Elissa Hamlat: I have always been a scientist in how I seek to interpret and make sense of the world. Obtaining and understanding new information has been a huge drive in my life and I spent many years of my free time reading when I was a child. I was interested in understanding the natural world, and the human brain is kind of the last frontier in science, in that our understanding of some basic processes of the mind still seems rudimentary and so far from completion. A secondary spark was that by the time I was in college, I had several personal experiences with depression that showed me how common and how disabling it was, and how much remained to be done in the etiology, treatment, and prevention of depression.

Elissa Hamlat: I still have an interest in psychological interventions at the individual level, but I have seen firsthand how their practical application can be limited. For one, many individuals do not have access to adequate mental health care, and many do not have sufficient insurance to cover such care. Thanks to Medi-Cal, I had some basic health needs covered as a child but most of the time, my family was uninsured. Secondly, some of our best treatments do not work well for many individuals. For example, behavioral activation has a proven track record as a treatment for depression and I have used it successfully with children, adolescents, and adults.

I want to work toward adapting systems to support individuals, rather than just treating individuals as in a traditional clinical approach.  During my internship at the University of Illinois, Chicago, I conducted behavioral activation with children and adolescents, but many told me that their neighborhood was unsafe, and they could not leave their homes easily to do activities in their community. This made it very difficult to find appropriate activities to include in our treatment plan. I don’t think this is necessarily intentional but when a psychological treatment doesn’t work for someone, especially someone who has struggled to implement the treatment, there is a sense of shame and that the individual is to blame at some level for the treatment failure. After all, it has worked for so many others. To combat the shame, I feel we should work to adapt our treatments for individuals from diverse backgrounds and those who have experienced higher levels of adversity. There is a clear need to develop approaches to intervene at a higher level — at an institutional level, which leads to change in the neighborhood, school, community, state, country, and (hopefully!) world level.

At UCSF’s Center for Health and Community, mentored by Dr. Elissa Epel, I find myself embracing a public health perspective by looking for mechanisms of psychopathology that could have an impact on more than just the individual level. Another part of this is looking at the context in which psychopathology develops, including the institutional discrimination and economic inequality we have in this country.

Elissa Hamlat: 

My biggest hope is that my research will result in interventions at different levels, at both the individual and institutional levels, and lead to a body of evidence that ultimately supports public policy and legislation. I am focused on intervention during puberty, which is a sensitive period for the onset of serious mental and physical problems that often recur throughout the lifespan. It’s also a period of plasticity, a time when a small change in behavior or input can lead to a large difference later in life. Ideally, puberty is an opportunity to right wrongs that occurred during early life and even lessen cycles of illness that have coursed through families for generations. 

I also want to disturb the narrative of depression as solely a first-world women’s disorder that non-White and individuals from low SES backgrounds rarely experience. In depression research, we have primarily studied White Americans and Europeans, and in work on puberty, we have traditionally studied White women and girls. Our assessments and treatments for depression are largely based on this body of work. But depression may present differently in children and adults due to socially constructed race and gender differences. For example, when I worked at the Philadelphia VA, I assessed men who did not meet our current criteria for depression, instead, they were diagnosed with insomnia, addiction, anger issues, impulsivity, and health issues such as heart disease and diabetes. But listening to their stories, some were clearly depressed, and their coping behaviors were leading to their diagnoses.  I am especially interested in studying depression in Black Americans, as this is currently understudied. There has been this narrative that earlier puberty leads to depression in White girls and Black girls are strong, have better body image, and don’t get depressed. My research shows that this is not necessarily the case and that puberty-related mechanisms and health outcomes may differ for White and Black girls. Research suggests depression may present more somatically in Black girls, at the physiological level. Early puberty in Black girls may also lead to worse cardiovascular and metabolic outcomes in later life and their experience during puberty deserves a focus.

Elissa Hamlat: I am lucky to be part of a cadre of fantastic researchers working with the women from the National Growth and Health Study. This study has been following Black and White women (and now their children) for more than 30 years. This is one of the largest longitudinal samples of Black women with data every year from age 10 to age 20 and now again in their 30s and 40s. I am most interested in studying the pubertal transition in two generations and how transgenerational adversity may get encoded in the body and passed on to children. I plan to continue to work with these women and children as they age throughout their lifespan. Historically, the study has been focused on physical health outcomes and I am excited to include mental health outcomes in this study as well.