Friday, July 1, 2022

Young Adults Who Identify as Sexual, Gender Minority Report More Mental Distress

Young homosexual, bisexual, and gender-diverse people experience more mental distress than their heterosexual and cisgender peers, a study in Psychiatric Services has found. The difference in rates of mental distress between people who identified as a sexual and gender minority and those who identified as cisgender and heterosexual was strongest in those between the ages of 18 and 24 years.

“Possible policy and practice implications of the study’s findings include addressing the increased mental distress among [sexual and gender minority] young adults by prioritizing service delivery and reducing barriers to accessing mental health services for individuals in this age group,” wrote Lucas Zullo, Ph.D., of the University of California, Los Angeles, and colleagues.

The researchers examined data from 762,541 people who participated in the Behavioral Risk Factor Surveillance System between 2014 and 2018. Among all participants, 734,670 (95.6%) were heterosexual, 12,166 (1.8%) were lesbian or gay, 12,609 (2.1%) were bisexual, and 3,096 (0.5%) were gender diverse. The age of respondents was categorized into six groups: 18 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 years or older. Mental distress was assessed with the following question: “For how many days during the past 30 days was your mental health not good?”

Respondents aged 18 to 24 years reported the following rates of mental distress in the previous 30 days:

  • 34.5% of gender-diverse respondents experienced mental distress, with a mean of 6.5 days of distress.
  • 29% of bisexual respondents experienced mental distress, with a mean of 5.6 days of distress.
  • 25% of gay or lesbian respondents experienced mental distress, with a mean of 4.9 days of distress.
  • 14.5% of heterosexual respondents experienced mental distress, with a mean of 3.9 days of distress.

The level of mental distress also differed between sexual and gender minority respondents and cisgender respondents aged 25 to 34 years and aged 35 to 44 years, but not among those aged 45 to 54, 55 to 64, or 65 years or older.

“One possible explanation of the study’s findings is that, over time, older [sexual and gender minority] adults may have learned effective coping strategies that buffer against the health consequences of discrimination,” the researchers wrote. “To counteract the negative effects of discrimination, it may be effective to support the implementation of mental health services for [sexual and gender minority] young adults, such as affirmative cognitive-behavioral therapy.”

For more information, see the Psychiatric Services article “Predicting the Transition From Suicidal Ideation to Suicide Attempt Among Sexual and Gender Minority Youths.”



APA Online Systems Upgrade Coming, Password Reset Required

APA is upgrading its member portal (my.psychiatry.org), which is used to log into many connected APA websites. Information about this transition are available on this web page. Several APA systems will be unavailable during maintenance on July 9 and 10. All members and APA website users will need to activate their accounts and set a new password. Going forward, the username you use to log into the system will always be the same as your primary email address on file. If you do not see an email by July 12, you may proceed to my.psychiatry.org and click “Forgot Password?” If you have forgotten your username, contact apa@psych.org or call APA Customer Service at 202-559-3900.

Thursday, June 30, 2022

Many Parents Screen Positive for Depressive Symptoms After Postpartum Period, Study Finds

More than a quarter of parents with children over age 1 may show signs of depression, according to a report published this week in Pediatrics. The findings suggest that screening for parental depression beyond the immediate postpartum period has the potential to identify families in need of support.

“Early recognition and treatment of parental depression can mitigate negative effects on child health and development,” wrote Ava Marie Hunt, M.D., of the Children’s Hospital of Philadelphia and colleagues. Currently, the American Academy of Pediatrics recommends that pediatric clinicians screen for maternal depression during the initial postpartum period (the first year of life), the authors continued.

Hunt and colleagues searched PubMed, CINAHL, SCOPUS, Web of Science, and APA PsycInfo for studies concerning screening for maternal and/or paternal depression or mood disorders by a pediatric clinician when children were older than age 1.

The authors identified 41 studies, including more than 32,700 parents and caregivers, 68% of which included only mothers. An average of 25.5% of participants in the studies screened positive for depressive symptoms, with the highest reported proportion among mothers of patients with cystic fibrosis. Single motherhood and parental educational attainment less than a high school degree were associated with increased risk of depressive symptoms. Additionally, parental depression was associated with an increased risk of both child behavioral and physical health outcomes, including anxiety, depression, and malnutrition. It was also associated with parents’ negative views of child behavior. Four of the studies examined the acceptability of the parental depression screenings, and all found that screenings were acceptable to clinicians and/or parents/other caregivers.

The authors identified numerous gaps in the existing literature, including that structured screening programs outside of the postpartum period in pediatric settings were rare, especially for fathers. They also found that appropriate referral and follow-up of positive screens posed a major challenge in the studies.

“[T]he current literature clearly documents the high number of parents who screen positive outside of the immediate postpartum period as well as its impact on the well-being of parents and children,” the authors concluded. “The findings also suggest that additional research is required to assess the best practices for referral and follow-up of parents who screen positive for depressive symptoms to ensure they receive the support they need.”

For related information, see the Psychiatric News article “Postpartum Anxiety, Depression Raise Risk of Developmental Delays.”

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Wednesday, June 29, 2022

Cyberbullying Linked to Youth Suicidality, Study Shows

Youth who are bullied online are more liable to have suicidal thoughts or attempt suicide than others who do not experience such bullying, even when accounting for other risk factors such as offline bullying or peer aggression, according to a report in JAMA Network Open.

“At a time when young adolescents are spending more time online than ever before, this study underscores the negative impact that bullying in the virtual space can have on its targets,” senior author Ran Barzilay, M.D., Ph.D., of the Children’s Hospital of Philadelphia said in a news release. “Given these results, it may be prudent for primary care providers to screen for cyberbullying routinely in the same way that they might screen for other suicide risk factors like depression.”

The researchers analyzed data from 10,414 U.S. youth aged 10 to 13 years who are participants in Adolescent Brain Cognitive Development (ABCD) study. The main outcome was youth-reported suicidality, as reported in the ABCD two-year follow-up assessment.

ABCD participants were asked about past and current suicidal ideation and suicide attempts (using the Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5) as well as past experiences of being the victims or perpetrators of cyberbullying. The ABCD Cyber Bully Questionnaire defined cyberbullying as “purposefully trying to harm another person or be mean to them online, in texts or group texts, or on social media (like Instagram or Snapchat).” The participants were also asked about their experiences as the victims or perpetrators of offline aggression.

A total of 796 of the participants (7.6%) endorsed suicidality—either suicidal ideation, having made a suicide attempt, or both; 930 participants (8.9%) reported being a target of cyberbullying, and 96 (0.9%) reported being a perpetrator of cyberbullying. Female and Black participants, respectively, were more likely than male participants and participants of any other race or ethnicity to experience cyberbullying.

After controlling for demographics, the researchers found that adolescents who were the targets of cyberbullying were 4.2 times more likely to report suicidality than those who had not. Experiencing cyberbullying remained associated with suicidality when accounting for multiple environmental risk and protective factors previously linked to suicidality in the ABCD study and for psychopathology. In contrast, engaging in cyberbullying was not associated with suicidality.

“For clinicians working directly with adolescents, this work suggests that cyberbullying experiences are associated with suicidality over and above multiple known risk factors; therefore, it may be prudent to ask adolescents about this exposure as part of primary care evaluations,” the authors wrote. “For policymakers wishing to optimize youth suicide prevention efforts, this study should further encourage addressing … cyberbullying experiences in interventions,” they wrote.

For related information, see the Psychiatric News article “Youth Online Behavior Offers Clues to Suicidality.”

(Image: iStock/Highwaystarz-Photography)




APA Online Systems Upgrade Coming, Password Reset Required

APA is upgrading its member portal (my.psychiatry.org), which is used to log into many connected APA websites. Updates about this transition are available on this web page. Several APA systems will be unavailable during maintenance on July 9 and 10. All members and APA website users will need to activate their accounts and set a new password. Going forward, the username you use to log into the system will always be the same as your primary email address on file. If you do not see an email by July 12, you may proceed to my.psychiatry.org and click “Forgot Password?.” If you have forgotten your Username, contact apa@psych.org or call APA Customer Service at 202-559-3900.

Tuesday, June 28, 2022

Pregnant Women Don’t Perceive Regular Cannabis Use to Be of Great Risk, Survey Suggests

Despite evidence to the contrary, nearly 3 of 4 pregnant women in the United States do not characterize regular cannabis use as a great risk, according to a report in the American Journal of Preventive Medicine. These findings were based on survey responses of more than 15,000 pregnant women aged 12 to 44.

While the data are still emerging, “several studies suggest that marijuana use during pregnancy could be linked to problems with attention, memory, problem-solving skills, and behavior in their children later in life,” according to the Centers for Disease Control and Prevention.

Omayma Alshaarawy, M.B.B.S., Ph.D., and Alyssa Vanderziel, M.S., of Michigan State University analyzed data collected between 2002 and 2019 from the National Survey on Drug Use and Health (NSDUH), an annual survey by the Substance Abuse and Mental Health Services Administration that asks participants about tobacco, alcohol, and drug use; mental health; and other health-related issues. The data are extrapolated to the U.S population. The analysis included the responses of 15,109 pregnant women to questions about their cannabis consumption and perception of risk of regular cannabis use.

The authors defined cannabis consumption as the use of cannabis at least once in the past 30 days. To assess perceptions of risk of cannabis use, the participants were asked “How much do people risk harming themselves physically and in other ways when they smoke marijuana once or twice a week?”

The prevalence of prenatal cannabis use nearly doubled from 2002 to 2017, but there was no significant change in the prevalence of prenatal cannabis use between 2016-2017 (5.8%) and 2018-2019 (4.7%), Alshaarawy and Vanderziel reported. The percentage of pregnant women perceiving regular cannabis use as a great risk was about 50% from 2002 to 2007; by 2019, this percentage had dropped to 27%.

The researchers noted that because the question of risk of cannabis use was not specific to prenatal use, it is possible that the participants’ responses “might reflect perceptions of risk related to use among nonpregnant people and not necessarily related to potential harms inflicted on the pregnant mother and/or fetus.”

They concluded, “As cannabis legalization increases, public health efforts are needed to raise awareness of the possible harms associated with cannabis use.”

For related information, see the Psychiatric News article “Cannabis Use During Pregnancy on the Rise.”

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Monday, June 27, 2022

Brain Stimulation May Reduce Negative Symptoms of Schizophrenia, Meta-Analysis Suggests

Noninvasive neuromodulation therapies that excite neurons in a specific part of the brain’s prefrontal cortex are effective at reducing negative symptoms of schizophrenia such as social withdrawal or lack of communication, according to a meta-analysis in JAMA Psychiatry. The analysis found that both magnetic stimulation and electrical stimulation approaches can be effective.

“Although antipsychotic drugs are relatively effective in mitigating positive symptoms of schizophrenia, their efficacy is limited for the treatment of the negative symptoms of the illness,” wrote Ping-Tao Tseng, M.D., Ph.D., of Asia University in Taichung, Taiwan.

The researchers compiled data from 48 randomized clinical trials comparing the effects of active brain stimulation versus a sham control in patients with schizophrenia or schizoaffective disorder. The combined data included 2,211 participants and 22 neuromodulation techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS).

The meta-analysis revealed seven neuromodulation therapies that led to greater improvements in negative symptoms compared with sham stimulation. These included high-definition transcranial random noise stimulation (which involves stimulating the brain with electrical currents that continually change frequency), high frequency (10 Hz) and extreme high frequency (20 Hz) rTMS, intermittent theta burst stimulation (TMS that is applied in very rapid bursts), and three slight variations of tDCS. All seven approaches involved high-frequency stimulation to a region in the dorsolateral prefrontal cortex called F3.

High-definition transcranial random noise stimulation was associated with the greatest alleviation of negative symptoms. The analysis also revealed that patients who received combined tDCS stimulation to both F3 and another cortical region called F4 experienced significant improvements in both negative symptoms and depressive symptom severity compared with patients who received sham stimulation. Tseng and colleagues cautioned both these results came from just one study each.

“To our knowledge, this is the first network meta-analysis to directly investigate the potential benefits of [noninvasive brain stimulation] for treating negative symptom severity in patients with schizophrenia,” Tseng and colleagues wrote. “Our findings might serve as a starting point for future large-scale RCTs with longer follow-up periods and sham control to investigate the association between [noninvasive brain stimulation] and negative symptoms in schizophrenia.”

For related information, see the American Journal of Psychiatry article “Cerebellar-Prefrontal Network Connectivity and Negative Symptoms in Schizophrenia.”

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Friday, June 24, 2022

APA Issues Statement Opposing Dobbs v. Jackson Decision

Today APA issued a statement expressing disappointment in the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization regarding abortion rights. Today’s decision overturns that of Roe v. Wade, which guaranteed women nationwide the right to a safe abortion. Now the legality and access to abortion will be left up to the states to determine. APA urged Congress and the Biden administration to act immediately to protect access to abortion services.

APA summarized its response to the decision this way: “By dismantling nearly 50 years of legal precedent, the Court has jeopardized the physical and mental health of millions of American women and undermined the privacy of the physician-patient relationship.”

The organization added that the Dobbs decision will disproportionately affect vulnerable populations, such as communities of color, people living in rural areas, and people who have low incomes and may have to travel long distances to receive abortions.

“In light of the ruling, the American Psychiatric Association, alongside many of its colleagues in the house of medicine and in the field of mental health, pledges to continue its long-standing support for legal abortion services,” APA said.

APA also joined the American Psychological Association and the National Association of Social Workers in a joint statement decrying the decision. “Our nation is already experiencing a mental health crisis. This is yet another factor that will contribute to negative mental health outcomes for our society,” the organizations said. They also noted how the inability to obtain an abortion increases the risk for domestic abuse when women must stay in contact with violent partners, which puts both the women and their children at risk.

For further information, see the Psychiatric News article “APA Joins Amicus Brief Opposing Abortion Restrictions.”




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Thursday, June 23, 2022

APA Praises House Passage of Legislation to Address Nation’s Mental Health Crisis

APA yesterday applauded the passage of the Restoring Hope for Mental Health and Well-Being Act (HR 7666) by the House of Representatives, calling the bill “an important step to expeditiously address the nation’s mental health crisis.”

In addition to reauthorizing federal programs that promote access and coverage to behavioral health and substance use disorder services, APA noted in a news release that HR 7666 includes several provisions that are high priorities for APA:

  • Parity: Eliminates the parity opt-out for non-federal governmental health plans and provides funding for state insurance departments to enforce and ensure compliance with the mental health parity law.
  • Collaborative Care: Supports uptake of the evidence-based Collaborative Care Model via grants to primary care practices to better integrate behavioral health care into primary care settings.
  • Crisis Services: Directs funding through the Substance Abuse and Mental Health Services Administration (SAMHSA) for 988 Lifeline implementation and supports state implementation of the lifeline through technical assistance and coordination.
  • Workforce Equity Investments: Makes crucial investments in the behavioral health care workforce by reauthorizing and increasing authorized funding for SAMHSA’s Minority Fellowship Program.

A summary of the bill notes that the bill also “expands access to opioid and other substance use disorder treatments and recovery support services. For example, the bill (1) eliminates a provision that generally requires individuals to be addicted to opioids for at least a year before being admitted to an opioid treatment program, and (2) promotes access to high-quality recovery housing.”

“Our nation faces an unprecedented mental health crisis among people of all ages, one that has been exacerbated by the pandemic and continuing acts of mass violence. At the same time, more than one million Americans have lost their lives to drug overdoses over the past two decades, devastating their families, our communities, and nation as a whole,” a statement from the White House noted. “To ensure we have a mental health and substance use care system that works for everyone, investments to shore up these systems are essential.”

The bill will now move to the Senate. APA encourages members to contact their senators to ask for their support in passing this bill.




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