Friday, September 18, 2020

Researchers Warn of Post-Lockdown Influx of Alcohol-Related Emergencies Among Youth

Hospitals and emergency services should be prepared for a possible influx of adolescents and young adults with alcohol-related emergencies as their localities open up after COVID-19 lockdowns, suggests a study in the Journal of Adolescent Health. The study found that the proportion of alcohol-related emergency department (ED) visits to two Italian hospitals jumped for this population in the weeks following the end of this spring’s lockdown compared with the same time frame in 2019.

Veronica Grigoletto, M.D., of the University of Trieste and colleagues analyzed data on ED visits of patients aged 13 to 24 years that occurred during the following periods:

  • The last three weeks of lockdown, April 10, 2020, to May 3, 2020
  • The first three weeks after reopening, May 4, 2020, to May 27, 2020
  • April 10, 2019, to May 3, 2019
  • May 4, 2019, to May 27, 2019

When the researchers compared the number of ED visits by adolescents and young adults for the three weeks after reopening with that of the same time frame for 2019, they found that although the total number of ED visits in this age group was lower in 2020, a greater proportion of those visits were related to alcohol intoxication. From May 4 to May 27, 2019, 506 adolescents and young adults visited the ED, and 15 of those patients (2.96%) came because of alcohol abuse. In the three weeks after reopening in 2020, 221 patients in that age group visited the ED, and 25 of those patients (11.31%) came because of alcohol abuse.

“Considering that the reference population did not change and that other emergency facilities are not available in the area, these numbers seem to reflect an actual change in the relative impact of severe alcohol intoxication on ED arrivals,” the researchers wrote. They added that transitioning after lockdown “demands rapid adjustment and appropriate reintegration strategies, requiring mental skills that not everyone is able to implement.”

“Excesses belong to the typical pattern of behavior of adolescents and young adults, but to this extent, they may even result in life-threatening events,” they wrote. To that end, they suggested that both pediatric and adult services be prepared for a possible upswing in post-lockdown emergencies related to alcohol abuse.

For related information, see the Psychiatric News article “Pandemic Creates Challenges, New Opportunities for Treating Patients With Substance Use Disorder.”

(Image: iStock/MJFelt)

Thursday, September 17, 2020

To Protect Public Health, U.S. Must Prioritize Worker Safety During COVID-19 Pandemic

The COVID-19 pandemic presents an enormous worker safety crisis to those caring for patients and others providing public-facing services, according to a Viewpoint article published in JAMA. Today is World Patient Safety Day, and the article highlights the importance of ensuring the safety of health workers, today’s theme.

U.S. employers are required under law to provide their employees with safe workplaces, and the Occupational Safety and Health Administration (OSHA) is tasked with enforcing the law, wrote David Michaels, Ph.D., M.P.H., of the Milken Institute School of Public Health, and Gregory Wagner, M.D., of the Harvard T.H. Chan School of Public Health.

“While OSHA could be making an important contribution to reversing the spread of the SARS-CoV-2 virus and mitigate risk to workers, their families, and communities, the federal government has not fully utilized OSHA’s public safety authority in its efforts to reduce the risk of COVID-19,” the authors wrote.

As of September 16, more than 155,000 hospital and nursing home staff have been infected by COVID-19 at work, and nearly 700 have died, according to the Centers for Disease Control and Prevention. “As the epidemic has spread, many other workers, including emergency responders, corrections officers, transit workers, and workers in meat and poultry factories, farms, grocery stores, and warehouses, also have been infected by SARS-CoV-2,” Michaels and Wagner wrote.

“As businesses reopen, not only ‘essential’ workers but all workers need to be protected,” they continued. “Unprotected workers will inevitably bring the virus from work to their homes and communities, setting back efforts to decrease the spread of infection, reduce morbidity and mortality, and rebuild the economy.”

All workplaces must have clear COVID-19 prevention plans, Michaels and Wagner wrote, that include the following:

  • Workplaces should be designed to eliminate crowding and allow physical distancing.
  • Employees should be provided with personal protective equipment (PPE).
  • Workplaces should have enhanced ventilation and adequate hand sanitation and hand-washing facilities.
  • Potentially contaminated surfaces should be disinfected.
  • Workers should be screened for COVID-19.
  • Adequate paid sick leave or unemployment compensation should be provided for those who cannot work due to COVID-19 concerns.

The authors urged the federal government to increase PPE production and OSHA to issue an emergency temporary standard (ETS) “that would require every employer to develop and implement an infection control plan,” they wrote. The federal government should also provide subsidies to businesses to meet the requirements of an ETS.

“The unprecedented nature of the COVID-19 pandemic requires strong and immediate action, including by government agencies, unions, employers, and workers,” the authors concluded. “Failure to exert leadership and develop effective policy in this area, including involving and engaging all affected groups and constituencies in stopping workplace spread of the virus, has had and will likely continue to have serious repercussions, not just for workers, but for the health and economy of the nation.”

For related information, see the Psychiatric News article “Psychiatrists Respond to MH Needs of Patients, Frontline COVID-19 Workers.”

(Image: iStock/Halfpoint)

Wednesday, September 16, 2020

Older Physicians Experience Less Work-Related Stress, Psychological Distress Than Younger Colleagues

Physicians experience higher rates of psychological distress and suicidal ideation than the general population, but the experience of age may act as a buffer for older physicians, a study in the American Journal of Geriatric Psychiatry suggests. The study also found that work-life conflict declined as physicians grew older.

Chanaka Wijeratne, M.D., of the University of Notre Dame, Australia, and colleagues analyzed data from 10,038 physicians who responded to the National Mental Health Survey of Doctors and Medical Students, which was conducted in Australia. They divided responses into three groups according to physician age: younger (40 years old and younger), middle aged (41 to 60 years old), and older (61 years old or older). Physicians were asked whether they had experienced suicidal ideation and/or had been given a diagnosis of anxiety or depression over the preceding 12 months. They were also asked if they were distressed over work stressors such as conflict between study/career and family/personal responsibilities, finances and debt, long work hours, sleep deprivation, and difficult relations with senior colleagues, among others. They were asked to rate their distress over these stressors as “not at all stressed,” “not that stressed,” or “very stressed.” Physicians also answered questions about feelings of exhaustion, cynicism toward their work, whether they felt they were effective at work, and their drinking habits.

Compared with middle-aged and younger physicians, older physicians reported fewer workplace stressors that made them feel “very stressed,” and they were less likely to report distress over work-life conflict. As a group, older physicians felt less distress over work-related stressors in general, less exhaustion, less cynicism toward their work, and greater personal efficacy at work compared with their younger and middle-aged peers, and they were less likely to report suicidal ideation or a diagnosis of anxiety or depression over the preceding 12 months. However, their likelihood of reporting distress increased if they had a history of mental illness. There were no significant differences in high-risk drinking between groups, although younger physicians were more likely to engage in moderate-risk drinking compared with their middle-aged and older colleagues.

“Whilst the extant literature has suggested that physicians experience poor mental health, it can be seen that it needs to be considered more broadly in the context of age and career stage as there is an improvement in physicians’ reporting of psychological distress, suicidal ideation, burnout, and experience of workplace stress as they age,” the researchers wrote.

For related information, see the American Journal of Psychiatry article “Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession.”

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Tuesday, September 15, 2020

Suicide Rates Peak Among Veterans Shortly After Transition to Civilian Life, Study Finds

Suicide rates among veterans peaked six to 12 months after they left the military, and those at higher risk included veterans who were younger, were male, had a shorter length of service, were not married, or were separated from the Marine Corps or Army, according to a study published in JAMA Network Open.

“National leaders at the highest levels of the U.S. government have been concerned about suicide rates among service members transitioning to civilian life,” wrote Chandru Ravindran, M.S., of the Center of Excellence for Suicide Prevention and colleagues. “We believe this cohort study provides much needed data to help inform prevention efforts among this veteran cohort.”

The authors used data from the VA/Department of Defense Identity Repository to identify 1.8 million veterans who served in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard. The participants separated (meaning they were either discharged or transitioned to a Reserve component category) from active duty between January 1, 2010, and December 31, 2017. Mortality data were obtained through the VA/Department of Defense Mortality Data Repository. Service members were followed for six years from the date they left service.

“Through the end of the study period, 3,030 suicides (2,860 men and 170 women) were identified as having occurred within 6 years of separation from the military,” wrote the authors. “The highest suicide rates were observed in year 1, but they increased over the first 6 months and generally peaked in the 6 to 12 months after separation. This pattern was true for service members who left the Army, Marine Corps, or Air Force; the rates for those who last served in the Navy peaked 3 to 6 months after their transition.”

Veterans who had served in the Marine Corps or Army had a higher risk of suicide compared with those who had left the Navy or Air Force, and male veterans had a higher risk compared with females. The rate of suicide was 4.5 times higher among those who were 17 to 19 years old compared with those who were over 40 when they transitioned from the military. Also, those who had served for fewer than two years had a statistically higher rate of suicide over the study period compared with those who had served longer.

“[W]ithin the high-risk cohort of transitioning service members, suicide prevention resources are especially important in the first year and remain important for at least 6 years given that the rates did not decline substantially within the study period,” the authors wrote. “Prevention efforts may be helpful for younger service members with fewer than 2 years of military service. Furthermore, service branch remains a risk factor for many years after transition and could be examined for more focused suicide prevention efforts.”

For related information, see the Psychiatric News article “Brief Test May Help Pinpoint Soldiers Likely to Attempt Suicide.”

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Monday, September 14, 2020

Sexual Minorities More Likely to Experience Comorbid SUDs, Psychiatric Disorders Than Heterosexuals

Adults who identify as gay, lesbian, or bisexual with alcohol or tobacco use disorder are more likely to have another psychiatric illness than adults who identify as heterosexual, according to a report in AJP in Advance.

“[I]t is important for clinicians to know that psychiatric comorbidities are more often present than not among sexual minorities who present with an alcohol or tobacco use disorder,” wrote Rebecca Evans-Polce, Ph.D., of the University of Michigan and colleagues. “This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities.”

Evans-Polce and colleagues used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions–III. As part of the survey, participants were asked questions about past-year alcohol use disorder and tobacco use disorder. The researchers analyzed data from 35,796 participants who had reported information on their sexual orientation (options included heterosexual, gay or lesbian, bisexual, or not sure) and other psychiatric conditions. Psychiatric disorders were grouped as mood disorders, anxiety disorders, or posttraumatic stress disorder (PTSD).

Among all survey respondents, 5,042 reported alcohol use disorder, and 7,188 reported tobacco use disorder in the past year. Of this group, 34.0% of adults with alcohol use disorder and 35.6% with tobacco use disorder also had a mood disorder, anxiety disorder, or PTSD. The researchers found that psychiatric comorbidities were more prevalent among members of sexual minorities; for example, 51.2% of gay or lesbian adults and 55.2% of bisexual adults who met the criteria for a past-year alcohol use disorder had a psychiatric disorder compared with 32.9% of heterosexual individuals.

Evans-Polce and colleagues also found that among members of sexual minorities, the number of stressful life events, number of adverse childhood experiences, and frequency of discrimination due to sexual orientation all contributed to the risk of comorbid psychiatric and alcohol and/or tobacco use disorders. Greater social support slightly reduced the risk of comorbid tobacco use disorder and anxiety disorders as well as comorbid tobacco use disorder and mood disorders.

“Clinicians should be cognizant of the challenges faced by sexual minorities and should consider these factors as part of their initial assessment and treatment,” Evans-Polce and colleagues wrote. “Importantly, treatment environments should be affirming of sexual minority status. Clinicians should examine their policies and practices to ensure that they are not engaging in discriminatory practices.”

For related information, see the Psychiatric Services article “Stress, Coping, and Context: Examining Substance Use Among LGBTQ Young Adults With Probable Substance Use Disorders.”

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Friday, September 11, 2020

E-Cigarette Use Tied to Sleep Deprivation in Young Adults

E-cigarette use, also known as vaping, may be associated with an increased risk of sleep deprivation in young adults aged 18 to 24 years even after they quit, a study in Addictive Behaviors has found. The study also suggests that e-cigarette use is rising in this age group.

Sina Kianersi, D.V.M., of the Indiana University School of Public Health and colleagues analyzed data from 18,945 young adults who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2017 and 2018. The BRFSS is an annual telephone survey of adults living in the United States and its territories in which participants report on their health behaviors. Kianersi and colleagues drew their data from responses to questions that asked respondents how many hours they sleep in a 24-hour period; whether they have ever used an e-cigarette or other vaping device; and whether they currently use e-cigarettes or other vaping devices and, if so, how often. Sleep deprivation was defined as less than seven hours of sleep.

In 2018, 47% of young adults had ever used an e-cigarette, up from 39% the year before. In 2018, roughly 16% of young adults currently used e-cigarettes, up from 10% the year before. For both years, roughly 34% of young adults experienced sleep deprivation. Compared with young adults who had never used e-cigarettes, those who used e-cigarettes every day were 1.42 times more likely to report sleep deprivation. Those who had used e-cigarettes in the past and stopped were 1.17 times more likely to report sleep deprivation than those who never used e-cigarettes.

“Those who use e-cigarettes on a daily basis might consume higher doses of nicotine, compared to some days, former, and never users, and therefore get fewer hours of sleep,” the researchers wrote. They added that nicotine withdrawal is associated with sleeping more, which could explain why former e-cigarette users were less likely to report sleep deprivation than current e-cigarette users even though former e-cigarette users still had an elevated risk.

“Future studies with longitudinal designs and more precise measurement of different aspects of sleep will be critical to better understand the strength, magnitude, and causal nature of these relationships,” they wrote.

For related information, see the Psychiatric News article “National Academies Report Details Health Impact of E-Cigarettes.”

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Thursday, September 10, 2020

Suicide-Related ED Visits in United States Continue to Rise

The rate of emergency department (ED) visits related to suicidal ideation or attempt increased for all age groups between 2008 and 2017, according to a Healthcare Cost and Utilization Project statistical brief. Today is World Suicide Prevention Day, and the brief’s findings highlight the need to work to prevent death by suicide.

“Suicide is a major and growing public health concern in the United States, ranking among the top 10 leading causes of death.” wrote Pamela L. Owens, Ph.D., of the Agency for Healthcare Research and Quality and colleagues. “From 2001 to 2017, the suicide rate increased 31%, from 10.7 to 14.0 per 100,000 population. In 2017, this equated to more than 47,000 deaths.”

The authors’ findings included the following:

  • The rate of ED visits related to suicidal ideation or suicide attempt in 2017 was highest among those aged 15 to 19 (952.5 per 100,000 population), 20 to 24 (719.3 per 100,000 population), and 25 to 44 (642 per 100,000 population).
  • Overall, the rate of ED visits related to suicide was higher among males compared with females in 2017. However, among those aged 10 to 19, the rate was higher among females.
  • Overall, the highest rate of suicide-related ED visits was for females aged 15 to 19 years.
  • Medicaid and Medicare were the most frequent payers for ED visits related to suicide.
  • In 2017, nearly 65% of ED visits related to suicide resulted in a hospital admission or transfer to another facility, compared with only 17% of other ED visits.

“Suicide is preventable,” the authors wrote. “Suicidal thoughts or actions are indications of extreme distress and require immediate intervention. [EDs] are an important site of care to identify individuals at risk, to provide timely support and intervention, and, in some cases, to facilitate entry into more intensive treatment. Information on trends in ED utilization related to suicidal ideation or suicide attempt can help inform resource needs and target prevention efforts.”

(Image: iStock/MJFelt)

Today Is World Suicide Prevention Day; Help Stop Needless Deaths

Each year more than 45,000 people die by suicide. But there is hope—new research is revealing who is at greatest risk, and this understanding will help psychiatrists save lives.

Read More

Wednesday, September 9, 2020

Depression Symptoms Soar During Pandemic, Study Finds

The prevalence of symptoms of depression in U.S. adults during a two-week period of the COVID-19 pandemic was more than three times higher than before the pandemic, according to a report in JAMA Network Open.

Moreover, people with a lower income, savings of less than $5,000, and greater exposure to COVID-19 stressors were more likely to have depressive symptoms than people who did not fall into those categories.

“These findings suggest that there is a high burden of depression symptoms in the United States associated with the COVID-19 pandemic and that this burden falls disproportionately on individuals who are already at increased risk,” wrote Sandro Galea, M.D., Dr.PH., of Boston University School of Public Health and colleagues.

Between March 31 and April 13, Galea and colleagues surveyed a nationally representative sample of 1,470 U.S. adults aged 18 or older about COVID-19 exposure, life stressors, and mental health using the COVID-19 and Life Stressors Impact on Mental Health and Well-being study questionnaire. COVID-19 stressors included, among others, the loss of a job, the death of someone close due to COVID-19, and financial difficulties. Depression symptoms were assessed using the Patient Health Questionnaire-9.

The prevalence of depression symptoms reported during the COVID-19 pandemic was then compared with that reported by 5,065 participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES).

The researchers found that a total of 382 participants (27.8%) had depression symptoms during COVID-19 compared with 458 participants (8.5%) before COVID-19. Higher levels of depression symptoms were observed in all demographic groups during COVID-19 compared with before, and across all levels of severity—mild, moderate, and severe.

Compared with individuals with an annual household income of $75,000 or more, those with a household income of $19,999 or less had 2.4-fold increased odds of depression symptoms. Individuals with household savings less than $5,000 had 1.5-fold increased odds of depression symptoms. Experiencing more COVID-19 stressors was also associated with greater odds of depression symptoms compared with people with low stressor exposure.

In an editorial accompanying the study, Ruth Shim, M.D., M.P.H., director of cultural psychiatry at the University of California, Davis, emphasized the need to address socioeconomic factors and their impact on mental health. “The study … might remind us of the importance of investing (both during and after the COVID-19 pandemic) in stable housing, unemployment benefits, access to healthy food, and policies that end discrimination and exclusion to effectively manage a highly disabling, common mental health condition that will likely only increase in prevalence as the pandemic rages on.”

For related information, see the Psychiatric News article “Expect a ‘Long Tail’ of Mental Health Effects From COVID-19.”

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World Suicide Prevention Day Is Tomorrow; Help Stop Senseless Deaths

Each year more than 45,000 people die by suicide. But there is hope—new research is revealing who is at greatest risk, and this understanding will help psychiatrists save lives.

Read More

Tuesday, September 8, 2020

Considering Mental Health Apps? APA App Advisor Can Help

As the number of mental health apps available for download continues to rise, psychiatrists are likely to receive questions from patients on the risks and benefits of these products. To help psychiatrists and other mental health professionals when selecting apps, APA has created the APA App Advisor—a website that guides users through questions to consider when evaluating mental health apps.

The APA App Advisor is an outgrowth of a mobile app evaluator put forth by an APA work group in 2017. Last December, APA brought together a diverse expert panel to assess the evaluation tool and consider ways to enhance it. The panel included not just psychiatrists but also psychologists, social workers, nurse practitioners, medical students, and people with lived experience of mental illness.

“We wanted to make sure a lot of different voices were heard,” John Torous, M.D., director of the Digital Psychiatry Division at Beth Israel Deaconess Medical Center and chair of the expert panel, told Psychiatric News.

The panel recommended the following questions as a good “jumping off” point when considering any mental health app:

  • On which platforms/operating systems does the app work? Does it also work on a desktop computer?
  • Has the app been updated in the last 180 days?
  • Is there a transparent privacy policy that is clear and accessible before use?
  • Does the app collect, use, and/or transmit sensitive data? If yes, does it claim to do so securely?
  • Is there evidence of specific benefit from academic institutions, end-user feedback, or research studies?
  • Does the app have a clinical/recovery foundation relevant to your intended use?
  • Does the app seem easy to use?
  • Can data be easily shared and interpreted in a way that is consistent with the stated purpose of the app?

The App Advisor features written and video tutorials on the evaluation tool, including some basics on navigating it. It also includes sample evaluations of 11 popular mental health and well-being apps conducted by panel members.

Torous emphasized that APA is not endorsing any of these apps by evaluating them. “These evaluations are aimed at giving psychiatrists a sense of what to look for when reviewing an app so they can make the most informed decision for their patient and practice,” he said.

For related news, see the Psychiatric Services article “Smartphone Apps for College Mental Health: A Concern for Privacy and Quality of Current Offerings.”

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Friday, September 4, 2020

One 20-Minute Call May Encourage Medication Treatment, Lower Overdose Risk in Patients With OUD

Receiving a 20-minute phone call from a trained peer counselor may help prompt people who have overdosed on opioids to begin medication treatment and lower their risk of another opioid overdose, suggests a study in Drug and Alcohol Dependence.

Theresa Winhusen, Ph.D., of the University of Cincinnati College of Medicine and colleagues compared the rates of medication treatment enrollment, opioid overdose, and opioid use in 80 patients who were randomized to receive either standard education or education with a personalized call. Standard education consisted of an information packet with three reports that were generated from the patient’s responses to two surveys, the Personal Opioid-Overdose Risk Survey and the Opioid Overdose and Treatment Awareness Survey (OOTAS). Those in the intervention group received the standard education as well as the phone call. All patients received a naloxone nasal spray kit.

Peer counselors were enrolled in a medication treatment program for at least a year; had not used opioids for at least a year; and had experienced, witnessed, or lost a family member or friend to an overdose. They completed practice calls as part of their training, and they were required to score at least 90% on the OOTAS. All told, training and certification as a peer counselor took four hours. During the phone call with the patient, the peer counselor discussed medication treatment and answered the patient’s questions. The peer counselors were provided with guidelines for the calls, but the calls were not scripted.

At 12-month follow-up, 32.5% of patients who had received a call had begun medication treatment for opioid use disorder, compared with 17.5% of those who did not receive a call. Those who had received a call also had a lower rate of opioid overdose, 12.5% compared with 32.5% among those who had not received a call. However, there were no significant differences between opioid use between the groups, as shown by urine drug screenings conducted at different points throughout the 12 months.

“In the current era of COVID-19, it is notable that this intervention was designed to be implemented by phone, thus eliminating the need for in-person contact,” the researchers wrote. “[T]he results from this randomized pilot trial suggest that a brief, telephone-delivered intervention has promise for increasing [medication for opioid use disorder] enrollment and decreasing recurring opioid overdoses in individuals surviving an opioid overdose. Further development and testing of this … intervention, particularly in light of the current U.S. opioid epidemic, seems warranted.”

For related information, see the Psychiatric News article “SAMHSA Issues Guidance on OUD Treatment During COVID-19.”

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Thursday, September 3, 2020

Risk of Type 2 Diabetes Among Youth Who Initiate SSRI Treatment Found to Be Small

Children and adolescents who initiate treatment with selective serotonin reuptake inhibitors (SSRIs) may have a small increased risk of developing type 2 diabetes, particularly if they are publicly insured, according to a study published Wednesday in JAMA Psychiatry.

“The magnitude of association was more modest than previously reported, and the absolute risk was small,” wrote Jenny Sun, Ph.D., and Sonia Hernández-Díaz, M.D., Dr.P.H., of the Harvard T.H. Chan School of Public Health and colleagues. “This potential risk, which is much lower in magnitude than the other known risk factors for [type 2 diabetes], should be weighed against the known benefits and risks of SSRI treatment to help inform treatment decision-making in the pediatric population.”

Researchers used U.S. claims data on more than 1.5 million patients from two databases. The Medicaid Analytic eXtract (MAX) database included information from 2000 to 2014 of patients enrolled in Medicaid and the Children’s Health Insurance Program. The IBM MarketScan database consisted of information from 2003 to 2015 of privately insured patients. Patients with evidence of antidepressant use, diabetes-related conditions, pregnancy, hospice care, or serious medical conditions were excluded.

Researchers identified patients aged 10 to 19 with diagnoses commonly treated with SSRIs, such as depression, generalized or social anxiety disorder, panic disorder, or obsessive-compulsive disorder. They compared patients who initiated SSRI treatment with those who had a diagnosis indicating such treatment, but who had not initiated treatment.

In total, 316,178 patients initiated SSRI treatment in the MAX database group, and 211,460 started the treatment in the IBM group. Among publicly insured patients, the rate of type 2 diabetes was 2.32 cases per 1,000 person-years among those patients who initiated SSRI treatment, and 1.65 cases per 1,000 person-years among those patients who did not receive the treatment. The association strengthened with longer treatment periods, corresponding to 6.6 additional cases of type 2 diabetes per 10,000 patients continuously treated for at least two years. There was no meaningful increased risk for type 2 diabetes among privately insured patients.

“The increased risk of [type 2 diabetes] was observed in publicly insured patients, who are of lower socioeconomic status and represent a population with greater overall medical burden, more comorbidities, and a higher prevalence of risk factors for [type 2 diabetes],” the authors wrote. “When making treatment decisions in young patients, this potential small risk of [type 2 diabetes], along with other potential adverse effects of SSRIs such as nausea and sleep disturbances, should be weighed against the benefits of treating pediatric depression and anxiety disorders.”

For more information, see the Psychiatric News article “Exposure to Antipsychotics May Increase Risk of Type 2 Diabetes in Youth.”

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Wednesday, September 2, 2020

APA Releases Updated Practice Guideline for Treatment of Patients With Schizophrenia

Yesterday, APA released a new evidence-based guideline on treating patients with schizophrenia.

The APA Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, replaces the previous practice guideline released in 2004. It is also the first APA guideline for an entire disorder that uses standards set forth by the Institute of Medicine in 2011 to ensure clinical guidelines meet high standards of transparency and scientific rigor.

As with APA’s previous guidelines, clinical recommendations were made by a diverse group of experts following a systematic evaluation of relevant literature. The expert work group made 24 recommendations spread across the topics of patient assessment and treatment planning, pharmacotherapy, and psychosocial interventions.

For the key first step of patient assessment, the guideline recommends that patients with schizophrenia receive a thorough evaluation, including assessments of a patient’s physical health; cognitive health; their risk of harming themselves or others; and substance use, including nicotine. Afterward, physicians and patients should work together on a comprehensive, person-centered treatment plan that includes evidence-based pharmacological and nonpharmacological treatments.

The guideline reaffirms that patients diagnosed with schizophrenia should be treated with an antipsychotic medication and that patients whose symptoms improve while taking an antipsychotic medication should continue with maintenance antipsychotic treatment. With the exception of clozapine—recommended as the first choice for treatment-resistant schizophrenia, patients with high suicide risk, and patients with a high risk of aggressive behavior—the guideline does not make any recommendations about specific oral or long-acting injectable antipsychotics. The guideline, does, however, include detailed tables with dosing considerations, metabolic properties, and potential side effects of all FDA-approved antipsychotics.

“Although there may be clinically meaningful distinctions in response and tolerability of different antipsychotic medications in an individual patient, there is no definitive evidence that one antipsychotic will have consistently superior efficacy compared with another, with the possible exception of clozapine,” the work group wrote.

Among psychosocial interventions, the guideline strongly recommends that patients receive cognitive-behavioral therapy for psychosis, education about schizophrenia, and supported employment services. The guideline also strongly recommends that patients experiencing their first episode of psychosis are treated in a coordinated specialty care program. If possible, patients should also receive interventions aimed at developing their self-management skills.

All the outlined recommendations “should be made in collaboration with the patient, whenever possible, and should incorporate the patient’s personal and sociocultural preferences and values in order to enhance the therapeutic alliance, adherence to treatment, and treatment outcomes,” the work group wrote.

To read more about this topic, check out APA’s Schizophrenia Resource Center.

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Tuesday, September 1, 2020

Discrimination May Increase Risk of Severe Alcohol Use in Minorities

Racial and ethnic discrimination may increase the risk that members of minority groups will experience severe alcohol use disorder (AUD), according to a report in Drug and Alcohol Dependence.

“Our findings [should] prompt researchers and practitioners to consider the extent to which systems of oppression can impact the pathogenesis, trajectories, and recoveries (including relapse) of AUD, and how shifting policies and practices can move toward the dismantling of oppression that give rise to illnesses,” wrote Joseph E. Glass, Ph.D., M.S.W., of Kaiser Permanente Washington Health Research Institute and colleagues.

The authors analyzed data from 17,115 racial/ethnic minorities who participated in the National Epidemiological Survey on Alcohol-Related Conditions III (NESARC-III), a national survey that took place in 2012-2013. This included the responses of individuals who identified as American Indian or Alaskan Native; Asian, Native Hawaiian, or Other Pacific Islander; Black or African American; and Hispanic or Latino.

During in-person interviews, participants were evaluated using the AUD and Associated Disabilities Interview Schedule-5. (AUD severity levels were classified as mild, moderate, or severe: endorsing 2−3, 4–5, or ≥6 DSM-5 criteria, respectively.) The participants were also asked how often in the past year they felt they had “experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior” because of their race or ethnicity. Specifically, the participants were asked about discrimination in several situations, including when receiving health care treatment, when applying for housing and jobs, and when interacting with the police.

In comparison with those who did not experience discrimination, those who experienced any discrimination had a 1.5-fold greater risk of mild AUD, a 1.6-fold greater risk of moderate AUD, and a 2.3-fold greater risk of severe AUD. “We found no evidence to suggest that the strength of the association between racial/ethnic discrimination and AUD severity varied across race/ethnic group or poverty status,” the authors noted.

“Strategies to reduce risk for severe AUD should include efforts to minimize the occurrence and impact of interpersonal and institutional racism,” they concluded.

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Help Determine APA’s Future
Nominate yourself or a colleague

As chair of APA’s Nominating Committee, Immediate Past President Bruce Schwartz, M.D., is seeking to diversify the elected leadership of APA and invites all members to consider running for one of the open Board of Trustee offices in APA’s 2021 election: president-elect; secretary; early-career psychiatrist trustee-at-large; minority/underrepresented representative trustee; Area 1, 4, and 7 trustees; and resident-fellow member trustee-elect. You may nominate yourself or a colleague—the important point is that you get involved! The deadline is today, September 1.

Access Nomination Requirements and Form

Monday, August 31, 2020

Digital CBT May Reduce Eating Disorder Symptoms in College Women

A digital cognitive-behavioral therapy (CBT) intervention that includes personal coaching may help to reduce several symptoms of eating disorders in college women. As reported today in JAMA Network Open, women who received the digital CBT had greater reductions in negative eating-related thoughts or beliefs and the frequency of binge eating compared with women who were referred to usual university care.

“Current treatment delivery efforts for [eating disorders] on college campuses are hindered by factors such as limited counseling center capacity and access to evidence-based treatments. College students report additional barriers, including lack of time and stigma,” wrote Ellen Fitzsimmons-Craft, Ph.D., of Washington University in St. Louis and colleagues. “Digital technologies, highlighted as the future of psychiatry, have the potential to improve mental health care on college campuses by overcoming [these] barriers.”

Fitzsimmons-Craft and colleagues recruited women who had screened positive for a DSM-5 eating disorder excluding anorexia nervosa (which requires more intense medical monitoring) from 27 universities across the country. In total, 690 women were randomly assigned to participate in the online CBT program Student Bodies–Eating Disorders (SB-ED) or receive usual care, which involved a referral and encouragement to attend their university counseling center.

The women in the SB-ED group received access to the self-help CBT program for eight months with a personal coach. SB-ED includes modules that teach such skills as improving body image, regulating emotions, addressing shape-checking behaviors, and challenging negative thoughts. The program also includes meal planning and tracking tools and a personal log. The coaches provided regular feedback and support using an in-program chat function. 

The primary assessment was change in the Eating Disorder Examination-Questionnaire (EDE-Q), which assesses the severity of negative eating-related thoughts or beliefs. The investigators also measured changes in binge eating, compensatory behaviors (vomiting, laxative use, excess exercise), depressive symptoms, and academic problems (such as withdrawing from courses or taking a leave of absence). 

After eight months, EDE-Q scores decreased from 3.62 to 2.70 in the SB-ED group and 3.55 to 3.05 in the usual care group, which was a significant difference. The women in the SB-ED group also reported fewer binge-eating and compensatory behaviors as well as fewer depressive symptoms. There was no difference between SB-ED and usual care in terms of the total number of women who achieved abstinence from all eating disorder behaviors, withdrew from a course, or took a leave of absence.

“Finally, with regard to realized treatment access, the [SB-ED] intervention was far superior,” Fitzsimmons-Craft and colleagues wrote. “83% of students offered the intervention began it, whereas only 28% of students in the control group reported seeking treatment for their ED at any point.”

For related information, see Handbook of Assessment and Treatment of Eating Disorders, by APA Publishing.

(Image: iStock/martin-dm)

Friday, August 28, 2020

Drug Company Payments to Doctors Linked to Higher Pimavanserin Prescribing, Medicare Costs

Higher physician payments from drug manufacturer Acadia for Nuplazid (pimavanserin) are associated with increased pimavanserin prescription volume and Medicare costs, a study in Psychiatric Services in Advance has found. Pimavanserin is approved by the U.S. Food and Drug Administration for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis. Physician payments include payments for speaking, consulting, education, food, travel, and lodging.

“Our study adds to the growing evidence of the association between pharmaceutical industry payments to physicians and physician prescribing,” wrote Hemalkumar B. Mehta, M.S., Ph.D., of the Johns Hopkins Bloomberg School of Public Health and colleagues.

The researchers analyzed 2016 and 2017 data from the Centers for Medicare and Medicaid Services (CMS) Open Payments database and the CMS Part D Prescriber Public Use Files. The Open Payments database contains information on financial payments made by drug and medical device companies to physicians and teaching hospitals. The Part D prescriber data provide information on physician specialties and which drugs they prescribe to Medicare Part D beneficiaries.

The researchers found that physicians receiving payments wrote 46% more prescriptions for pimavanserin than those who did not receive payments, and their total prescriptions were 71% more costly to Medicare, totaling a median of $66,311 compared with a median of $38,716 for those who did not receive payments. Of 1,609 physicians who prescribed pimavanserin, 45% had received payments totaling $6,369,922. Each $10,000 in physician payments was associated with a 14% increase in pimavanserin prescription volume. Every $100 in physician payments was associated with a $175.84 increase in Medicare pimavanserin expenditures.

Half of the physicians who prescribed pimavanserin were neurologists, who received a combined $4,764,689. Seven percent of the physicians who prescribed pimavanserin were psychiatrists, who received a combined $1,462,615. Overall, psychiatrists received higher payments than neurologists, with a median of $13,543 compared with $5,890. However, Medicare expenditures associated with pimavanserin prescribing were lower for psychiatrists than for neurologists. Other medical specialists received a combined total of $142,618. The bulk of the payments, more than $5.6 million, were for speaking, consulting, and education, with the rest for food, travel, and lodging.

The researchers noted several possible reasons for the association between consulting and speaking fees paid to physicians and higher pimavanserin prescription volume.

“Physicians receiving industry payments are often content experts or key opinion leaders; in this study, physicians may have been selected on the basis of their experience treating Parkinson’s disease,” they wrote. “These prescribers also may have participated in clinical trials of the product or have otherwise interacted with pharmaceutical company representatives.”

For more information, see the Psychiatric News article, “Experts Discuss Challenges of Treating Neuropsychiatric Symptoms of Dementia.”

Thursday, August 27, 2020

Social Services Staff Found to Experience Mental Health Problems a Year After Mass Shooting

In a neighborhood where a mass shooting had occurred less than a year before, one-third of social services staff screened positive for mental health disorders, according to a study published in JAMA Network Open.

Eleven months after the shooting at the Tree of Life synagogue on October 27, 2018, in Pittsburgh, Rafael J. Engel, Ph.D., of the University of Pittsburgh and colleagues reached out to nonprofit organizations in the synagogue’s neighborhood. Eight executives of the social service agencies and educational institutions emailed surveys to their staffs aimed at measuring mental health symptoms , comprising 374 individuals.

The survey screened for depression, suicidal ideation, generalized anxiety disorder, posttraumatic stress disorder, alcohol misuse, marijuana use, and drug use for nonmedical reasons. Among the screening measures used were the Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, and Primary Care for PTSD Screen for DSM-5.

Of the 167 staff members who completed the online survey, 33.3% screened positive for at least one of the mental health disorders.

  • 24.4% screened positive for alcohol misuse
  • 21.8% screened positive for marijuana use
  • 19.9% screened positive for posttraumatic stress disorder
  • 19.2% screened positive for generalized anxiety disorder
  • 10.9% screened positive for depression
  • 9.6% screened positive for suicidal ideation
  • 9% screened positive for nonmedical drug use.

There was no statistically significant difference between the participants’ mental health screening results and their work position. “The extent to which there are positive mental health and substance use screens and no differences by work position suggests that a mass shooting is a collective trauma and the professionals within an organization are not immune from the effects, regardless of position,” the authors wrote.

“There are devastating ripple effects for communities that suffer a mass casualty event," Engel told the news outlet UPI in an interview. “We tend to focus on the immediate period after a mass shooting and, unfortunately, the individuals who work at agencies in the communities where mass-shootings occur are often overlooked.”

Help Determine APA’s Future
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As chair of APA’s Nominating Committee, Immediate Past President Bruce Schwartz, M.D., is seeking to diversify the elected leadership of APA and invites all members to consider running for one of the open Board of Trustee offices in APA’s 2021 election: president-elect; secretary; early-career psychiatrist trustee-at-large; minority/underrepresented representative trustee; Area 1, 4, and 7 trustees; and resident-fellow member trustee-elect. You may nominate yourself or a colleague—the important point is that you get involved! The deadline is Tuesday, September 1.

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Wednesday, August 26, 2020

Internet Searches for 'Anxiety' Soared in First Month of COVID Pandemic

The number of internet searches on Google for information about “anxiety” or “panic” skyrocketed in the period immediately after the declaration of a national emergency in response to COVID-19, according to a research letter published in JAMA Internal Medicine.

The number vastly exceeded the expected number of searches based on historical trends.

“Although this study cannot confirm that any search was linked to a specific acute anxiety event or panic attack, it provides evidence of the collateral psychological effects stemming from COVID-19,” wrote lead author John W. Ayers, Ph.D., of the Division of Infectious Disease and Global Health at the University of California and colleagues.

The researchers used Google Trends to analyze the percentage of internet searches that used the terms “anxiety” or “panic” in combination with the term “attack”—such as “panic attack,” “signs of anxiety attack,” or “anxiety attack symptoms”—between March 13, when President Trump declared a national emergency, and May 9. It was the period when physical distancing guidelines were imposed, the Centers for Disease Control and Prevention began urging the use of face masks, and the number of deaths from COVID-19 in the United States began to surpass that in other countries. 

The researchers compared results with historical trends from January 1, 2004, to March 12, 2020. They found that anxiety-related searches for information increased 11% during the study period compared with the period from 2004 to March 12—translating into approximately 375,000 more searches than expected. The highest spike in acute anxiety queries occurred on March 28, with 52% more queries than expected.

The number of anxiety-related searches returned to expected levels on April 15. In light of the findings, Ayers and colleagues offer three recommendations:

  • Monitoring of these trends should continue as changes during the pandemic may spark new increases in acute anxiety.
  • Communities, states, and health systems should prioritize responses to anxiety during the pandemic. For instance, Illinois launched “Call4Calm,” a hotline to help people cope with acute anxiety related to COVID-19. Such programs could be expanded nationally.
  • Google and other tech companies providing internet search tools should prominently link mental health search results with ways people can access help, such as the Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline.

For related information, see the Psychiatric News article “Netflix Drama About Teen Suicide Prompts Related Google Searches.”

Tuesday, August 25, 2020

APA Traces History of Racism in Psychiatry and the Nation in Second Member Town Hall

Just a few days before the 57th anniversary of the civil rights March on Washington, where Martin Luther King Jr. gave his “I Have a Dream Speech,” APA hosted the second in a series of town hall meetings to address structural racism in psychiatry. A distinguished panel of Black psychiatrists spoke to approximately 425 APA members about how the Black Lives Matter movement is an outgrowth of the civil rights initiatives of the 1960s, what anti-racism is, and the impact of racial injustices within the organization, the profession, and the country.

APA President Jeffrey Geller, M.D., M.P.H., described how the actions and ideals put forth in the March on Washington are not only relevant, but necessary today.

“The tradition of advocacy and organizing continues because racial injustices are very much alive in the United States,” Geller said. “Beyond the appalling scenes of police brutality and the deaths of innocent Black people, the systemic impact of racism hits home in the house of medicine and psychiatry as health inequities and racism impact Black people, Latinos, indigenous people, Asian-Americans, and others.”

Geller called upon the APA Board of Trustees to address racism within APA and psychiatry. He noted that Board members are predominantly white and that they must take initiative and be proactive in confronting and dismantling structural racism.

“We cannot turn to the Black members of the Board to guide us. That would take them out of the role of being Board members with us,” Geller said. “It would signify our lack of understanding that racism is about us [whites].”

Aletha Maybank, M.D., M.P.H., the AMA’s chief health equity officer and group vice president, described how the harmful legacy of segregation is evident today in the housing, health, and economic status of many Black individuals. She also spoke of the importance of providing space in which young people may use their voices to propel societal change.

“I really don’t feel we would be here today if it weren’t for the young people of the Black Lives Matter movement,” Maybank said. “The young people who speak … continue with the tradition of the civil rights movement, but in their own way because they’re young [and] it’s a new time. I feel they are leading with great power, great purpose, and great authenticity and truth. … We, as we get older, need to step aside and allow them to have that place of leadership.”

Kevin M. Simon, M.D., the 2020-2021 Recognizing and Eliminating disparities in Addiction through Culturally informed Healthcare (REACH) scholar, described anti-racism as supporting anti-racist policy through action or the expression of anti-racist ideas.

“It has to be something that becomes part of your daily routine,” said Simon, who is completing a fellowship training in child and adolescent psychiatry and addiction medicine at the Boston Children's Hospital/Harvard Medical School. “Much like we ask patients to practice behavioral techniques, we have to practice being anti-racist.”

Former APA President Altha J. Stewart, M.D., discussed critical junctures in history when psychiatrists, as represented by APA and its precursor, the Association of Medical Superintendents of American Institutions for the Insane, failed to address racism. These touch points in history include the years before, during, and after the Civil War, the years of the “separate but equal” doctrine, and the Jim Crow era.

“[Now] we have this very important moment in time where what we do will be looked back upon by generations in the future,” said Stewart, who is senior associate dean for community health engagement at the University of Tennessee Health Science Center. “When they ask what did we do to move the needle, what did we do to improve the psychological well-being of [Black people] in this country, I’d like to say that we took the bull by the horns, addressed these issues head on, and did the hard work … that is emotional, that makes you vulnerable, that can be challenging, but that is not too difficult for psychiatrists.”

She added that psychiatrists are primed for doing the work of dismantling racism both in the profession and in society at large.

“Our wheelhouse is in the difficult place. We are the people that people bring their most private, chaotic thoughts, and we help sort that out,” she said. “We have to be on the front lines of doing that for psychiatry, for America, and for the American Psychiatric Association.”

The next town hall will be held Monday, November 16. APA’s town hall meetings on structural racism are archived for members at

Help Determine APA’s Future
Nominate yourself or a colleague

As chair of APA’s Nominating Committee, Immediate Past President Bruce Schwartz, M.D., is seeking to diversify the elected leadership of APA and invites all members to consider running for one of the open Board of Trustee offices in APA’s 2021 election: president-elect; secretary; early-career psychiatrist trustee-at-large; minority/underrepresented representative trustee; Area 1, 4, and 7 trustees; and resident-fellow member trustee-elect. You may nominate yourself or a colleague—the important point is that you get involved! The deadline is Tuesday, September 1.

Access Nomination Requirements and Form

Monday, August 24, 2020

Several Antihypertensive Medications Associated With Reduced Depression

Adults who take blood pressure medications are not at an increased risk of depression, according to a report published today in Hypertension. In fact, nine of the 41 medications assessed in the study were associated with a decreased incidence of depression.

The medications that were found to protect against depression were amlodipine, atenolol, bisoprolol, carvedilol, enalapril, propranolol, ramipril, verapamil, and verapamil combinations.

Studies have shown that about 30% of people with hypertension or other cardiovascular problems have comorbid depression. Moreover, individuals with both disorders have worse mortality and a poorer quality of life and need more health care services.

“It is, therefore, important to prevent the development of depression in people with hypertension and cardiovascular and cerebrovascular diseases, and widely used treatment interventions should be thoroughly evaluated,” wrote Lars Vedel Kessing, M.D., D.M.Sc., of the University of Copenhagen and colleagues.

Kessing and colleagues used Danish health registry data to assess the incidence of depression and use of antihypertensive medications among all Danish adults who had no history of depression over a 10-year period starting in January 2005. The participants were then divided into groups based on the number of antihypertensive prescriptions they received during the study period. The study encompassed 41 antihypertensive medications in four drug classes: angiotensin agents, calcium antagonists, beta-blockers, and diuretics.

The researchers found that adults who had never been prescribed an antihypertensive had about a 40% to 50% reduced risk of depression compared with adults who had received such prescriptions. However, among adults who did take antihypertensives, the amount of medication usage did not affect depression risk for any of the 41 medications analyzed. For nine of the medications tested, in fact, longer use was associated with reduced depression rates.

The medications associated with reduced depression included two angiotensin agents (enalapril and ramipril), three calcium antagonists (amlodipine, verapamil, and verapamil combination), and four beta-blockers (propranolol, atenolol, bisoprolol, and carvedilol); no diuretics were associated with reduced risk of depression.

“Real-life population-based data suggest a positive effect of continued use of nine individual antihypertensive agents,” wrote the researchers. “This evidence should be used in guiding prescriptions for patients at risk of developing depression including those with prior depression or anxiety and patients with a family history of depression.”

Register Now for Tonight’s ‘Structural Racism, Part 2: The March Continues’

APA Past President Altha Stewart, M.D., AMA Chief Health Equity Officer and Group Vice President Aletha Maybank, M.D., M.P.H., and 2020-2021 REACH Scholar Kevin Simon, M.D., will join APA President Jeffrey Geller, M.D., M.P.H., for a virtual town hall tonight (Monday, August 24) at 8 p.m. ET to commemorate the 57th anniversary of the March on Washington. This is the second in a series of town halls on structural racism planned by Dr. Geller.


Friday, August 21, 2020

Time Is Now for Addressing Racism in Medical Education

As APA leaders continue to work to eliminate systemic racism within psychiatry, a group of psychiatry resident leaders recognized with APA/APA Foundation Minority Fellowships described an action plan they believe will reduce racism in medical education in the most recent issue of Psychiatric News.

“Many health care institutions and medical schools, including the AMA, have released statements condemning police brutality and racism. However, such statements ring hollow without action,” the APA/APAF Minority Fellows wrote. “We believe that one of the first steps in combating systemic racism in the medical field is addressing issues within our training institutions.” They outlined the following actions as key steps forward in dismantling racism in medical education:

  1. Create networks and communities that encourage open discussion for minority and marginalized providers.
  2. Support the recruitment and retention of a diverse workforce through inclusion initiatives that are adequately funded, appropriately staffed, and well integrated.
  3. Support intentional mentorship and sponsorship of trainees of color into leadership positions.
  4. Support continued training for health care providers on how to productively address racist or biased behaviors as they occur in health care and educational settings.
  5. Support educational research and scholarship that focuses on identifying best practices on training in implicit bias, structural racism, and cultural humility.
  6. Increase resources including financial and protected time for research and academic endeavors around race, culture, and socioeconomic disparities.
  7. Review current medical curricula, didactic and clinical based, with the goal of better understanding how racist ideas are embedded within and using that knowledge to make the needed changes.
  8. Increase the use of holistic review processes by medical training institutions, including the further de-emphasis of standardized testing such as the MCAT and USMLE.
  9. Increase awareness and evaluation of racial/ethnic disparities in certain academic awards, such as the Alpha Omega Alpha Honor Medical Society, with appropriate changes or removals of these items.
  10. Support institutional systems for reporting incidents that negatively impact individuals from minority or underrepresented groups. Aggregate anonymous data from these systems should be used to help analyze, identify, and address systemic needs.
  11. Increase training opportunities in diverse and socioeconomically disadvantaged areas. We recommend the utilization of innovative technologies and systems to aid in this endeavor.

“As leaders in undergraduate and graduate medical education, our duty is to ensure that future physicians lead in anti-racist work and are aware of the biases that can affect their care to individuals,” they continued. “We believe that the implementation of these items will begin to dismantle the current racist underpinnings within our education, help to improve treatment and experiences of people of color in medicine, and consequently work to better the treatment of all patients.”

(Image: iStock/Avatar_023)

Register Now to Attend ‘Structural Racism, Part 2: The March Continues’: August 24

APA Past President Altha Stewart, M.D., AMA Chief Health Equity Officer and Group Vice President Aletha Maybank, M.D., M.P.H., and 2020-2021 REACH Scholar Kevin Simon, M.D., will join APA President Jeffrey Geller, M.D., M.P.H., for a virtual town hall on Monday, August 24, at 8 p.m. ET to commemorate the 57th anniversary of the March on Washington. This is the second in a series of town halls on structural racism planned by Dr. Geller.


Thursday, August 20, 2020

40% of U.S. Adults Reported Worsening Mental Health in Late June Due to Pandemic, CDC Finds

U.S. adults reported worsening mental health associated with the COVID-19 pandemic, according to a study published in the Morbidity and Mortality Weekly Report. Young adults, individuals who identified as Black and/or Hispanic, essential workers, and unpaid adult caregivers reported disproportionately worse mental health outcomes.

“Addressing mental health disparities and preparing support systems to mitigate mental health consequences as the pandemic evolves will continue to be needed urgently,” wrote Mark É. Czeisler of the Turner Institute for Brain and Mental Health in Melbourne, Australia; Emiko Petrosky, M.D., of the Centers for Disease Control and Prevention COVID-19 Response Team; and colleagues.

The researchers conducted web-based surveys of 5,470 adults aged 18 and older across the United States from June 24 to 30. The surveys used the Patient Health Questionnaire to assess whether respondents had symptoms of anxiety and/or depressive disorders and the Impact of Event Scale to assess trauma- and stressor-related disorder symptoms. Respondents were also asked if they had started or increased substance use to cope with stress or emotions related to the pandemic and if they had seriously considered suicide in the past 30 days.

Overall, 40.9% of respondents reported symptoms of at least one adverse mental health condition, including anxiety, depression, and increased use of substances to cope with stress related to the pandemic. About a quarter of the respondents reported symptoms of trauma- and stressor-related disorders (including posttraumatic stress disorder, acute stress disorder, and adjustment disorders) related to the pandemic.

The percentage of respondents who reported having seriously considered suicide in the past 30 days was significantly higher among those aged 18 to 24 years, members of minority/racial ethnic groups, self-reported unpaid adult caregivers, and essential workers. “Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic,” the authors wrote.

Compared with results of similar surveys conducted in 2019, the prevalence of anxiety disorder symptoms was three times higher, while the prevalence of depressive disorder was four times higher.

“Markedly elevated prevalences of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions,” the authors concluded. “Expanded use of telehealth, an effective means of delivering treatment for mental health conditions, including depression, substance use disorder, and suicidal ideation, might reduce COVID-19-related mental health consequences.”

(Image: iStock/Juanmonino)

Help Determine APA’s Future
Nominate yourself or a colleague

As chair of APA’s Nominating Committee, Immediate Past President Bruce Schwartz, M.D., is seeking to diversify the elected leadership of APA and invites all members to consider running for one of the open Board of Trustee offices in APA’s 2021 election: president-elect; secretary; early-career psychiatrist trustee-at-large; minority/underrepresented representative trustee; Area 1, 4, and 7 trustees; and resident-fellow member trustee-elect. You may nominate yourself or a colleague—the important point is that you get involved! The deadline is Tuesday, September 1.

Access Nomination Requirements and Form


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