It enables a global cohort of advocates for brain health eg, the coaches and community health workers to be empowered to deliver brain health advice with both a human touch and advanced technology. Moreover, responsible innovation and regulation of technology are important guarantors of brain health.
While loneliness and lack of purpose remain large sources of poor brain health amplified by the increasingly exploitive uses of technology, Brain Capital technologies that integrate value-driven technology development and a human-centered approach might minimize these issues. Additionally, as many technologies generate large communities of users, the Brain Capital technology approach can be harnessed to accelerate, enrich, and ground these communities in human-centered values.
As another example, brain-computer interfaces BCIs fuse human capabilities with technology, spanning from health applications such as managing stroke and movement disorders to optimizing human performance such as increasing empathy.
Select examples of promising Convergent Brain Capital startups are outlined in Sidebar 1. As we previously noted , robust operational, governance, and investment innovations will be required to sustain the brain health technology sector. There is the opportunity and potential to address the massive underutilization of Brain Capital, especially from older people and meaningfully involve citizens in debate and dialogue about what is needed and possible to support Brain Capital.
To ensure greater replicability of brain research and promote evidence-based approaches translations of the science to benefit humanity, a major push toward standardization for data sharing, curation, and federation is needed. Brain Capital technologies require this foundational infrastructure to be successful. Further, larger validation and real-world studies will be needed to generate critical and dependable foundational data.
Philanthropy, health systems, and venture capital must recognize and support this. On the private investment level, existing ESG approaches have driven positive business and societal value; however, they are incomplete. Brain Capital is an exemplar of the increasing importance of the impact investing space, and a clear sign of the evolution and expansion of ESG. Historically, ESG choices have been slim, and scalability was considered nearly impossible.
Conversely, addressing the interdisciplinary, multisectoral nature of mental, neurologic, and substance use MNS disorders and the fostering of brain performance would make such investing inherently broader and more scalable. The fact that impact investments and ESG are still in the early stages of becoming mainstream investment areas, means the use of early-stage startups is also the path with the most upside and potentially lucrative returns for investors.
As such, investors can take a relatively inexpensive, large position in companies while assuming a more active role in their development and governance. Likewise, accelerators can engage as early movers to provide a boost to the growth and ultimate success of brain tech companies. Finally, a B-ESG approach would send a signal for more investment in venture capital-type vehicles to fund the scaling of neuroscience-backed solutions.
ETFs are a type of security that track an index, sector, or commodity and can be purchased or sold on a stock exchange like regular stocks. Such thematic ETFs have already been established for areas such as longevity , psychedelics, and sustainable development goals. For a Brain Capital ETF, rules—optimized for brain health and skills building—would need to be generated to determine which company stocks are included and excluded.
Potential companies engaged in Brain Capital-building activities may include pharmaceutical and biotech companies, technology companies, health systems and health insurers, educational technology companies, and many others. The neuroscience innovation market is often riddled with perverse incentives at the detriment of brain health in social media, for example , as companies and shareholders chase returns.
We need a new model to link brain-based innovation with economics—a disciplined approach, methodology, and a set of services for accelerating responsible innovation. We believe that in the 21st century, there are no brains without capital, and no capital without brains. Therefore, a novel approach to building Brain Capital and mitigating global brain challenges is critical to ensuring and improving societal health and for economic growth and prosperity.
Brain Capital technology and investment, carefully interwoven into our economy, will advance neuroscience and bring lasting, high-value, durable benefits to our global community. We invite you to consider this Brain Capital framework as you innovate, invest and tackle social challenges. Mr Faulkenberg is a managing director of investment management at Boomtown Accelerators. Mr Das is a senior financial and business executive. Mr Hackett is a leader in energy management and investing, a faculty member at Rice University and the University of Texas, and a cofounder of a mental health policy center and an Emmy Award-winning mental health web channel.
Dr Ling is a professor of neurology, neurosurgery, anesthesiology, and critical care medicine at Johns Hopkins University and the Uniformed Services University of the Health Sciences, and an attending neuro critical care physician at Johns Hopkins Hospital. He serves as co-leader of The BrainHealth Project. Mr Bennett is chief investment officer of Tolleson Wealth Management. Chan School of Public Health. Mr Carnevale is a venture capital investor and technology executive.
Dr Robertson is a T. He is a professor of radiology, neuroscience, pathology, and laboratory medicine at Weill Cornell Medicine. Dr Tomori is vice president of medical affairs at Akili Interactive. He is an adjunct professor of psychiatry with the New Mexico School of Medicine. Dr Soares serves as professor and Pat R. Rutherford, Jr. Dr Winter is a physician-scientist, social entrepreneur, and health policy analyst. She is a distinguished professor at UT Dallas.
Psychiatric Times. May 14, A brain capital grand strategy: toward economic reimagination. Mol Psychiatry. The brain of an entrepreneur. December 9, Accessed February 15, Avoiding a brain health innovation market failure: lessons from the hype cycle. November 17, Building brain capital.
Positive psychiatry: its time has come. J Clin Psychiatry. LinkedIn Pulse. November 10, The next 50 years of neuroscience. J Neurosci. OneMind at Work. Medical Finance News. January 12, Tan G. December 8, The brain economy. The RSA Journal. February 4, Preventing market failure in brain health: moving toward fixes in investment, operations, and governance.
November 9, Convergence science arrives: how does it relate to psychiatry? Acad Psychiatry. The new field of 'precision psychiatry. Vanes LD, Dolan. Transdiagnostic neuroimaging markers of psychiatric risk: a narrative review. Neuroimage Clin. Picardo E. Two and twenty. March 3, Sustaining investment in brain health: the dangers of information asymmetry. October 12, Brain health: key to health, productivity, and well-being.
Twitter Facebook. This Issue. Views 8, Citations Comments 1. View Metrics. Ravi N. Access through your institution. Add or change institution. Limit characters. Limit 25 characters. Conflicts of Interest Disclosure Identify all potential conflicts of interest that might be relevant to your comment. Err on the side of full disclosure. Yes, I have potential conflicts of interest. No, I do not have potential conflicts of interest.
Limit characters or approximately words. The following information is required and must be completed in order to submit a comment:. Thank You. Your comment submission was successful. Please allow up to 2 business days for review, approval, and posting. Shah is right when he says that using software to address mental health care needs to be carefully considered. However, let's be clear They are essentially band-aids being slapped onto a festering wound.
Psychiatric illnesses are biological diseases, and they need medical treatments.
You need to Required Name Required. The bird at Date modified newest first Date created that caused. However, to reduce area was changed email address will remained the same.
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|Alexander hamiltons financial plan||Charisma is a flexible virtual platform combined with live, interactive cognitive coaching to enhance how individuals think, interact, and thrive socially. Human societies continue to be plagued by brain challengesfrom mental health disorders and dementia to learning disabilities, the impact of long COVID, and disparities in forex for beginners forex for beginners health care access. November 10, Patkar, Prakash S. Psychiatric illnesses are biological diseases, and they need medical treatments. Concurrently, there is an increasing convergence of these types of solutions as experts, systems, and payors attempt to simplify workflows and minimize fragmentation of new products and services Figure 2. We need a new model to link brain-based innovation with economics—a disciplined approach, methodology, and a set of services for accelerating responsible innovation.|
|Border binary options||FloreoVR is leveraging the power of VR to provide a method of teaching social, behavioral, communication, and life skills for individuals with autism spectrum disorder ASD and related diagnoses. LUCID are producing real-world applications to establish music as medicine. Potential companies engaged in Brain Capital-building activities may include pharmaceutical article source biotech companies, technology companies, health systems and health insurers, educational technology companies, and many others. The following information is required and must be completed in order to submit a comment:. Mr Hackett is a leader in energy management and investing, a faculty member at Rice University and the University of Texas, and a cofounder of a mental health policy center and an Emmy Award-winning mental health web channel.|
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Self-directed work under the supervision and guidance of a faculty member or instructional staff, and often in conjunction with a day-to-day mentor that is a graduate student or postdoc researcher in the faculty member's or instructor's group. Students normally participate in aspects of ongoing research projects.
Enroll Info: None. Requisites: Consent of instructor. Repeatable for Credit: Yes, unlimited number of completions. Last Taught: Spring Become familiar with reliable and valid screening and assessment tools of social, emotional, cognitive, communication, motor and regulatory capacities in infants and young children in the context of their caregiving relationships; developmentally appropriate diagnostic nosologies; methods of conceptualizing risk and protective factors; and planning for therapeutic interventions that build on strengths and address vulnerabilities.
Unique features include assessment of early parent-child relationships and the use of video replay to engage parents in assessing their relationship with their child and the benefit of faculty from multiple departments at UW and luminary national guest instructors. Repeatable for Credit: No. Last Taught: Fall Provides a foundation in reflective practices through discussion of cases, infant and family observations and mindfulness experiences as applied to students' work with infants, young children and families.
Learn mindfulness strategies for developing self-awareness and regulation that may be brought to their work with families of infants and young children. In small Reflective Mentoring Groups, students will experience both descriptive and in-vivo examples of reflective practice through case based presentations, deeper introspection and supportive discussion to increase clarity and engagement in work with families of young children. Consider boundaries and ethical decision making related to the dilemmas faced by professionals working with families during the perinatal period and in early childhood, especially those in high risk and challenging circumstances.
This small group and individualized course offers students an opportunity to reflect upon their work with mothers and partners in the prenatal and postpartum period, infants, young children and their families. Course faculty and a senior, clinical consultant will guide students in exploring their individual responses to the literature, course content and issues raised in their work including personal experience and reactions as well reflecting on the parallel process.
The intent is to support the student's professional development in ways that broaden and deepen the effectiveness of their work. Offers students the opportunity to apply knowledge of Infant, Early Childhood and Family Mental Health concepts, assessment and diagnosis to planning and implementation of relationship-based and individual treatment approaches as well as to program development and policy. Students will be introduced to best practices and evidence based multi-disciplinary treatment approaches to address a range of presenting issues, settings, and cultural contexts for vulnerable children who are evidencing social, emotional, behavioral or attentional disturbances and parents with psychiatric disorders.
Implications for informing policy across systems of care will be addressed. During the course of the semester, students will benefit from invited state and national speakers and guest faculty and instructors from the UW speaking on their areas of expertise.
Continued advancement in reflective practices through case discussion, infant and family observations, mindfulness and self-compassion experiences as applied to their work with infants, young children and families. Additional strategies and in-depth opportunities for introspection and self-awareness. Discussion of relationship-based therapeutic consultation and interventions and attention to the parallel process between the nature of their relationship with a parent and the parent's relationship with their child.
Focus will be on underserved populations and contribution of maternal depression, substance abuse disorders and trauma on the parent-child relationship and the child's development. Complex ethical decision making and policy issues will be addressed. Inclusion of a self-assessment process that will support students in appraising their competencies and readiness to apply for the WI Alliance for Infant Mental Health Endorsement.
Improve skills in providing psychiatric health care to athlete populations. Sports psychiatry as a sub-specialty within psychiatry focuses on diagnosis and treatment of psychiatric illness in athletes. While utilization of psychological approaches to enhance performance can be part of the work of the sports psychiatrist, the emphasis is more on addressing actual mental illness in this population.
Sports psychiatry may also involve the use of exercise as a therapeutic or preventative intervention for mental illness. Sports psychiatry typically focuses on mental health care for individual athletes, but systems-wide initiatives e.
Sleep occupies a third of our life, and is found in all animal species. Loss of sleep has both acute and long-term negative consequences on the brain and the body. Still, why we sleep remains unclear, and hypotheses on the role of sleep for synaptic homeostasis, learning and memory, cardiovascular and metabolic health, are being tested in humans and animal models.
Learn how the sleeping brain can either support vivid conscious experiences dreaming or not deep slow wave sleep ; brain structures involved in wake and sleep; how sleep pressure increases during waking; effects of sleep deprivation; causes of narcolepsy and other sleep disorders. How to study sleep in genetic models like flies; electron microscopy to assess effects of sleep loss on synapses; enhancement of sleep slow waves in humans; development and testing of theoretical models; methods to assess levels of consciousness in humans.
During time at the WI Sleep Clinic, learn how sleep disorders are diagnosed and treated. Develop a customized experience with relevant faculty not offered by our already established electives. Previous studies have revealed that coping mediated the association between stress and depression, and could predict the severity of depression. Xu and colleagues investigated the mediating role of coping in relationship between work stress and mental health of nuclear enterprise employees, and found that work stress not only posed a direct effect on mental health but also had an indirect effect on mental health through negative coping style [ 18 ].
In the study of depressive symptoms among overseas Chinese students conducted by Chou et al. Lardier Jr et al. In addition, according to the similar research performed by Rogowska and colleagues during the Covid pandemic, partial mediation effect of coping style was also found on the relationship between stress and life satisfaction among university students [ 19 ].
Based on these findings and the stress coping theory, we propose the second hypothesis H2 : Coping plays a mediating role in the association between Covid pandemic-related stress and depressive symptoms among international medical students. A large body of research has focused on social support as a mechanism that protects people from the deleterious effects of stress.
There are two hypotheses on the mechanism. One is the main-effect model, in which social support provides beneficial effects on mental health independent of stressors. The other is the buffering model, which posits that social support alleviates the impact of stressors on mental health only in times of high stress. However, Stroebe et al. Social support is most often categorized into two basic types: received social support and perceived social support.
Received social support is the objective or actual support, including assistance of materials and direct services. Perceived social support refers to the cognitive perception of availability and adequacy of support from others [ 25 ]. Although social support theory emphasizes the role of actual support, most evidence shows that perceived social support plays the essential function, especially under the condition of stress [ 26 ].
In relation to depression, it is reported that perceived social support is an important predictor of depression [ 27 ] as well as a buffer of depression in response to life events and chronic strains [ 24 ]. In a four-year prospective model of cardiac patients, Holahan et al.
Thus, there might be a moderating effect of perceived social support on the relationship between coping and depression. Based on these findings, we further formulate the following hypotheses: H3 Perceived social support plays a moderating role in the association between coping and depression among international medical students; H4 Perceived social support moderates the indirect effect of Covid pandemic-related stress on depression through coping. The conceptual framework of our study is summarized in Fig.
A cross-sectional study, an online survey was conducted during November The target population for the study was the international students currently studying at China Medical University. In order to participate in the study, the students should meet the following inclusion criteria: 1 a current student of the University, 2 can get access to the internet, 3 can read and understand the survey content.
The email addresses of potential participants who met the inclusion criteria were provided by the staff from International Education School. The procedures for the study began with emails to the potential participants which described the purpose of the study and a link to access the online questionnaire. When the participants visited the website to answer the survey, they were greeted with an informed consent letter stating that the survey was completely voluntary.
In total, international students gave their consent to participate, among whom completed the survey with a response rate of Depressive symptoms were assessed with the Patient Health Questionnaire-9 PHQ-9 , which asked the frequency of problems that bothered the respondents.
The total score was used to determine the severity, where the higher scores indicated more severe depressive symptoms. The total score can be further categorized as mild depressive symptoms , moderate depressive symptoms and severe depressive symptoms [ 30 ]. Participants answered 1 not at all to 4 very much to the questions. Higher total score represents higher level of Covid pandemic-related stress.
It consists of 20 items to identify the attitude or potential actions that an individual will adopt when experiencing setbacks or difficulties. Each item was rated on a four-point scale ranging from 0 never to 3 very often. The dimensions of the questionnaire include positive coping style 12 items and negative coping style 8 items.
Higher scores indicate preference of adopting the relevant coping style. The questionnaire has been proven to have a good reliability and validity in previous studies [ 37 , 38 ]. A higher summative score indicates a higher level of social support perceived by an individual.
Descriptive statistics were calculated for obtaining detail information regarding each variable within the total sample. We tested the normality for continuous variables before data analysis and found the scores of PHQ-9 were not normal distribution. Mann-whitney U test and Kruskal-Wallis H test were conducted to determine whether significant differences existed between categorical variables.
Statistical analyses were conducted using SPSS The PROCESS macro program was performed to run a regression-based path analysis, which could verify moderated mediation models and mediated moderation models based on the bias-corrected percentile bootstrap method. It was suggested to perform the testing from the simpler model to more complex one [ 43 ]. Therefore, we started with examining the simple mediation model of coping by Model 4 in PROCESS, which generated direct and indirect effects in mediation.
In this model, Covid pandemic-related stress was entered as X, PHQ-9 was entered as Y and coping style was entered as the mediation variable. When the direct effect became nonsignificant, but the indirect effect was significant, then full mediation was established. Partial mediation was confirmed if both effects are significant [ 44 ]. Once the simple mediation model was confirmed, the moderated mediation model of coping style and perceived social support was run using Model 14 in PROCESS.
In this model, Covid pandemic-related stress was entered as X, PHQ-9 was entered as Y, coping style was entered as the mediation variable and perceived social support was entered as the moderation variable in the association of coping style and PHQ This model tested whether the direct effect or the indirect effect between Covid pandemic-related stress and depressive symptoms varied under different level of perceived social support.
Simple slope analysis was conducted to explore the moderation effect further. The interaction plot based on values plus and minus one standard deviation from the mean of the moderator showed the strength of the slopes [ 45 ]. In order to avoid multicollinearity, continuous variables were all centralized before the model was validated.
Categorical variables were dummy coded, as necessary, for inclusion in multiple regression procedures. Level of significance was set at 0. The descriptive statistics of the sample are shown in Table 1. The variables included were PHQ-9, gender, educational background, current place of residence, residence style, outbreak of Covid in the city, age, Covid pandemic-related stress, coping style, and PSSS.
In general, 51 9. The correlations among continuous variables are shown in Table 2. Results revealed that age, Covid pandemic-related stress, negative coping and perceived social support were significantly related with PHQ-9 score. However, positive coping was not significantly correlated with PHQ-9 score. The differences of PHQ-9 score in categorical variables are presented in Table 3. The differences were found in residence style and the variable outbreak in the city.
The PHQ-9 score was lower when the students lived with family or friends. According to the results of comparison between groups of outbreak in the city, the students who stayed in the cities without Covid outbreak had a lower PHQ-9 score than the students who did not know the actual situation of outbreak or stayed in the cities with Coivid outbreak. Since positive coping was not significantly correlated with depressive symptoms, only negative coping was introduced into the simple mediation model as a mediator.
Results of the simple mediation model testing are shown in Table 4. As the direct effect and the indirect effect were both significant, negative coping partially mediated the association between Covid pandemic-related stress and depressive symptoms. Moderated mediation analysis was performed to assess whether depressive symptoms were indirectly affected by Covid pandemic-related stress via mediation through negative coping and whether the effect was conditionally moderated by perceived social support.
Table 5 presents the results of the moderated mediation model. The nature of the interaction was examined further by the simple slope analysis, and the results were depicted in Fig. As shown in Fig. The moderating effect of perceived social support on the relationship between negative coping and depressive symptoms.
The conditional indirect effect of Covid pandemic-related stress on depressive symptoms through negative coping at various values of perceived social support was analyzed when the score of PSSS was the sample mean and at plus or minus one standard deviation. The results are shown in Table 6. These results revealed the indirect effect of Covid pandemic-related stress on depressive symptoms through negative coping weakened as the level of perceived social support increased.
Depression in the students is one of the top concerns for university administrators and educators worldwide. Reported rates of depression or depressive symptoms among college students from various sources in the past generally ranged from 13 to In our study, we found that 9. Furthermore, the standardized coefficient of Covid pandemic-related stress was the largest among the variables in the model, indicating that stress had the strongest association with the depressive symptoms.
The finding was also consistent with those of other studies [ 52 , 53 ], which provided evidence that Covid pandemic-related stress adversely impacts on depression. Based on the stress coping theory proposed by Lazarus and colleagues, we tested the simple mediation model which hypothesized H2 that the coping played a mediating role in the association between Covid pandemic-related stress and depressive symptoms among international medical students.
The results supported H2 partially, because the mediation effect was only found in the association via negative coping, not via positive coping. This finding indicated that the international students who perceived more Covid pandemic-related stress tended to adopt more negative coping. This phenomenon deserves attention, because it may lead to more subsequent depressive symptoms. In support of our views, it has been found that depressive individuals in stressful situations used avoidant coping strategies more often and had more difficulties in observing positive aspects of stressful life events [ 54 ].
Moreover, the use of avoidant coping strategies was found related to higher levels of depressive symptoms [ 55 ]. Similarly, results from the university students showed that the more frequently the passive coping strategies were used, and more severe depressive symptoms were reported among the overseas Chinese students who were more likely to choose the passive coping strategies under stressful situations [ 16 ].
Moreover, Lardier Jr et al. Thus, reduction of adopting the negative coping style may indirectly reduce the adverse effect of Covid pandemic-related stress on depressive symptoms among international students. In the moderated mediation model we proposed H3 that perceived social support would play a moderating role in the association between negative coping and depressive symptoms among international students.
Our results confirmed H3 in that the effect of the interaction between negative coping and perceived social support on depressive symptoms was statistically significant. Further simple slope analysis revealed that negative coping was positively correlated with depressive symptoms only when perceived social support was low, which indicated that international students who chose more negative coping would have more severe depressive symptoms when they perceived less social support.
With regard to the conditional indirect effects of Covid pandemic-related stress on depressive symptoms through negative coping at different values of perceived social support, our results indicated a weakened indirect effect with the increase of perceived social support, which supported H4. When the level of perceived social support was low, depressive symptoms were affected more by negative coping style, thus the impact of Covid pandemic-related stress might be stronger.
The finding implied the positive role of perceived social support on reducing the indirect adverse effect of Covid pandemic-related stress on depressive symptoms via negative coping. Besides, we also found a significant negative association between perceived social support and depressive symptoms among international students, which also supported the main effect of social support on mental health.
In brief, these findings confirmed that perceived social support was a significant protective factor for depressive symptoms among international students, which were in line with results from other studies [ 58 , 59 ]. Among the demographic variables controlled in the final model, age was negatively correlated with depressive symptoms among international students.
The possible reason is that elder students have more knowledge and skills to deal with diseases. Therefore, they may have more stable psychological status compared with younger students. Living with family or friends was also a protective factor for depression in our study.
According to the research on stress from social groups, the threat and negative influence of stressful situations will be greatly reduced if people shared the situations with others [ 60 ]. If the individual is in a totally unsupported environment to encounter life events, he or she has to cope with the stressful situations all alone, and they will feel more threatened, which may lead to a negative impact on mental health.
In addition, our research revealed that the students who did not know the actual situation of Covid outbreak had more depressive symptoms than the students who stayed in the cities without outbreak. This may not be surprising since the uncertainty to the outbreak is also a stressful state for the international students.
This study has a few limitations. Firstly, as the participants were all from a medical university, so the results may not apply equally well to the students from other type universities. Secondly, all measures used in this study were self-reported, so there may be discrepancies between what the students reported and how they actually performed. Thirdly, the study used cross-sectional data, so a longitudinal model in the future is needed to verify the causalities among the variables.
Fourthly, although this study was designed to examine the association between Covid pandemic-related stress and depressive symptoms, it is possible that other variables also influenced the results of this investigation.
Notwithstanding these limitations, this study supports the stress coping theory by providing evidence of mediation effect of coping in the association between Covid pandemic-related stress and depressive symptoms. In addition, the current study supports the beneficial role of perceived social support on mental health by finding the negative moderation effect of perceived social support on the relationship between negative coping and depressive symptoms, as well as on the indirect effect of Covid pandemic-related stress on depressive symptoms via negative coping.
Finally, the findings of the present study have important implications for university educators and administrators. University educators, administrators or even the students themselves should be educated to identify the risk or protective factors of mental health and understand the interaction mechanism among these variables. In this regard, findings of this study should be very conducive for the university staff and students to combat the adverse mental health outcomes of the pandemic, because several risk or protective factors of depressive symptoms were identified and the mechanism of interaction revealed.
In this study, we carried out a research on stress and depressive symptoms among international medical students during the Covid pandemic. We found a positive association between the Covid pandemic-related stress and the depressive symptoms, and that negative coping mediated the association. In addition, we found that perceived social support played a moderating role in the relationship between negative coping and depressive symptoms, and moderated the indirect effect of Covid pandemic-related stress on depressive symptoms via negative coping.
Findings from the current study highlighted the need for reducing the negative coping and increasing the perceived social support among international medical students under the background of continuing pandemic, as this may help international medical students alleviate the depressive symptoms induced by Covid pandemic-related stress.
Training programs for that purpose should be recommended to implement within the campus to reduce the depressive symptoms of international medical students in China. The data used during the study are available from the corresponding author on reasonable request. Liang B. Psychological stress, coping and health. Beijing: Educational Science Publishing House; Google Scholar. Data Brief.
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Psychiatry Investig. ;19(6) View: PDF. Correlations Between Psychological Status and Perception of Facial Expression. In alone, venture capital (VC) companies invested a In response, the American Psychiatric Association has developed a framework for. We need a new investment opportunity: Brain Capital. Human societies continue to be plagued by brain challenges, from mental health.