AU’s first health psychologist: Dr. Kharah Ross

Health psychology (also called behavioural medicine) is where the health sciences and psychological sciences collide. It’s a very young area (under 40-years-old), but is incredibly broad. It includes clinicians who specialize in psychological and social problems that affect specific patient populations (think fatigue and distress in cancer patients, or depression in heart disease patients), and researchers who study health behaviours, the interconnections between the mind and body, or causes and consequences of well-being, and how all that relates to health and disease.

My first plan was to go to medical school, and I originally enrolled in a biological sciences undergrad program to prepare for that. But the more experience I gained, the more volunteering I did, and the more competitive I got for medical school programs, the more I felt that there was an important “human” element missing in medicine and healthcare. Around this time I happened to take a health psychology course and it was an absolute revelation – here was everything I felt was missing. A big focus of health psychology is the biopsychosocial model of health, not just the biomedical model that tends to dominate medicine and healthcare. That biopsychosocial approach includes all those behavioural, psychological and social aspects that are so much a part of being human and are also major contributors to health and well-being. I decided I wanted to be part of the work that was reshaping our approach to health and medicine, and so I shifted gears. I upgraded my psychology minor to a second major, approached the health psychology professor about doing an honours’ project, and swapped out medical school for graduate training in psychology. And many years later – here I am.

I have specific expertise in psychoneuroimmunology, which is the study of how psychological and social factors “get under the skin” to affect the immune system and immune-related health and disease. The immune system is an incredibly complex and important system, and can—for example—actually blow up other cells, differentiate between “self” and “other,” rebuild damaged tissue, and “remember” past infections in case of future exposure. Not surprisingly, the immune system has a far-reaching influence on health. For example, seven of the top 10 causes of death in Canada have roots in immune activity—the three exceptions are all behaviour based (e.g. self-harm or homicide). And not only that, but we know that the brain can “talk” to the immune system, essentially communicating information about our environmental, psychological and social states to affect immune activity. And—even more amazing—the immune system can “talk” back to the brain.

I tend to focus on social connections and close relationships, and how those specifically affect biology and health. Humans are social creatures, and access to and quality of social connections is a powerful predictor of health—potentially even more so than major health behaviours like smoking or exercise. I’m particularly interested in understanding how support and conflict together affect health, which is important work because health researchers often only consider support when they think about social connections and health.

I also tend to focus on maternal-child health. Pregnancy, the postpartum period, and early childhood are unique periods. The immune system and social connection rule books are often thrown out the window here. The immune system behaves very differently during pregnancy and the postpartum period, and matures during infancy. And social connections change, are re-defined or develop during this period. It’s absolutely fascinating how all those dynamics come together during these periods to affect health over the lifespan.

The Clinical Epigenetics study explored whether immune-based markers of biological age during pregnancy predicted risk for adverse pregnancy outcomes, specifically shorter pregnancy or having smaller babies. I know that there wasn’t anything “psychology” about this study, but in order to understand how psychological and social factors affect health, you first have to understand which biological patterns are “healthy” and which are “unhealthy” or signal risk for poor health outcomes. This is a big challenge for pregnancy research because there’s still not a lot known about how the pregnant immune system works. And to the best of my knowledge, this was the first study to look at how immune cell-based epigenetic clocks during pregnancy might affect pregnancy outcomes.

Epigenetic clocks are indicators of biological age that are calculated from DNA methylation patterns. DNA methylation refers to the presence or absence of methylation groups on regions of DNA; these methyl groups affect how easily information in our DNA is accessed and used to affect biological activity. Dr. Steve Horvath at the University of California – Los Angeles noticed that how DNA is methylated can change as we age. He used these systematic shifts to calculate biological age or the “epigenetic clock.” Moreover, he realized that some people have accelerated epigenetic clocks (they’re biologically older than you’d expect based on their chronological age), and “faster” epigenetic clocks predict increased risk for a number of adverse outcomes, including earlier death and risk for diseases like cancer.

In the Clinical Epigenetics study, we found that accelerated immune cell epigenetic age has implications during pregnancy, too. Women who had accelerated epigenetic age during pregnancy—specifically for an index called GrimAge—were also at risk for earlier births and smaller babies. This was a pilot study and so is preliminary work, but it suggests that epigenetic age might also be a marker that could be used to identify at-risk women during pregnancy and then intervene before an adverse outcome happens.

COVID-19 has been a challenge because a lot of this work traditionally requires face-to-face contact with participants and we just can’t do that the same way during the pandemic. But researchers can be very resourceful, and have a talent for turning lemons into lemonade.

For example, I wanted to understand how the COVID response is affecting social connections, and how that in turn is affecting health. It wasn’t possible to focus on physical health because of physical distancing and lockdowns, so I pivoted to consider mental health (which is also very important) through a COVID-safe online survey. That project was funded by an Athabasca University COVID-19 grant, and we were able to recruit ~350 Canadian adults that we’ve followed over a 6 month period. We’re still working on analyses, but preliminary findings have already been presented at the Canadian Psychology Association and American Psychosomatic Society meetings. A small silver lining, but we never would have had this opportunity if it weren’t for the pandemic.

Another impact is on how we think about blood sample collection. Typically blood samples need to be collected by trained staff in a lab setting and processed immediately—again, not possible during COVID-19. But this problem is exactly what inspired some of my colleagues to devise ways for participants to safely collect their own blood samples at home and then mail them back to the research centre for processing. This could revolutionize how we do research and break down barriers to not only research participation, but healthcare. I’m working on a study with my postdoc, Dr. Lubna Anis, to test different ways to collect blood samples at home, and then see how we can adapt this for use in an on-going study of a parenting intervention (ATTACH™) and health at community agencies across Canada. Again, these advances might not have happened so quickly if not for the pandemic.

And finally, this is an opportunity to highlight how important Health Psychology and Behavioural Medicine are in healthcare and public health. In the absence of a vaccine or cure for COVID-19, the best tools we have to slow the spread of the virus are all behavioural, psychological and social. And that’s exactly what Health Psychologists are experts at. If anything, the pandemic is showing that the traditional focus on biomedical models of health are seriously problematic, and funding agencies need to do a better job at supporting and recognizing health psychology and behavioural medicine research. If that message gets through, that’d be a major win.

I’m always happy to answer any questions about Health Psychology, explore collaborations, or talk about student research opportunities. Please don’t hesitate to contact me!