 Thank you. I'm real excited to be here and to be presenting on this topic We always joke about how many dear friends caramel has but you know we have this idyllic scenario in our head of Belonging to a tribe where we have this balance of competition and teamwork and shared resources that allows us to thrive and to become better But then we also have this modern narrative and you know, I've heard this from mentoring physicians I've heard it from complete strangers and uber drivers about how people Don't seem we don't seem to be able to have a real conversation anymore or how Social media and technology seems to invade our social relationships in our social world so I want to really investigate this topic a little bit further specifically in the context of Depression and so we'll discuss depression today a little bit about the who and what of our social environments and how these affect depression and then the effects of technology which is really a big a big one in this area and then some ways We can re-engage with our tribe. So overall the worldwide prevalence of Depression is 4.4 percent That seems small until you realize that's over 300 million people and in the US this is leading to almost 45,000 suicides per year and You can see that that trend is increasing over time Now we don't have a very good Kind of way of assessing depression and ancestral populations or of assessing that change over time A lot of studies use different methods and come to different conclusions. So, you know, there's not a lot We can see with that But what we do know is that we need to change this trend and that we is very necessary Because I believe that this is something we need to do as a society and as a tribe So one thing that we do see correlated with depression rates are some of these modern influences that you're all very well aware of And some of the ones that are more relevant to this to this presentation are that loneliness and social isolation Component and that's been mentioned at talks earlier today as well Now when we look at depressive symptom patterns We see something really interesting emerge and when we have depression in the context of a loss We see a difference in the pattern of symptoms depending on whether it's a social loss or a non-social loss So a social loss being the loss of a loved one the loss of social status things like that Whereas the non-social loss is something like the inability to achieve an important life goal So that's that's very interesting to see that difference there now Contemporary hunter gatherer studies can give us a little bit of insight onto the social structure of those ancestral groups and what we see within those groups is a lot of cooperation We have this sharing of resources this gathering of food the sharing of food and then aloe parenting Which is the parenting of a child who doesn't share the same genetic material as you We also have these very fluid social networks so we can have a family unit going and residing with the husband's kin or the wife's kin or with a large number of unrelated individuals and Even though there's a preference for living with kin It appears that they ended up or they end up living with mostly unrelated people which was very interesting and now that Sex equality that we see in the ability to go and live with the husband's family or the wife's family was thought to come about because of the higher cost of Raising a human offspring that required a better investment from both parents and then Because of those fluid social networks and because we can go to you know the husband's family or the wife's family We can use the grandparents as a resource and by moving between different you know localities and Using those other people we have a little bit of a buffer against unpredictable environments and then we have this very important sharing of information and The really interesting you know there's some really cool examples in the literature on this information sharing within social networks and what we see is that in a Large social network where you have the opportunity to observe an innovation many many times So you have a lot of social interaction that innovation can be refined and maintained over time But when you have this core ancestral group and you have these other groups splitting off They actually forget how to Do certain things they forget how to make fire or they forget certain hunting or fishing techniques Which you know it seems seems bizarre, but there's just not enough Interaction to maintain the observation of those innovations Now this cooperation and pro-social behavior is thought to be partly because of that co-residence with unrelated people But also because of the association of one female with many unrelated males So for example father daughter Husband wife brother brother sister sister-in-law brother-in-law and cousins husband You know these these people aren't these males aren't necessarily related to each other But they're already related to the same female So that's thought to decrease some aggression and promote cooperation that extends beyond a local unit to other communities So what are some other kind of unique human traits that we don't see in other? species and You know we have this ability to work together with a shared intention that's really important We have this orientation towards teaching and learning and then we have this really interesting thing where we'll punish norm violators And that's that's seen even when those norm violators aren't directly affecting us personally So that's pretty interesting and it's a way of kind of protecting that social structure Now when we look at our modern social structure, we can see that technology has really given us a lot of options Technology is what allows us to all travel here, you know fly or drive or use things like uber and To be here and to use this technology to share information like this so, you know, it's really given us a greater access to resources and allowed us to expand on those fluid networks, but You know that same technology Also lets us work at home order food right to our door and essentially not leave the house So while we can use the technology to you know enhance our social interactions We can also use it to in a sense hide, you know if we don't want to go out. We really don't have to So let's take a moment to consider your social networks and by this I don't mean the number of Facebook friends you have but I mean the number of people that you have discussed personally important topics with in the last six months and This is the same question that they asked in a survey over 30 years ago and then again more recently in 2004 So I realize that's still you know a little a little old by now because it's you know 14 years since then but the results were interesting enough that I still wanted to share them Now the people that you're thinking about Are really important to you for social support and for information sharing and they can be both family and non-family And what you discuss with your important people will be different than what the person sitting next to you will be You know discussing with their important people So there's a lot of variety in that discussion Some other things you might think about within that network are how big is your network? How often do you talk to these people? How long have you known these people? How diverse are these people and then how interconnected are these people are your friends friends with each other? And that's actually a really important factor So some of these variables haven't changed a lot over time But what did change was the number of people that these respondents had to discuss important topics with So when they said how many people can you discuss these personally important topics with them the most common answer in 1985 was three people and in 2004 the most common answer was zero So that's a little sad, but it's also important to remember that you know If you're if you see any kind of patient or client in the health care field Remember that when they talk to you and they're discussing all these really personal or important things You might be the only person that they have to talk to about that you might be their main contact And so that's an important kind of connection to have to help build those support networks And that's something I've seen in the clinic too where you know You have these patients coming in and they will have these Visits very frequently and really what they want is just that social interaction. That's the main interaction that they have in their life Now it's important to make a distinction between loneliness and isolation So loneliness, you know, you can actually feel lonely while sitting in this room right now Surrounded by people Whereas you know if you're on a deserted island you can also feel lonely But you can also be socially isolated in this room you can be lonely But you're not socially isolated because there's a lot of people here seeing around you Then we have these positive and negative interactions the positive interactions generally Outweigh the negative interactions in terms of number and number of sources But those negative interactions have a really significant effect on our physical and psychological health And then when it comes to emotional support our perceived emotional support is actually more important than The actual emotional support we get so that's really interesting And then we have this concept of contagion and usually I would be talking about that in the context of bacteria But today there's something much more interesting and that's this idea that Depression or loneliness can be contagious. And so this was a very interesting study done in college roommates You may be able to appreciate a little bit more if you're staying in the dorms while you're here But essentially what they did was they took students and they ran randomly assigned them into Roommate pairs and they assessed their levels of cognitive vulnerability at the beginning of the study and then three months later And when students were paired with a roommate that had a higher cognitive vulnerability They caught that cognitive thinking style and had greater risk for depressive symptoms Now we can also see that loneliness is contagious and the interesting thing with this is that it's contagious Up to three degrees of influence. So your friend your friend's friend your friend's friend's friend That's how far it can spread on the bright side happiness is also contagious and Happiness spreads through networks better than unhappiness. So that's a little bit on the bright side there now This need for social belonging is so important that it's placed right after safety needs on Maslow's hierarchy And so when we have our needs for belonging met We have higher life satisfaction and lower levels of depression. We all need to feel like we belong We all need a place in society. We all need to be loved. It's a basic human need So let's look at at some of the who and what of our social environment And there's a lot of different things that go into this we won't get through all of them But just some things for you to think about So we'll start at the beginning so you were when you were born or perhaps when your older siblings were born your parents transitioned into a new social role and At this time your mom would have been at an increased risk for depression and why is this well? There's a lot, you know, we can talk about you know regarding hormonal fluctuations and all that but we can't ignore the effect of Society and social roles. So some of the important questions here are did your mother feel supported during pregnancy? Did your parents get along? how did giving birth to you affect your mother's career and the problem with this increase in Woman in careers is there's this work family conflict that happens where You know, we're kind of judgmental of mothers as a society And now we have that judgment Amplified by things like social media where everything is up, you know for public comment on You know what they're doing and and how they're they're looking after their kids and then we also have judgment around daycare use and mother's feeling very guilty about having kids in daycare or Not being able to spend the time with them that they would like and then we have that compromise of work life and family life And then you know when women get home, there's still an unequal division of labor that happens So they're still responsible for outside the house and inside the house work now in Terms of you know social support social reciprocity is a protective factor here for postpartum depression So having that social support in place is really important Now as you get a little bit older, it's amazing to see how quickly social status becomes important So they've studied this in kindergartners and they see that kindergartners with lower social Status have increased risk for aggression and depressive symptoms Now if the child kind of self-corrects and adds in some pro-social behaviors We see that in grade one their social preference improves and they have decreased depressive symptoms and decreased aggression Now if you participated in any guide or scout groups when you're a little you're probably still reaping the mental health benefits of that so there's been some interesting research on this and They found that even by age 50 Participation in these groups as a child decreased risk for depression and anxiety by 18 percent And the effects were so great, you know controlling for all other variables that it essentially erased the effect of socio-economic Status on risk for depression and anxiety, which is really quite significant Now when we hit adolescents It's a little bit of a rough time because we have an intersection of physical emotional and social changes and so we see that youth at this time have a lot of increased risks and One of them is that you know if an adolescent commits suicide their friends are at an increased risk for also committing suicide now on the other hand having those Really good school connections is protective against suicidal ideation and suicide attempts in that population so we live in a very competitive world and You know we compete for schools. We compete with grades We compete to get jobs careers attention and that competition has kind of expanded and into new territories So now it's the fairytale Pinterest boards. It's the wild Instagram adventures. It's the number of Facebook friends It's a number of likes, you know it never really ends and although You know large social networks can be beneficial in some ways if we have this increase in competition and we and we get Beyond the motivating aspect of that competition and we end up with you know hostility that hostility is going to give us an increased risk for Aggression and depression, which is going to give us decreased support But then on the other hand social stress is also going to lead to things like aggression Which also in turn decreases support? so it's a little bit of a vicious cycle and One of the social stresses that could come into play here, especially, you know in childhood is bullying and Some protective factors for victimized youth against you know developing those depressive symptoms or suicidal ideation Are a really good, you know, facilitative parenting school connection and community connection and that community connection is important even if it's a disadvantaged community in either economically or socially Now in young adults, we have particular risks with sexual minorities because they face a level of harassment and discrimination At you know across a wide range of settings. So school family friends all different environments and The rate of suicidal ideation in that population is 45 percent Which is really quite high and then with youth in general or young adults in general There's particular risks when starting college and that's because you know, you're moving away from home You're adapting to new social roles You have new academic pressure and social pressure and then you have poor sleep to compound all of that I don't know kind of what you guys thought when you were a little You know what you want to do when you grew up if you wanted to do, you know Whatever your mom did or whatever your dad did or maybe you really didn't want to do any of those things I always said I would never do public speaking That didn't really turn out I guess but it's interesting because they've studied this social and occupational Reproduction between generations and they've seen that you know, it does that social and occupational status does Reproduce itself through generations and they've found that that's independent of mental health status So that was really interesting and then as we get older our neighborhoods become more and more important and our relative income Within our neighborhood has an effect on our risk for depressive symptoms But even more important than that was the number of neighbors that we could go and we could visit and that had the greatest impact on The lowering of depressive symptoms in the context of neighborhood Now our family extends beyond just our Spoused children, you know siblings or parents and we've seen an increase in multi-generational living in America in recent years And there's several reasons for this it's more common for you know young adults to end up in this situation if they don't have a college degree and finances are a little bit a part of this but it's you know, it's it's interesting because This is similar to what we've seen in some of those ancestral populations where we have adult siblings living together or adult family units living with grandparents and this has a lot of benefits even if those Triggering events such as you know financial situation are kind of negative being in that living arrangement does have some Protective effect on depressive symptoms by social inclusion and the proximity of those other people So that's that's really interesting and what I really like about this is that Loneliness is a huge problem in elderly populations and with this trend We've seen a decrease in the number of older Americans living alone. So that's that's really cool with that And now we get on to the question of technology So there's been some that argue that technology isn't disintegrating our social worlds It's just evolving our social worlds and so we really have to look at both sides of this You know, how is it helpful? Where is it detrimental and how can we use it best? So first, you know, let's consider how much time, you know, youth are actually spending on technology And that number is really high. So that's I mean, that's incredible really But it's there's also a lot of difficulties in studying this topic because Screen time can mean a lot of different things. Is it entertainment? Is it work? Is it school? Is it communication? So some might be more social aspects. Some might be more problematic And so it's really tricky to look through some of these studies, but what is some of this screen time doing? And we can see a lot of physical effects here One of the important things to point out here is this place time and with this place time we have You spending time on technology or maybe even us spending time on technology that could be spent on other things So relationships careers homework, you know time spent outside play movement those things are all really really important and then there's some very real concerns about privacy and Confidentiality who are these kids contacting through technology? What are they accessing and there's been studies showing that kids can actually have trauma like symptoms Based on fear reactions from some of the things that they're viewing and that's quite a concern We can also have a lot of dissatisfaction from negative social comparison And then we can have technology being used to deal with our emotions and instead of or kind of hide from our emotions Rather than learning effective coping strategies There's also this concern of inadequate connection, which is Essentially, you know when you text someone and you don't get an immediate reply. So you soon that they hate you And that's definitely something that's been mentioned in the literature as well And then cyberbullying which is another big concern and it's interesting because both perpetrators and victims of Cyberbullying are likely to experience or to bully both on and offline So there's been drastic changes in technology over time. There's been changes in who is accessing this technology There's been changes in how the technology is used and we don't really know the long-term effects on this. So One interesting Connection here is that with parents and kids using FaceTime or Skype can be a positive source of Connection and there's actually a doctor. I know who uses this, you know FaceTime to Maintain a connection with her kids while she's at work and it's really fun to watch them interact that way So there's some potential positives here. We don't know all the long-term effects Now in older groups, there's an effect of screen time But it also depends on what type of screen time it is So some particularly problematic ones that have been mentioned are multiplayer online gaming video gaming and Computer use as far as depressive and anxiety symptoms Now in longitudinal studies, we can see screen time predicting depression We can also see depression predicting screen time. So, you know, it can potentially go either way here now Screen time isn't inherently bad and there is kind of a curve here So at one hour and I personally don't know anybody who only uses technology one hour a day But at one hour, there's a benefit. There's a decrease in depressive risk Now when you hit over five hours, there's an eight percent increased risk in depressive symptoms So just something really interesting to keep in mind. So there are some positive effects and these are some ways in which technology might be helpful But in order to use this to our advantage, we also need to be aware of the potential pitfalls And one of the ways in which this can be detrimental is with media multitasking This is really common in adolescence, you know, using multiple platforms at the same time multiple devices and Interestingly, this is related to or correlated to an increased number of friends that parents don't approve of or think are bad influences So we see that and then we also see that low social support in students leads to Increased or I need to correct that is correlated with not leads to it's correlated with increased Internet addiction and depressive symptoms and there's been a couple studies on that There's also this thing called Facebook addiction disorder, which isn't an official DSM disorder at least not yet But it's a very interesting one to consider. It's associated with increased depressive symptoms and it seems to be more problematic in males particularly and Then I had to throw in something more positive on here So again, we have with this three degrees of influence. We see that Twitter when you have your Twitter use is affected by your Friends your friends friends and your friends friends friends and that affects kind of the happiness. So there's this This three degrees of influence with happiness that we see spreading through this network again And remember that that happiness spreads faster than unhappiness Now there are some definite advantages to face-to-face communication over other forms of media and Those include better social success and better sleep no surprise there so there's also with face-to-face verses Other forms of communication. There's this very interesting phenomena where you have if you have more face-to-face Connections that also overlap with your social media connections that has a decrease in your depressive risk Now when you have a large proportion of those social media contacts that aren't related to or you that you don't have a face-to-face Connection with that so is associated with an increased depressive risk So, you know following strangers or when you friend someone and maybe they don't friend you back So things like that There are some definite advantages that have been proposed for social media especially in youth faced with anxiety and depressive disorders because it removes a lot of barriers it removes Barriers based on how you look it removes barriers based on You know social skills like wit or extraversion It gives you a chance to think about how you want to respond and how you want to portray yourself before you actually You know respond to that text or post something So there's a lot of potential benefits there But we also have to consider that this is a population and a time where they can be especially vulnerable to the negative effects of social media so exclusion or victimization And when we look at social media use in these young young people and depressive risk We see that part of that risk is mediated by this fear of missing out So they're wondering what is everyone else doing and so instead of forming real relationships They're busy worrying about what everyone else is doing that they're not part of and Then a few other things that are associated with more Detrimental effects as far as social media use so you know following strangers like we've talked about and negative social comparison So these are just some ways in which you know, we need to be cautious in how we're using this social media There was an interesting study specifically on the pattern of use so they they categorized Participants into these five categories and they found that these two wired and connected were the problematic ones and What these meant were people spent a lot of time on social media. They checked it really often They used multiple platforms and they were so emotionally invested in this So, you know if that was their whole emotional connection and you know, they you know They post something and someone doesn't comment right away or you know things like that These were the ones or the categories that were associated with increased depressive and anxiety symptoms So like Diana Rogers says it's not the cow It's the how and I feel like a similar sentiment can apply to technology, you know technology isn't bad it's it's about how we use it and You know, there's a lot of positive ways we can use it So there's actually something called tribe our X which is an online Social support program that essentially allows physicians to write a prescription to their patients for a support group And for people who don't have a lot of in-person real-life support There are online social support groups and those are associated with decreases in depressive symptoms Then again better social media use like we said So are you using your your devices and your social media to the inclusion of people that matter to you? Are you using them to the exclusion of people who matter to you? You know, are you Face-timing someone who's in a different country who you're good friends with to catch up? Or are you using your phone to scroll through Facebook at the dinner table, you know surrounded by your family and friends? You know, there's a big difference there, and then we talked a bit about multi-generational living another really cool Innovation here is it's a parent of university students with seniors And by doing that there's benefits for both the university students in terms of reduced living costs and for the seniors in terms of You know classes held by the students or social interaction or other forms of assistance And then good health so Poor health is a huge barrier to going out and Maintaining your social life and being involved in social activities This is a big problem in the older population But it's something I've also seen in younger patients with say chronic pain and that's promotes or Provides a barrier to their social life And then again community involvement volunteering and then there's something called interpersonal therapy which deals with the social context of Depression and then conferences like this. So you don't have to wait. We're all here you know, this is a great time to meet up with old friends and make new friends and When we have that, you know, we come here and Some people we already know but we all have similar goals And so we get here and we feel like we belong we were part of a tribe when we're here So that's really cool and overall I want to encourage each of us to consider, you know How we spend our time. How can we engage better in our communities to create positive change? And then not only that but how can we better appreciate the connections that we already have so thank you very much You can find me in Scottsdale at the integrative health clinic in the fall Or at my website beyond 20 questions Excellent talk to me and one thing that you brought up that I thought really needs to be stressed some more is a big evolutionary mismatch in The hunter-gatherer societies and modern societies, especially in our industrial world And one of those is pro-social behavior and furiously egalitarian Where if somebody a lot of people Report that if somebody's being a little bit boastful about something self-ability. They get taken down by the other people Like there's mechanisms in place that promote pro-social behavior among related the unrelated individuals that prevent differences in strata and in modern societies what we see at the workplace and starts an education system in schools is as opposed to fiercely egalitarian and pro-social we see competitive competitive the norm from you know winning awards How you're competing as your peers for good grades and getting crazed or not? And all the way to our political system. Oh, the Democrats won It's lost like Think it's a huge mismatch in terms of what we're designed to optimal system and what I think is important about that is that then that Competition that runs throughout our world our modern world really corrodes corrosive towards These collaborative Relationships community relationships you should be able to go to work and feel like all these are my people But a lot of that people don't work in a little lonely This is a serious issue that needs to be addressed Yeah, and then you know bullying isn't just with kids It's you know There's workplace bullying as well and and one of the big problems with you know social media is Relationship asymmetry, you know you you follow someone they don't follow you back you friend someone they don't friend you back things like that That's that's also You know creating that unequal kind of relationship where it's very Unidirectional unidirectional, you know, you're you're providing something or you're you're following someone or you know You care about what someone does and they don't reciprocate And just an in equals one I live in a co-housing community and I So my in my experience Like my neighbors were all like really happy a lot. We have each other and I'll just give a really quick example When somebody well just basically when somebody needs something there's a lot of people around so like last week Someone was ill had to be in bed for a few days and they were able to get a whole bunch of people bringing dinners in and it just We have we see these kinds of things through churches or different organizations, but actually living with people in this manner It's really different the depth of the relationship Is more family like but I like but anyway, I was wondering if you Know any research on does this matter in quality of life? I've mostly looked just at the kind of multi-generational households and it is really interesting because you do have that That resource there where you know grandparents can look after the kids while the parents are at work or you know they can help split household costs or You know, I Saw one example where the grandparents would actually like make the meal for the adult You know family when they came back from work and they're all tired and everything And then also the kids can look after the older adults, especially if they have any kind of health concern And so there's actually even you know housing that you can get where you have two houses in one And so you can share that house with another part of your family and still have a little bit of your own space Which is really cool And I'll thank you for the motion of primal play Smart from devices or any any device technology device is can we follow interesting in the real world? And as much as we try Healthier behaviors Most of us will use our devices purely for to become our self-absorbed or say Comparison or compare and despair Do you feel that there will never be a time where we can make better utilization a technology? Rather than something that will just detract us from Or the thing that we're trying to achieve Yeah, I mean it's it's a it's a good question. It's It's very difficult because you have you know, it's so kind of addicting that oh someone liked my photo Oh someone liked my post, you know on and on and on and it's like every time you get a little alert It's like oh someone likes me. Oh someone likes me again. Oh someone likes me more. So, you know, you have that constant, you know reward With those kind of likes and things like that So it's really, you know, you have to really evaluate How how it's affecting your life and kind of where your boundaries are going to be with it because it You know, I mean it can be very detrimental. It can be fairly benign or it can be beneficial So I you know, I really struggled with I really didn't want social media I really didn't want social media and then the first social media account I opened was to It was a private account so that I could keep In touch with some younger relative friends of mine And you know, and then I got talked into one for you know more for my career And so there are certain uses of it, but I think just kind of evaluating The time that you spend on it and how valuable that time is to you, you know What else could you be doing with that time and and how does that compare to the time you just spent? You know scrolling through facebook for 15 minutes and just feeling miserable because everyone else is You know on vacation and you're not or something like that So but you know, it's going to be a little bit of time. I think before We have a better sense of You know, exactly how it's affecting us Thanks Tiffany. Um, I was wondering if you have recommendations for those of us who have clients or patients who we recognize are relying on us for They're probably How we can best kind of address that you're not something And I have encountered with a view of our individual clients and we're working to try to help them reestablish a more robust social network and more support, but we you know, sometimes that's kind of resistant And you feel like How do I address this for my client? Yeah Well, you know, it's interesting because I have seen with Uh patients that they come in and they're lonely, but you know, they work at home That's what they do And so for those patients doing something like you know, can you work at a coffee shop? Or is there another setting that you can move yourself to or can you take breaks or You know, can you make a habit of you know going to the park or going outside for a walk in your community or you know Uh volunteering volunteering is a really good way to get some social interaction You're out there. You're doing something for your community And by doing that you feel really good about yourself and you get that social interaction And then there's also uh things like, you know, like I mentioned tribe rx, which is specifically for pain patients But it's a very interesting model. It's a very interesting idea. So that's something um, you could look at and maybe that will be developed for You know other groups. Um, I know that there's a few there's a few pilot studies on something That was kind of similar. It was a very interactive social online group But I haven't seen any of those pilot trials turn into an actual program But yeah, I mean send me an email or talk to me after and I can give you the papers on those too because they're pretty interesting Thank you Thanks guys