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I was really struck by the fact that receiving social support seem to be the most effective in terms of those long-term positive mental health effects for the college students. So I was wondering if you could talk a little bit more about

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what that interaction was like. Did they just speak to someone about their problems that they advise them. I'm wondering what that social support actually meant in that context, because it was so powerful. I thought that was really amazing. So I just want you to talk a little bit about that.

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I apologize for not emphasizing the details of the social support.

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So in South Africa we have a concept of ubuntu. I don't know how many of you are aware of that.

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Some of you with that term.

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and it means

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literally that I am

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because you are

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all right.

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So in South Africa we have a term known as ubuntu

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and

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It's translated as I am because you are. and it emphasizes the relational community really and emphasizes the relational aspect of of social interaction.

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And for this project what we did was to pair people up with what was known as accountability partners. and these accountability partners were for context. This project was piloted during the lockdown. We started in 2,029,

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and then we piloted it during the lockdown.

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So, and one of the prerequisites for being an accountability partner was that you will have access to Internet data.

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and then you'll be able to the most of the accountability partner. Sorry, most of the okay. So we had peer mentors, right who were trained for 16 weeks, and then they became accountability partners to participants in the project, one

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now, in order for them to become participants. Accountability partners. They also had to take some some courses on counseling on how to spot mental mental health triggers and on how to offer emotional support. So they had 6 things, 6 key points of discussion each time they called the person of the we required to call the person at least once or twice a week.

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so they would call and ask how things were. Generally they were in France, but they were just accountability partners, and to find out from the participants in this project, whether they they were journaling

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because the first the first routine most of them had was, when you wake up in the morning. You journal, do your breeding exercise. Take a 15 min walk for those in the control group and the other people who weren't required to do that. We just required to just call the accountability partner in the evenings and tell them what they had done the previous day.

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So the accountability partners would call them up and remind and find out from them way their way on a scale of one to 10. How are you emotionally? What happened today? So they'll probably recount what happened during the day

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and

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and after that they will ask them, Do you need any kind of support? Because it was important to us that people defined the kind of support they needed. We didn't think that it was okay to impose on them.

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because for most of them you would think that the problem was getting groceries where exactly they had missed most of. They were quite social before the lockdown, so they were just missing that ability to be able to interact with other people. I'll be able to talk to people. So we wanted them to. We wanted to peer mentors to find out from the participants what exactly support meant to them. So when you call them up, you ask, what do you need right now? Do you need emotional support.

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is it? food! What exactly do you need? And we found out that the quality was the quality of the conversation that made the difference, contrary to what people think he has. Poverty does contribute to to mental illness and depressive symptoms, and in South Africa we had a most of the this again, I think I forgot to mention this, that this most of the participants with drawn from the from the shacks, right? So it means that most of them do not earn up to

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10,000 runs. Most of their families do not end up to 10,000 runs a month, which is, I'm not sure 10,000 ones is less than

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less than

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3 $3,000. So so most of these people are from low income families, but quite surprisingly, we noticed that they were more interested in the quality of the conversation, and we had a bit of a an alcohol crisis in South Africa during the lock down where people were looting shops and stealing, and all of them some people were also making home homemade beers. We realized that most of the people there prior to being enrolled in the program

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where some of them were functioning alcoholics. But by the time they had left the program after the 18 weeks they

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came quiet. They some of them had withdrawn from alcohol, most of them. We're now adopting healthier coping mechanisms. We also found out, too, that because we created. We found that we asked them to construct and to to to define what support means to them.

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Most of them were quite open, so we allowed them to lead. So there were no power imbalances, and we paid people we we now what I don't know which is, which seems to be a limitation to the study now we paid, but we didn't pay people across genders

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the meals we're paid with males females. We're paired with females just because of stravoid ethical issues. But perhaps by the time we start with

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the second phase of the project will figure out how to work our wrong dos. Thank you.

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We have some minutes more. Would you like to somebody? Any other question or a comment

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even before the

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Zone Zone room?

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No.

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Was she that have you any other? No. so

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thank you.

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Thank you a lot. Soon.

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Next time, bye, bye.