Friday, September 20, 2019

Obstructive Sleep Apnea May Increase Depression, Anxiety Risk

Obstructive sleep apnea (OSA) is associated with an increased risk of developing depression and anxiety in adults, a study in JAMA Otolaryngology-Head & Neck Surgery has found. OSA is a condition in which the muscles of the throat relax during sleep and block the airway, which causes breathing to stop and start repeatedly throughout the night. 

Jong-Yeup Kim, M.D., Ph.D., and colleagues at Konyang University in Korea analyzed the health records of 985 adults from the Korea National Health Insurance Service–National Sample Cohort in South Korea database. Between January 2004 and December 2006, 197 patients were diagnosed with OSA. The researchers matched these patients with 788 patients of similar age, sex, income, and more who were not diagnosed with OSA to compare diagnoses of affective disorders between the two groups over the follow-up period.

Over nine years of follow-up, patients who were diagnosed with OSA were nearly three times as likely to develop a depressive disorder and nearly twice as likely to develop an anxiety disorder than those who were not diagnosed with OSA. Women with OSA were more likely to develop these conditions than men.

Kim and colleagues cited prior research of possible reasons why risk of depression and anxiety may be higher in people with OSA, including reduced oxygen saturation (how much oxygen is attached to red blood cells) and increased daytime sleepiness.

“Further studies appear to be needed to validate [our] findings and explore possible underlying mechanisms,” they wrote. “Clinicians may consider taking specific precautions to reduce the risks of development of depressive or anxiety disorders among patients with OSA.”

For related information, see the Psychiatric News article “Overlapping Symptoms Complicate Diagnosis, Treatment of Psychiatric and Sleep Disorders” and the Journal of Neuropsychiatry and Clinical Neurosciences article “Update on Obstructive Sleep Apnea: Implications for Neuropsychiatry.”

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Thursday, September 19, 2019

Transgender Conversion Therapy Linked to More Psychological Distress, Suicide Attempts, Study Finds

Individuals who identify as transgender may be at a greater risk of psychological distress and suicide in adulthood if they were exposed to conversion therapy, according to a study in JAMA Psychiatry. These risks were found to be particularly high if the individual was exposed to the therapy when they were 10 or younger.

“Our results support the policy positions of the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association, the American Academy of Pediatrics, and the American Medical Association, which state that gender identity conversion therapy should not be conducted for transgender patients at any age,” Jack Turban, M.D., M.H.S., of Massachusetts General Hospital and colleagues wrote.

The researchers analyzed the responses of 27,715 transgender adults living in the United States to the 2015 U.S. Transgender Survey, whose protocol was reviewed and approved by the University of California, Los Angeles, institutional review board. The respondents’ mean age was 31.2 years, and 42.8% had been assigned male sex at birth; 19,741 reported they had spoken to a professional about their gender identity, and 3,869 reported exposure to gender identity conversion therapy (psychological interventions aimed at aligning an individual’s gender identity with the sex assigned at birth) in their lifetime. The researchers also measured respondents’ severe psychological distress during the previous month (using the Kessler Psychological Distress Scale), as well as their suicidality during the previous year and lifetime.

The researchers found that recalled exposure to gender identity conversion efforts was associated with higher odds of lifetime suicide attempts and severe psychological distress among transgender adults compared with those who discussed gender identity with a professional without conversion efforts.

The authors noted that “recalled lifetime exposure to GICE [gender identity conversion efforts] was highly prevalent among adults: 14.0% of all transgender survey respondents and 19.6% of those who had discussed gender identity with a professional reported exposure to GICE.” Exposure to gender identity conversion efforts before the age of 10 was less common among respondents, with only 1% reporting such an experience. It was, however, “associated with adverse mental health outcomes, including lifetime suicide attempts,” the authors wrote, adding that the odds of lifetime suicide attempts was higher for those exposed to conversion efforts before age 10 compared with those with lifetime exposure. This suggests that “rejection of gender identity may have more profound consequences at earlier stages of development.”

The researchers also found that respondents from more socioeconomically disadvantaged backgrounds more commonly reported exposure to gender identity conversion efforts. “These individuals may have been more likely to receive GICE, or exposure to GICE may have been so damaging that they were impaired in educational, professional, and economic advancement,” the authors wrote.

For related information, see the Psychiatric News article “‘Conversion Therapy’ Misleads, Harms Patients” and the Psychiatric Services article “Affirming Gender Identity of Patients With Serious Mental Illness.”

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Wednesday, September 18, 2019

Patients With Fewer Mental Health Symptoms May Fare Worse When Clinicians Leave

As it can both be costly and negatively impact care quality, clinician turnover is a concern within community behavioral health settings. When it comes to patient outcomes, though, a 12-month study published in Psychiatric Services in Advance observed mixed, and surprising, results, suggesting that turnover could have different impacts on patients depending on their initial symptoms.

Researchers found that turnover was associated with harmful effects for patients who were functioning well at the start of the study, yet, “Curiously, we also found that turnover was associated with no changes or positive changes” in patients with more difficulties at baseline, wrote Annalee Johnson-Kwochka, M.S., of Indiana University-Purdue University Indianapolis and colleagues. Patients “who are doing better may have more to lose when clinicians leave,” they noted.

Johnson-Kwochka and colleagues used observational data collected as part of a larger randomized, controlled trial from two community behavioral health centers (one in an urban setting and the other in a rural setting) for their analysis. As part of the trial, patients at the behavioral health centers identified the clinician they saw the most. The researchers also evaluated the participants for symptoms of depression (using the nine-item Patient Health Questionnaire), anxiety (using the Generalized Anxiety scale), and overall physical and mental health functioning (using the 12-item Short Form Health Survey) at the beginning of the study, after six months, and after 12 months. Of the 328 patients included in the analysis, 24% experienced clinician turnover.

Not only was turnover associated with clinical decline for those who had higher functioning at baseline, older patients also experienced a sharper decline.

“An important secondary finding [of this study] was that for physical health functioning, the relationship with turnover was moderated by age,” the researchers wrote. “Thus, for those who are younger, turnover may affect functioning less, possibly because their physical health may be more resilient in the face of disruptions in care.”

For related information, see the Psychiatric Services article “Clinicians’ Perceptions of How Burnout Affects Their Work.”

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Tuesday, September 17, 2019

Meta-Analysis Highlights Potential Mental Health Benefits of Obesity Treatment for Youth

Despite the known benefits of weight loss for children and adolescents who are obese, some studies suggest that youth who diet may be at an increased risk of depression. A meta-analysis published Monday in JAMA Pediatrics suggests obesity treatment in youth is not associated with an increased risk of depression or anxiety; rather, the analysis points to the mental health benefits of such programs for this population.

“Structured and professionally run obesity treatment with a dietary component is associated with improvements in depression and anxiety for most participants,” wrote Hiba Jebeile, M.Nutr.Diet., of the University of Sydney and colleagues. “Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.”

To examine the relationship between obesity treatment interventions and anxiety/depression symptoms in youth who were overweight, the authors searched through electronic databases for studies of interventions for youth who were overweight/obese published between 1987 and 2018. Only studies that evaluated outcomes in youth who participated in interventions with a dietary component (such as nutritional education) and assessed youth for anxiety/depression before and after participating in the intervention were included in the analysis. (Studies evaluating online interventions, pharmacotherapy, and bariatric surgery were not included in the analysis). A total of 44 studies, with a combined sample of 3,702 youth with a mean age range of 5.6 to 16.6 years (BMI range of 24.6 to 44.9), met these inclusion criteria. The duration of the interventions included in the analysis ranged from two weeks to 15 months.

The meta-analysis revealed a small reduction in depressive symptoms in the participants after the intervention, which the authors noted was maintained six months to 16 months from baseline. Similarly, anxiety symptoms were lower in study participants following the interventions and at follow-up.

“Interventions with weekly or fortnightly contact with the study team showed the greatest reduction in depressive symptoms, and longer intervention duration was associated with a larger reduction in anxiety. This may be due to the regular and extended support of a health care team,” Jebeile and colleagues wrote. Additionally, “interventions with a structured exercise program had a greater reduction in anxiety than physical activity education alone. A similar trend, although not statistically significant, was found for depressive symptoms.” They noted that the exercise programs, often delivered in a group format, were offered to participants several times per week, increasing their contact with study personnel and peers.

They concluded, “Overall, obesity treatment interventions are not associated with increased symptoms of depression and anxiety. However, clinicians should be aware that a small proportion of participants may be at risk of developing worsening pathology. Identification of these young people and provision of additional support may improve treatment outcomes.”

For related information, see the Psychiatric News article “Researchers Examine Link Between Mood, Food, and Obesity.”

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Monday, September 16, 2019

Slower Development of Working Memory in Adolescents Associated With Motor Vehicle Crashes

A person’s working memory—which helps one manage complex tasks and maintain attention when faced with distractions—is believed to be a critical element of safe driving. A study in JAMA Network Open has found that adolescents who were involved in a motor vehicle accident had slower development of their working memory than adolescents who were not involved in a crash.

“Monitoring WM [working memory] development across adolescence as part of routine assessment could help to identify at-risk drivers, as well as opportunities for intervention,” wrote Elizabeth A. Walshe, Ph.D., of the Annenberg Public Policy Center at the University of Pennsylvania and colleagues. “Attention and driving-skill deficits due to insufficient [working memory] may be one of the most modifiable risk factors—via experience and skill training.”

Walshe and colleagues analyzed data from a longitudinal study of 118 youth in Philadelphia, who received regular assessments of working memory, sensation seeking, substance dependence, and more between the ages of 11 and 20. A follow-up survey on driving experience identified 84 participants who had a driver’s license and were included in the analysis, and 25 of these drivers reported they had been involved in at least one crash.

All 118 youth performed better on working memory tasks as they grew older, as reflected in their scores rising over time. Additional analysis revealed that working memory gains appeared to slow in the 25 drivers with a crash history; that is, their total score rose less and less each year as they aged. In contrast, the drivers with no crashes showed steady gains in their total scores over time. The youth involved with crashes reported more reckless driving behaviors (like speeding) on average; however, even when factoring in this difference, the authors found that adolescents with slower memory gains had a greater risk of crashing.

Other developmental traits such as the youths’ baseline working memory score, their IQ, or their impulsivity levels were not associated with car crashes, the authors noted.

The rate at which working memory develops “may be an important underlying mechanism of age-graded risk for crashes during adolescent development. However, we do not yet know whether or how [working memory] development may predict crashes and need to further investigate factors that lead to differential trajectories of growth in [working memory] to identify high-risk groups,” Walshe and colleagues wrote. “Future studies should also investigate the role of [working memory] development in the observed increased risk for unsafe driving and crashes among atypically developing populations (e.g., ADHD).”

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Friday, September 13, 2019

Methamphetamine Involved in Rising Number of Heroin Treatment Admissions

Methamphetamine is involved in an increasing number of treatment admissions for heroin, especially among adolescents, a study in Addiction has found.

“The phenomenon of increasing methamphetamine use among people using opioids is of great concern,” Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H., of the Centers for Disease Control and Prevention and colleagues wrote. “Methamphetamine use carries its own risks, including a range of physical and mental health consequences such as psychosis and other mental disorders; cognitive and neurologic deficits; cardiovascular and renal dysfunction; transmission of HIV, viral hepatitis, and sexually transmitted infections; and increased mortality.”

The researchers analyzed data from more than 3.5 million treatment admissions for heroin between 2008 and 2017. The data came from the Treatment Episode Data Set, a national database that provides information on the admissions of people aged 12 years and older to federally funded substance use treatment centers. The percentage of primary heroin treatment admissions reporting methamphetamine use rose each year from 2.1% in 2008 to 12.4% in 2017, an increase of 490%.

In 2017, individuals aged 12 to 24 had the highest rates of admissions for heroin use involving methamphetamine of all the age groups examined: 27.8% of heroin treatment admissions for adolescents aged 12 to 17 years involved methamphetamine, and 17.4% of heroin treatment admissions for young adults aged 18 to 24 involved methamphetamine.

“Not only do these findings highlight a need to focus intervention and treatment efforts aimed at reaching younger age groups, but together with the finding that early age of heroin initiation was associated with methamphetamine use at treatment admission, these findings underscore the importance of expanding policies, programs, and practices that can prevent initiation of these substances in the first place,” the researchers wrote.

Among women, 15.1% of heroin treatment admissions involved methamphetamine in 2017, compared with 10.8% in men. The researchers noted that prior research suggests that females use more methamphetamine and transition from recreational use to dependence more quickly than males.

“Given the increase in risk for negative health outcomes among people using both substances, comprehensive prevention, treatment, and harm-reduction strategies that address the poly-substance nature of opioid use and are appropriately tailored to specific demographic groups and at-risk populations are needed,” Jones and colleagues wrote.

For related information, see the Psychiatric Services article “Use of Drug Treatment Services Among Adults With Opioid Use Disorder: Rates, Patterns, and Correlates.”

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Thursday, September 12, 2019

Mothers’ Stress Early in Life Found to Negatively Impact Their Children

A study in AJP in Advance provides further evidence that the detrimental effects of adverse life experiences can carry across generations. Researchers found that children of mothers who experienced stressful events during childhood had greater biological signs of stress and were more likely to have behavioral problems at 18 months.

“[O]ur data, when combined with findings from other studies, confirm maternal life-course experiences as a potent predictor of offspring mental and physical well-being,” wrote Kyle Esteves, M.P.H., of Tulane University School of Medicine and colleagues. “Our results suggest that screening for maternal ACEs [adverse childhood events] in obstetric, pediatric, and child mental health settings may provide an important indicator of risk for both the mother and the child, especially during infancy.”

Esteves and colleagues recruited 237 pregnant women for the study. During a prenatal assessment, study participants were asked to indicate the presence or absence of 10 types of childhood adversity, including abuse, parental mental illness, and divorce on the Adverse Childhood Experiences questionnaire. The women also completed anxiety, depression, and stress assessments during the prenatal assessment.

The mothers and their children returned for follow-up assessments when the children were 4, 12, and 18 months. At these visits, the researchers screened the mothers for postnatal depression and collected cheek swabs from the children for telomere analysis. Telomeres are the protective caps on the ends of chromosomes, and their length is considered a biomarker of biological stress and aging (shorter telomeres are associated with a broad range of age-related diseases). Child behavior was also assessed at the 18-month visit.

The final analysis included 155 mother-child pairs who completed at least two of the three assessments (103 pairs completed all three assessments). The results showed that higher scores on the Adverse Childhood Experiences questionnaire in mothers correlated with shorter telomeres in the children at all time points. Higher scores also correlated with more externalizing problems (for example, temper tantrums) in the children at 18 months, but not internalizing problems (for example, being quiet and withdrawn). Maternal depression also increased the risk of externalizing problems and internalizing problems; however, higher Adverse Childhood Experiences scores remained associated with shorter telomeres and more externalizing problems, even when accounting for maternal postnatal depression.

“Encouraging the widespread utilization of practical screening tools that have clinical utility and capture stressors across the life course and the broader environment in which children develop may enhance our ability to understand the origins of early mental illness and the effectiveness, rather than the efficacy, of current intervention and prevention efforts,” Esteves and colleagues noted. Additionally, such efforts could help identify ways to buffer the negative effects of maternal early adversity, they added.

For related information, see the Psychiatric News article “Researchers Tackle Complexity of Intergenerational Stress Transmission.”

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