Research Stories

Fighting for Equity

By Kim Krieger

an ipad with the following math equation demonstrating the  complex medical math you must do to figure out your own bill. How much will Robert Pay? Robert receives a bill for $530. The member rate charged by his in-network doctor to remove a wart from Robert’s foot in early January. Robert has a $30 co-pay. The amount paid at the time of the visit, which doesn’t count toward the deductible. His plan includes a $100 deductible. That’s how much Robert must pay before insurance kicks in. A 20 percent coinsurance applies to the visit. Robert has to pay this much of any covered service. Answer: $210


Working in the health care industry is no defense against insurance jargon, it seems. When Dr. Victor Villagra, director of policy at UConn’s Health Disparities Institute (HDI), recently posed the question at left to the audience at a health care industry conference luncheon, very few attendees answered correctly. And yet everyday people shopping for health insurance for their family or small business must routinely solve these types of questions to accurately compare plans — or risk making an expensive mistake. Many doctors are effectively small business owners and face these same complex calculations when choosing health insurance for their employees.

And doctors face a different, but related, dilemma on the other side of the equation, when a patient with a high deductible insurance plan suddenly cannot pay the full deductible amount. High deductible plans set the stage for an adversarial relationship between a doctor and patient, where the doctor feels compelled to hire a debt collector to get paid. The patient feels betrayed, and the caring relationship deteriorates beyond repair.

“New insurance designs are extremely complex. Patients don’t know how to use their insurance,” and often doctors get stuck in the middle, Villagra says.

If it were complex and equitable, I could deal with it. But it’s not equitable.

Besides confusing calculations, health insurance is rife with obscure vocabulary. A Kaiser Family Foundation survey found that 58 percent of uninsured survey participants didn’t know what a “health insurance formulary” was — it’s the list of drugs covered by that insurance provider — and 9 percent of those surveyed thought it was “the form you send to your insurance company when you need to have a medical bill paid.” Additionally, many did not know what a “health insurance physician network” was — some believed it was a collection of computers doctors use to talk to each other. Further, almost half the survey respondents could not pick out the correct definition of “deductible” on a multiple choice test.

More Americans have health insurance than ever before thanks to the Affordable Care Act, but a variety of factors still make it hard for many to access quality care. Villagra and his colleagues at the HDI are aiming to change that, by increasing literacy and lobbying for policies that help people choose the best care and coverage available.
They believe raising health insurance literacy is the best, and most immediate, way to help people avoid bad insurance policies — and broken relationships with their doctors. The question is, how?

In the near term, Villagra and his colleagues want to train “health insurance helpers” who can station themselves in libraries and community centers during open enrollment and help people shopping for health insurance make wiser choices. These helpers will be especially important in poorer communities and areas where many people do not speak English well, do not own their own computers, and may find the health insurance descriptions impenetrable. The HDI also wants to persuade health insurance companies to make insurance easier to use by writing the plan descriptions and subscriber agreements in plain English rather than legalese.

But the HDI is primarily engaged in research and policy development. In order to change the system, the HDI is partnering with organizations directly involved in providing health insurance to consumers. For example, the HDI is working with Access Health CT to make a computer app that can help people more easily compare benefits between health care plans.

Access Health CT is the operator of Connecticut’s health insurance exchange. Small business owners and private citizens without health coverage currently use the exchange to figure out which plans and subsidies they qualify for under the ACA, or Obamacare. After a rough start in 2014, when the exchange website malfunctioned and shut out many would-be enrollees, Access Health CT has rallied. It’s now considered one of the most successful exchanges in the U.S. But Access Health CT still has a lot of challenges to deal with, both in getting people covered and then helping them use the insurance they — or state taxpayers — are paying for. A majority of people who enroll in a health care plan through Access Health CT are eligible for Medicaid, and one of those challenges occurs when they ‘price out’ and are no longer poor enough to qualify.

For example, consider M., a carpenter living in central Connecticut who asked not to be identified. He had health insurance through his wife’s job as a certified nursing assistant until 2013, when her facility closed. M. lost his job six months later, and his family of four became eligible for Medicaid. They were able to enroll relatively easily by calling Access Health CT.

In order to change the system, the HDI is partnering with organizations directly involved in providing health insurance to consumers.

“My dentist didn’t take the insurance anymore, my dermatologist didn’t take it, but we made do,” M. says. The family switched dentists and worked a deal with the dermatologist. Their primary care doctors continued to accept their new insurance because they were existing patients. M. considers himself lucky.

But his income went up due to overtime this past year, and state law lowered the Medicaid income threshold for a family of four to just $37,665, down from $48,830 the year before. His wife called Access Health CT and spoke with someone about the family’s new situation. She was told they could purchase health insurance for somewhere in the range of $1,400-$1,800 a month.

“That’s a mortgage payment,” M. says. “I’d have to take on two more jobs.”
His wife is in nursing school now and he hopes they can get insurance through her new employer when she graduates. Until then, he hasn’t heard anything concrete about when they’ll lose their current coverage.

For Access Health CT, helping people obtain coverage and cope with the financial realities of health insurance in Connecticut is just the start of its mission. Now, the exchange wants to move forward with helping people find doctors who will treat them, and getting them the right type of care, focused on prevention and wellness, according to CEO Jim Wadleigh. And that’s where the HDI and Access Health CT intersect. HDI can give Access Health CT policy support and research backing, and Access Health CT can actually implement it.

“They are the lever of change,” says Pat Baker about Access Health CT. Baker is president of the Connecticut Health Foundation. The organization granted the HDI $155,244 this year to increase health literacy in the state, and is glad to see them partnering with other agencies. The Connecticut Health Foundation’s primary focus is increasing health equity in Connecticut, and Baker finds it particularly disturbing that half of African Americans and Latinos newly insured under the ACA in 2014 haven’t used their health insurance yet. Many of the non-users receive large subsidies. It’s an enormous transfer of wealth from taxpayers to private companies. Society isn’t doing that so citizens can stay sick or be turned away from doctors who “don’t take Obamacare,” Baker says.

Substantive change is needed, and in addition to Access Health CT and the Connecticut Health Foundation, the HDI is working with the Connecticut State Medical Society, the state Office of the Healthcare Advocate, ConnectiCare, the Department of Social Services, and many local community groups. Over the long term, HDI policy director Villagra has very specific goals. For example, he hopes the number of health plans available in marketplaces will be reduced, allowing consumers to choose from fewer, but better, options. This would also help insurance companies cross-subsidize risk across large populations. Another long-term goal would introduce performance-based regulation to make health insurance costs more transparent, similar to the rules that protect consumers from abuse by public utilities. And last but not least, Villagra hopes high-deductible plans will be eliminated and turned into insurance that provides better value and stays out of the doctor-patient relationship.

“We are in the health insurance capital of the world,” Villagra says, referring to Cigna and Aetna headquarters and many other insurance companies that have large presences in Connecticut. Villagra used to work at Cigna, and he doesn’t intend to cast a shadow over the industry.

“If it were complex and equitable, I could live with it,” he says. “But it’s not equitable.” Until it is, Villagra and his partners at the HDI and institutions across the state will work for a better, fairer system of health insurance.

Summer Breaks Help Prevent Burnout, Especially Among Physicians

Young man jumps into a body of pristine water on a summer day


It’s summertime, and you need a break! The U.S. has a culture of working too hard, and physicians are some of the worst offenders. Don’t let Labor Day pass without spending at least one afternoon at the beach.

We can joke about it, but there’s rising concern about burnout and depression among physicians. One recent study of 7,000 residents found that 50 percent showed depressive symptoms and 8.1 percent reported suicidal thoughts over a 12-month period.

“Physicians are given enormous workloads, make near-impossible life-and-death decisions regularly, and are expected to be alert and ready to go constantly. It’s unsustainable,” says Dr. Adam Perrin, a professor of family medicine and director of student wellness at UConn Health. “To enjoy life, you need balance and a break.”

Working too much can lead to burnout, or at the very least, a lack of enthusiasm. And that can be bad news not only for doctors, but for patients.

Taking care of yourself is taking care of your patients, too — even when the worst happens.

Studies show that depression and burnout make doctors significantly less likely to read about the next day’s cases, and up to five times more likely to make errors when prescribing medication.

Many doctors work too much because they don’t want to ‘abandon’ their patients. But taking care of yourself is taking care of your patients, too – even when the worst happens. Telling a dying patient that you have a vacation coming up, you regret the timing, and you wanted to tell them how much you care before you leave is very respectful, and patients are usually understanding,
Perrin says.

And while vacations are essential, your recovery and rest shouldn’t center on them. Rest and self-reflection should be a regular pursuit. For example, Perrin sings in a community choir.

“I’ve made many friends, we sing gorgeous music, and it fills the soul,” Perrin says. However you choose to take a break this summer, we hope it does the same for you.

Individualized

By Lauren Woods
Illustration by Yesenia Carrero

UConn Health’s Personalized Ovarian Cancer Vaccine Enters Clinical Trials

illustration of fingerprints overlayed on top of a woman's ovaries


Ovarian cancer relapses are deadly. UConn Health is testing its pioneering vaccine that could prevent them.

The experimental vaccine, named OncoImmunome, is administered as a simple injection in an outpatient setting. It works by boosting the patient’s immune response to enable it to destroy ovarian cancer cells, so that they do not resurface.

The genetic differences between the surface proteins on a patient’s healthy and cancerous cells constitute the fingerprint of that particular patient’s cancer, which is unlike the fingerprint of any other person’s cancer. Based on these variations, scientists create the personalized vaccine.

“This is the first vaccine of its kind developed for women diagnosed with advanced ovarian cancer,” says Dr. Pramod K. Srivastava, the vaccine’s developer, who is a leading cancer immunotherapy expert and director of the Carole and Ray Neag Comprehensive Cancer Center at UConn Health. “The personalized vaccine is specifically created using a patient’s own genomics information to prevent an often life-threatening recurrence of the disease and extend survival.”

There is no early-screening test for ovarian cancer. When a woman with the disease starts to actually experience non-specific abdominal symptoms such as bloating, the disease has often already advanced to stage III or stage IV cancer. Further, there is no effective long-term treatment for ovarian cancer. Even after a woman is successfully treated with traditional surgery and chemotherapy, the disease has a very high recurrence rate within just two years. Tragically, most women die within five years of their diagnosis.

But Srivastava believes that appropriate immunotherapy may stop an ovarian cancer diagnosis from becoming a death sentence.

“There is a huge need for a therapy to actually prevent recurrence in these women and I believe our approach to a vaccine may be just the tool to do it,” says Srivastava.

In October 2014, Srivastava published a study showing that his promising approach to cancer vaccines is effective in reducing tumor growth and in preventing cancer progression in mouse models. Based primarily on that work, the FDA approved testing of the experimental therapy in a human clinical trial.

The individualized vaccine is created using samples of a patient’s own DNA from both her unhealthy cancer cells and her healthy blood cells. Over a period of about two weeks, scientists sequence and cross-reference the entire DNA from both sources to pinpoint the most important genetic differences. These genetic differences constitute the ID card, or fingerprint, of that particular patient’s cancer, which is unlike the ID card or fingerprint of any other person’s cancer. Based on the cancer’s fingerprint, bioinformatic scientists, led by Ion Mandoiu of UConn’s School of Engineering, design the personalized vaccine that is meant to target the cancerous cells’ specific genetic mutations.

UConn Health’s new clinical trial will initially enroll 15 women with stage III/IV ovarian cancer and track them closely for two years, the window of time when recurrence most often occurs. Candidates for the clinical trial are women recently diagnosed with advanced ovarian cancer who will have traditional surgery and receive chemotherapy. If cancer-free three months after traditional treatment, the women will receive their personalized vaccine injections once a month for six months. Also, each month their blood will be drawn and evaluated for immune response.

“Our clinical trial will be testing the vaccine for safety and feasibility, but also will be testing whether the vaccine is making a real difference in patients’ blood; the timing of recurrence of cancers in these patients will also be monitored,” says Srivastava. “If, after receiving the vaccine, their cancer hasn’t recurred for a long time in a substantial proportion of women, we will know that the vaccine is promising.”


lab image of Ovarian Cancer cells

This UConn lab image shows how the new ovarian cancer vaccine works. Tiny immune cells known as lymphocytes (small purple dots) target and attack the cancerous ovarian cancer growths (outlined in blue) and prevent them from spreading to benign tissue (pink). Lab image courtesy of Dr. Pramod K. Srivastava


In October 2014, Srivastava published a study showing that his approach to cancer vaccines is effective in reducing tumor growth and in preventing cancer progression in mouse models. Based primarily on that work, the FDA approved testing of the experimental therapy in a human clinical trial.

Dr. Angela Kueck, assistant professor of gynecological oncology, and Dr. Jeffrey Wasser, assistant professor of medicine at the Carole and Ray Neag Comprehensive Cancer Center, are the principal and co-investigators of this study.

“We have received over a hundred messages from women in Connecticut and from around the world, in the hope of participating in our study,” says Srivastava.

He adds, “The most meaningful part of my life, at this time, is to serve. I hope that our results a few years from now will show that our unique ovarian cancer vaccine can prevent recurrence of the disease and even extend survival.”

If the clinical trials are successful against ovarian cancer, Srivastava plans to expand testing of his vaccine to bladder cancer and other solid-tumor cancers.

“This first-ever genomics-driven personalized vaccine has the potential to dramatically change how we treat cancer,” says Srivastava.

Blood Test Can Alert Doctors to Delirium Risk

artsy photo depicting two nurses walking down hospital corridor in the view point of someone experiencing the effects of confusion or delirium


Researchers at UConn Health and Beth Israel Deaconess Medical Center have found that a blood test could make it easier to identify patients at risk for delirium, the sudden, acute state of confusion that most often affects older adults and incurs $6.9 billion in medical costs each year in the U.S. Their study, published online in The Journal of Gerontology: Medical Sciences, reports that elevated blood levels of specific proteins called cytokines can hint that a patient will develop delirium during a hospital stay.

If you do things such as improve a patient’s vision and hearing, reorient them to where they are regularly, promote restful sleep, increase mobility, and stop medications that could be making the delirium worse, all that can help.

Dr. George Kuchel, director of the UConn Center on Aging and one of the authors of the study, says the suspected blood signature for delirium shows two cytokines at higher-than-normal levels in patients who develop delirium. Both cytokines are associated with inflammation.

Researchers don’t yet know exactly how inflammation and delirium are linked. The two cytokines the researchers saw in the blood signature, interleukin-6 and interleukin-2, can cause swelling of the membrane around the brain. Chronic stress from low-level illness can also elevate both cytokines and stress hormones such as cortisol, which over the long term can shrink part of the brain and perhaps increase an elderly person’s susceptibility to delirium.

Kuchel and his colleagues worked with patients who participated in the Successful Aging after Elective Surgery (SAGES) study to get a better handle on the relationship between inflammation and delirium. This large study, sponsored by the National Institute on Aging, has been following 566 surgical patients over the age of 70 for the past five years, with the goal of finding new approaches to prevent delirium and its long-term consequences in older adults.

The UConn study found that patients who developed delirium had higher levels of interleukin-2 than non-delirium patients at all times they were tested: before surgery, in the first two days afterward, and one month later.

This is the first study to look at cytokine levels in older surgical patients at several points in time, both before and after surgery. The results need to be replicated in other studies, but if they prove to be generally true, the blood signature could provide a quick way to alert doctors and nurses to seniors at higher risk of delirium. They can then take extra precautions to keep the patients oriented.

“If you do things such as improve a patient’s vision and hearing, reorient them to where they are regularly, promote restful sleep, increase mobility, and stop medications that could be making the delirium worse, all that can help,” says Kuchel.

New Epilepsy Drug May Be Safer, More Effective

A PET scan of human brain

A PET (positron emission tomography) scan shows blood flow and metabolic activity, used to diagnose the cause of epilepsy and for surgical planning.


A new drug that selectively affects potassium channels in the brain may offer effective treatment for epilepsy and prevent tinnitus, UConn neurophysiologist Anastasios Tzingounis and colleagues reported in a recent issue of The Journal of Neuroscience.

The existing drugs to treat epilepsy don’t always work, and can have serious side effects. One of the more effective, called retigabine, helps open KCNQ potassium channels, which shut down the signaling of overly excited nerves. Unfortunately, retigabine has significant adverse side effects, including sleepiness, dizziness, problems with urination and hearing, and an unnerving tendency to turn people’s skin and eyes blue. Because of this, it’s usually only given to adults who don’t get relief from other epilepsy drugs.

This drug gives me a better tool to dissect the function of these channels. We need to find solutions for kids – and adults – with [epilepsy].

There are five different kinds of KCNQ potassium channels in the body, but only two are important in epilepsy and tinnitus: KCNQ2 and KCNQ3. The problem with retigabine is that it acts on other KCNQ potassium channels as well, and that’s why it has so many unwanted side effects.

Tzingounis’ research has found that a new drug – SF0034, which is chemically identical to retigabine, except with an extra fluorine atom – seems to open only KCNQ2 and KCNQ3 potassium channels, not affecting KCNQ4 or 5. It was more effective than retigabine at preventing seizures in animals, and it was also less toxic.

The drug company that developed SF0034, SciFluor, now plans to start FDA trials to see whether the drug is safe and effective in people. Treating epilepsy is the primary goal, but tinnitus can be similarly debilitating, and sufferers would welcome a decent treatment.

“This drug gives me another tool, and a better tool, to dissect the function of these channels,” Tzingounis says. “We need to find solutions for kids – and adults – with this problem.”

‘Talk to Your Mother’ Proves to be Healthy Advice

Daughter has serious conversation with mother outdoors


Bringing out the proverbial “skeleton in the closet” can provide health benefits, but the degree of benefit depends on who you confide in, says a new UConn study.

The study of 400 people, published in the Journal of Health Psychology, found that people who are living with issues such as mental illness, substance abuse, domestic violence, rape, or childhood abuse reap considerable health benefits from discussing those issues.

But they experience more health benefits – both psychological and physical – from disclosing the issue to mom, a romantic partner, or a best friend than from disclosing it to dad, siblings, or a close colleague, says Diane Quinn, UConn psychology professor and study author.

People have unseen scars and they may be reluctant to talk about their stigmatized identity or experience … but if they do choose to talk about it, then they will gain even more benefit from their social interactions than if they remain silent.

“It seems that people expect their mothers to love them unconditionally, and they just assume that she will handle letting the rest of the family – including the father –know about a problem,” says Quinn.

Researchers studied a group of people who averaged 32 years old and who had at least one past experience that they kept hidden from others.

Participants were asked to rate their social networks according to differing degrees of support. Those ranged from a basic level of support, such as an offer to go to lunch, to more substantial support, such as an offer of a place to stay during an emergency. They were also asked to rate their own physical health, both in terms of actual symptoms of illness and how they perceived their health in general. Finally, they were asked to quantify how “out” they were about their issue within their social network.

Results showed that people who characterized themselves as being the most “out” derived the greatest health benefits, especially when their confidantes included mom, a romantic partner, or a close friend.

“People have unseen scars and they may be reluctant to talk about their stigmatized identity or experience,” says co-author Bradley Weisz, a doctoral student in psychology, “but if they do choose to talk about it, then they will gain even more benefit from their social interactions than if they remain silent.”

But while being “out” about a stigmatized identity or a traumatic experience can be helpful in the long run, Quinn says that not everyone has to follow the same path. “It’s a matter of your personal comfort zone,” she says.

Funded by the National Institutes of Health (NIH), the study was also co-authored by UConn psychology professor Michelle Williams.

Getting to the Heart of the Matter

Why do some patients with high ‘good’ cholesterol also show signs of heart disease? UConn research has found the common gene mutation that may be to blame.

By Kim Krieger

Scientific image of kidney cells dyed colors to show mutated cells

UConn Health endocrinologist Dr. Annabelle Rodriguez-Oquendo’s lab used color stains to figure out where the kidney cells were expressing a mutant gene: those areas glow yellow in this picture. Most of the yellow is in the endoplasmic reticulum, the cell’s transportation network. Photograph provided by Annabelle Rodriquez-Oquendo


Guidelines about cholesterol used to be straightforward: high-density lipoprotein (HDL) cholesterol is healthy, and low-density lipoprotein (LDL) cholesterol is not. Relatively high levels of HDL were no cause for concern, as long as LDL was low.

But recent discoveries show that may be an oversimplification. A common variant in a gene that regulates cholesterol levels may raise the risk of heart disease in carriers with high HDL, according to a new UConn Health study.

Researchers examined a variant called missense rs4238001, which alters the type of protein made by the gene SCARB1. The variant form of SCARB1 changes a liver receptor protein from a glycine to a serine. The change occurs in the liver receptor that grabs HDL out of the blood and breaks it down for disposal. The variant protein makes the receptor more fragile and not as effective at latching onto HDL, leading to higher levels of HDL in the bloodstream.

The study, led by Dr. Annabelle Rodriguez-Oquendo, an endocrinologist at UConn Health, was based on information about more than 5,000 people who participated in the Multi-Ethnic Study of Atherosclerosis in major American cities from 2000 to 2002.

The risk of heart disease among those with the variant was up to 49 percent greater than in the general population.

Rodriguez-Oquendo and her colleagues charted the genotypes of the participants and tracked episodes of heart disease over a period of seven years.

They found that the variant was associated with an increased risk of heart disease, particularly among men and African Americans, findings that were published in the May 20 issue of PLOS ONE.

The risk of heart disease among participants with the rs4238001 variant was up to 49 percent greater than the risk in the general population. Overall, men with the variant had a 29 percent higher risk of heart disease than men without it. African American males with the variant fared the worst, with a 49 percent increased risk. For white males with the variant, the risk was 24 percent higher.

The gene mutation itself is not rare, according to Rodriguez-Oquendo. It occurs in less than 3 percent of Chinese Americans, about 8 percent of African Americans, and 10 to 12 percent of Latinos and Caucasians in the U.S. A genetic test for the rs4238001 variant is already available to help clinicians identify patients who are carriers, so that they can offer counseling about heart risk prevention.

Dr. Annabelle Rodriguez- Oquendo and team

UConn Health endocrinologist Dr. Annabelle Rodriguez-Oquendo looks at DNA data with researchers in her lab. Peter Morenus – UConn Photo

UConn Health endocrinologist Dr. Carl Malchoff uses the test to help patients who aren’t sure whether or how they should treat their high cholesterol. For example, Malchoff had one patient with high HDL and a family history of longevity. But she had suffered a stroke at a young age, and wanted more information before deciding on a treatment.

This particular patient tested negative for the variant. But those who test positive would be advised to use a more aggressive type and dose of cholesterol medication. Patients with the variant could also inform their children that they might also have it.

“Usually if patients don’t have the variant, we assume their high HDL is protective,” Malchoff says.

Sometimes, however, a treatment decision might be more ambiguous, and could require further information before the best therapy is chosen. Another patient of Malchoff’s had high levels of both HDL and LDL cholesterol. She was taking a statin to lower her cholesterol, but was experiencing terrible muscle pain as a side effect. She wondered if there was a way to tell whether her high HDL protected her from the heart disease risk associated with high LDL. If so, could she stop taking the statin?

This patient could be tested for the same variant. If her test was negative, she could assume that her high HDL cholesterol was helping protect her against heart attack, even with high levels of LDL cholesterol. If the test was positive, she would know that her high HDL cholesterol would not protect her. She could then take another type of cholesterol-lowering medication, just not one classified as a statin.

Malchoff and his colleagues at UConn Health are working with Rodriguez-Oquendo to determine when testing for the variant is most helpful.

Read the full research article at the PLOS ONE website.

“My approach to patient care in an academic center is that we should look for things our colleagues in practice can’t do and do those things, so we can help them and be their partners,” Malchoff says of his role in the research.

Now that the UConn study has made the connection between the mutation in SCARB1 and heart disease, the researchers want to figure out a way to fix it.

“We want to go deep in the cell, and figure out how to repair it,” Rodriguez-Oquendo says. The researchers don’t know exactly why changing the protein in a liver receptor from a glycine to a serine makes it more fragile. “We’re really interested in understanding more about how this protein gets chewed up and degraded faster.”

The answers may impact the current standard of care for heart disease prevention and treatment for patients who are carriers of this genetic variant. That could happen through indirect means, such as adjusting hormone levels to alter cholesterol metabolism, or in the future through direct means such as genetic therapy.

Breaking the Cycle: How Anxious Parents Can Protect Their Kids from Becoming Anxious Adults

By Kim Krieger

Infographic showcasing logical and illogical fears oppressing a nervous child figure


A woman who won’t drive long distances because she has panic attacks in the car. A man who has contamination fears so intense he cannot bring himself to use public bathrooms. A woman who can’t go to church because she fears enclosed spaces. All of these people have two things in common: they have an anxiety disorder, and they happen to be parents.

These parents sought help because they struggle with anxiety, and want to prevent their children from suffering the same way. Anxiety tends to run in families, with 30 to 50 percent of children of anxious parents growing up to be anxious themselves. But that does not have to be the case, according to new research by UConn Health child psychologist Golda S. Ginsburg.

Ginsburg and colleagues at Johns Hopkins University tested a one-year therapy intervention as part of a study of 136 families where at least one parent had anxiety and at least one child was between the ages of 6 and 13.

The study, published in the August issue of The American Journal of Psychiatry, found that therapy-based intervention works. Only 9 percent of children who participated in a therapist-directed intervention developed anxiety after one year, compared to 21 percent in a group that received written instruction, and 31 percent in the group that did not receive any therapy or written instruction.

Children of anxious parents have up to a 50 percent chance of growing up to be anxious themselves. But that does not have to be the case.

Both inborn temperament and life experiences play a role in whether an adult has anxiety. The more negative experiences a person has growing up, the greater the likelihood he or she will struggle with anxiety as an adult. But there is also a component of anxiety that is learned, taught inadvertently by parents who model the behavior. It’s these learned behaviors and thought patterns that interventions can help change, according to Ginsburg.

“The finding underscores the vulnerability of offspring of anxious parents,” says Ginsburg. She wants to do something about that vulnerability. “If we can identify kids at risk, let’s try and prevent this.”

Most of the adults who participated in the study struggled in school and didn’t tell anyone. They didn’t raise their hands, or they got sick before exams. They might not have had any friends. As adults, their anxiety still limits their activities and sometimes those of their family members, and they are very motivated to help their children avoid the same.

Physicians can often identify children at risk before they develop an anxiety disorder. Such kids are often hyper-aware of aches and other bodily sensations, and are frequent flyers at the doctor’s office and emergency room. For example, such a child might think “my heart is racing — I’m having a heart attack!” when a less anxious individual would think “my heart is racing because I just ran up a hill.”

Other signs of children at risk for anxiety include avoidance of school, parties, and other social situations, as well as unusual worries.

“Anxiety and fear are protective and adaptive,” says Ginsburg. “But in anxious kids they may not be, because these children have thoughts about danger and threat when there really isn’t one.”

For such a child, meeting a new peer for the first time can be paralyzing. Trying an unfamiliar food might summon worries of being poisoned. To cope with this kind of debilitating anxiety, children start avoiding whatever provokes the anxious feelings. If they’re afraid of the dark they might insist on sleeping with all the lights on. If they’re afraid of failing they won’t try new things. In extreme cases, they may refuse even to leave the house.

I’d say we need to change our model of mental health to a checkup method. Like going to the dentist every six months.

One of the ways to reduce anxiety is to do a reality check. It’s a way to recognize when a fear is healthy and worth paying attention to (a growling dog) or unhealthy (a possibly poisoned birthday cake).

In the study, some of the families participated in eight, hour-long sessions with a trained therapist over a period of two months. Others were just given a pamphlet that contained general information about anxiety disorders and treatments. Still others received nothing at all.

The families who participated in therapy were taught to identify the signs of anxiety and how to reduce it. They practiced problem-solving skills, and exercised safe exposures to whatever made their child anxious.

“We taught the kids how to identify scary thoughts, and how to change them,” Ginsburg says.

If you are interested in collaborating on such a study or have patients who might benefit from a family intervention, contact Golda Ginsburg at Gginsburg@uchc.edu, or call her office at 860.523.3788.

For example, if a child is afraid of cats and encounters one in the street, the child can first identify the scary thought: “that cat is going to hurt me.” Then the child can test that thought — is it likely that cat will hurt me? No, the cat doesn’t look angry. It isn’t baring its teeth or hissing, it’s just sitting there. OK, I can walk past that cat and it won’t do anything.

In general, children who participated in the intervention had lower anxiety overall than children who did not participate in the intervention with their families.

Now the researchers have funding from the National Institutes of Health for a follow-up to see whether the effects are maintained over time. Ginsburg wonders whether there would be value in providing regular checkups for families on mental health issues. She is considering approaching insurers about offering this kind of service to families at risk, to see if it lowers their healthcare costs overall.

“I’d say we need to change our model of mental health to a checkup method,” says Ginsburg, “like going to the dentist every six months.”