Comorbid Symptoms of Depression, Anxiety Common in Fathers After Their Children Are Born

More than 1 in 5 fathers have symptoms of depression and anxiety at some point during the first year after their children are born, a study in Depression and Anxiety has found.

“The high rate of comorbidity between depression and anxiety among fathers demonstrates the importance of screening and early intervention for both depression and anxiety in men during the postpartum period,” wrote Cindy-Lee Dennis, Ph.D., of the University of Toronto and colleagues.

In the study, which ran from 2015 through 2019, couples separately completed a baseline questionnaire via telephone after the birth of their child and then completed follow-up questionnaires online at 3, 6, 9, 12, 18, and 24 months postpartum. The primary outcome was comorbid depression and anxiety symptoms in fathers as measured by the 10-item Edinburgh Postnatal Depression Scale and the 20-item State subscale of the State-Trait Anxiety Inventory. Overall, 2,544 fathers provided data for at least one time point during the first year postpartum, and 2,442 fathers provided data during the second year.

The researchers found that 22.4% of fathers had comorbid depression and anxiety symptoms at some point in the first year postpartum, and 13.2% of fathers had comorbid symptoms at some point in the second year postpartum. Overall, 2.2% of fathers had comorbid symptoms at baseline, and approximately 8% to 9% of fathers had comorbid symptoms at any time point in the study up to 24 months.

Fathers were more likely to experience comorbid symptoms of depression and anxiety if they had depression before the pregnancy, they had anxiety during the pregnancy, they had experienced significant adverse childhood experiences, they had screened positive for symptoms of attention-deficit/hyperactivity disorder, they were victims of intimate partner violence, or the mother or infant was in poor or fair health at 4 weeks postpartum.

“Many of these risk factors suggest potential modifiable targets to develop interventions to support paternal mental health in the first two years postpartum with the goal to optimize child and family outcomes,” Dennis and colleagues wrote. “Our findings demonstrate that the postpartum period may be a time of particular vulnerability for relapse or possibly worsening of symptoms in fathers with a history of mental illness, as it is for women.”

For related information, see the Psychiatric Services article “Public Attitudes and Feelings of Warmth Toward Women and Men Experiencing Depression During the Perinatal Period.”

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What Does the No Surprises Act Mean for You?

The No Surprises Act goes into effect on January 1. Psychiatrists and other health care professionals are required to give uninsured and self-pay patients a “good faith estimate” of costs for services when scheduling care or when the patient requests an estimate. The law also prohibits balance-billing, or “surprise bills,” to patients for emergency and certain nonemergency services provided at facilities.

The “good faith estimate” is a notification of expected charges for scheduled or requested services. The “expected charge” is either the cash rate or rate established by a provider for an uninsured or self-pay patient, reflecting any discounts for such individuals; or the amount the provider would expect to charge if the provider intended to bill a health care plan directly for the services.

For detailed information about the act and its requirements go to No Surprises Act Implementation on APA's website. See also Psychiatric News.

E-Cigarette Use Linked to Smoking Cessation Among Smokers Not Planning to Quit

Among smokers who never had plans to quit, those who used e-cigarettes daily were eight times more likely to stop smoking cigarettes than those who did not use e-cigarettes, according to a study published yesterday in JAMA Network Open.

“A long-standing theory suggests that taking even a first step toward contemplating quitting smoking can have a positive impact on net cigarette cessation rates,” wrote Karin A. Kraza, Ph.D., of the Roswell Park Comprehensive Cancer Center in Buffalo, N. Y., and colleagues. “Thus, evaluation of factors associated with cigarette discontinuation among smokers not planning to quit is important to understanding the range of potential impacts of e-cigarette use on net cigarette cessation.”

Kraza and colleagues analyzed four waves of the Population Assessment of Tobacco and Health Study, a nationally representative cohort study of youth and adults, collected between October 2014 and November 2019. Participants completed computer-assisted interviews during which they reported current cigarette and e-cigarette use and whether they planned to ever quit tobacco for good. Participants were included in the study if they completed baseline and follow-up interviews and if, at baseline, they smoked cigarettes every day, did not use e-cigarettes at all, and had no plans to quit smoking tobacco permanently. There were two outcome measures: cigarette discontinuation, defined as having not smoked cigarettes in the past 12 months or currently smoking not at all, and discontinuation of daily cigarette smoking, defined as having not smoked in the past 12 months, currently smoking not at all, or currently smoking some days.

A total of 1,600 participants were included in the study. Overall, 6.2% of participants reported at follow-up that they had discontinued all cigarette smoking. Twenty-eight percent of those who reported cigarette discontinuation at follow-up also reported using e-cigarettes on a daily basis, while 5.8% reported no e-cigarette use. Nearly 11% of participants also reported discontinuing daily cigarette smoking at follow-up; the odds of discontinuing daily cigarette smoking were higher among those who reported using e-cigarettes daily, compared with those who did not use e-cigarettes at all. Non-daily use of e-cigarettes did not significantly increase the odds of discontinuing daily cigarette smoking.

“Smokers with no plans to ever quit smoking tend to smoke more cigarettes per day and … are also often overlooked in the population-based e-cigarette use and cigarette discontinuation literature,” the authors wrote. “Our findings here suggest that such smokers should be specifically considered when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population.”

For related information, see the Psychiatric News article “Surgeon General on Smoking: Most Want to Quit.”

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Food Insecurity in Childhood Linked to Cannabis Use, Bullying, School Dropout Risk

Children who experience food insecurity are more likely to use cannabis, be bullied by their peers, and drop out of school than those who do not, according to a report in JAMA Open Network.

“Although supplying food to families in precarious situations is a vital service and may play a role in alleviating some of this stress, we suggest that children at high risk for food insecurity receive broader psychosocial services … to help them fulfill their academic and social potentials,” wrote Vincent Paquin, M.D., of McGill University and colleagues.

The authors analyzed data on 2,032 participants in the Québec Longitudinal Study of Child Development who provided information on food insecurity. The study included children born in Québec, Canada, in 1997 and 1998 and followed up annually or biannually from 5 months to 15 years of age. The analysis of outcomes at 15 years of age was based on data from 1,441 adolescents. Data were analyzed from November 2020 to October 2021.

Food insecurity was reported by mothers when children were 1.5, 4, 8, 10, 12, and 13 years of age in response to the following question: “In the past 12 months, has a member of your family ever experienced being hungry because the family had run out of food or money to buy food?”

Mental health and functioning outcomes were reported by adolescents at 15 years of age. Four broad domains were investigated: externalizing problems (including attention-deficit/hyperactivity disorder, opposition or defiance, and conduct), internalizing problems (depression, social anxiety, and symptoms of generalized anxiety disorder), substance use (frequency of alcohol and cannabis use), and social adjustment problems (peer bullying, dropout potential).

Seventy-three children were defined as having a high risk of food insecurity, with a 50% probability of experiencing food insecurity at each age. In the high-risk group, all children were exposed to food insecurity at least once, and 56 (76.7%) were exposed at least twice.

A total of 1,959 were defined as low risk with just a 1% probability of food insecurity over time. In this group, most children (1,857) were never exposed to food insecurity, and 102 were exposed once; none was exposed more than once.

The high-risk trajectory of food insecurity was associated with higher levels of conduct problems, cannabis use, peer bullying, and dropout potential compared with the low-risk trajectory. After adjusting for possible confounding factors—including family income and parental history of mental illness—associations with cannabis use, peer bullying, and dropout potential remained significant, whereas the association with conduct problems did not.

“Familial dynamics related to food insecurity may explain the observed associations with cannabis use, bullying, and dropout potential,” the authors wrote. “For example, household food insecurity may be associated with increased parental stress, leading to more intimate partner violence and child maltreatment in affected families. In turn, by affecting how a child learns to interact with others and to cope with stress, this interpersonal adversity during childhood may be associated with subsequently higher levels of cannabis use, bullying, and academic difficulties during adolescence.”

The Presidential Task Force on Social Determinants of Mental Health, appointed by APA President Vivian Pender, M.D., is examining food insecurity, among other social determinants.

For related information, see the Psychiatric Services article “Addressing the Social Determinants of Mental Health: If Not Now, When? If Not Us, Who?”

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APA Joins in Negotiations Over New Clozapine REMS

Problems with the new clozapine REMS threaten delays or discontinuation of doses for patients. Here is background information on the situation and the response so far.

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Specific Type of TMS May Be Effective for People With Alcohol Use Disorder

A study published in Biological Psychiatry found that people with alcohol use disorder who received deep transcranial magnetic stimulation (deep TMS) reported fewer heavy drinking days and alcohol cravings than those who received a sham stimulation. Deep TMS is a form of transcranial magnetic stimulation that is capable of reaching more interior brain regions than conventional TMS.

To test the efficacy of deep TMS, Maayan Harel, Ph.D., of Ben-Gurion University in Beer Sheva, Israel, and colleagues enrolled 51 treatment-seeking adults aged 18 to 65 with moderate to severe alcohol use disorder for their trial. The participants were randomized to receive either active or sham deep TMS targeted to their medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC), two regions associated with cravings and reward behaviors. Both groups received 15 sessions over three weeks (the acute phase), then five sessions over three months (the follow-up phase).

The main study outcome was the percentage of heavy drinking days (≥4 drinks a day for women and ≥5 for men) reported by the participants during the follow-up phase. The researchers also assessed the participants’ craving levels during both the acute and follow-up phases using the Penn alcohol craving scale (PACS).

At the end of follow-up, both groups of participants experienced significant declines in the frequency of their heavy drinking days. However, the improvement was more pronounced in adults who received active TMS (2.9% heavy drinking days over 12 weeks) compared with sham TMS (10.6% heavy drinking days over 12 weeks). PACS scores also dropped significantly among both during the acute treatment period (from 14 to 5 in the active group and 16 to 8 in the sham group). During the follow-up period, PACS scores remained level for the active group but rose in the sham group.

Participants experienced no severe side effects during the study; the only notable side effect was transient headache, a common side effect of TMS.

“We believe the findings presented here represent an important advance,” wrote the authors. “[Deep] TMS targeting the mPFC and ACC appears to be a safe and well-tolerated intervention, with promising initial evidence for efficacy in alcohol addiction. A full-scale multicenter study to confirm the efficacy of this intervention appears warranted.”

To read more on this topic, see the Psychiatric News article “Can Ketamine Curb Excess Drinking?”

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APA Joins in Negotiations Over New Clozapine REMS

Problems with the new clozapine REMS threaten delays or discontinuation of doses for patients. Here is background information on the situation and the response so far.

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Black Patients More Likely to Be Restrained During Emergency Psychiatric Evaluation

Black patients continue to be at greater risk of physical or chemical restraint during an emergency psychiatric evaluation than White patients, suggests a report published this week in Psychiatric Services in Advance. The findings are based on analysis of the electronic medical records of adults 18 years and older who received an emergency psychiatric evaluation at Duke University Hospital in Durham, N.C., over a six-year period.

“The finding that Black patients are more likely to undergo physical and chemical restraint in an emergency psychiatry setting adds to a growing body of literature regarding emergency care settings and restraint use and extends these findings to an intersectionally vulnerable group: patients of color receiving psychiatric consultation,” wrote Colin M. Smith, M.D., of Duke University School of Medicine and colleagues.

The researchers analyzed the electronic medical records of adults who received an emergency psychiatric evaluation at Duke University Hospital between January 1, 2014, and September 18, 2020. Specifically, the authors focused on the use of physical and chemical restraint “invoked for patient behaviors including violence, severely aggressive behavior, self-injurious behavior, or inability to exhibit safe behaviors.” Physical restraints included physical holds, mitts, soft restraints, locking cuffs, or neoprene cuffs; chemical restraint was defined as documentation of a first- or second-generation antipsychotic available on the hospital formulary (chlorpromazine, fluphenazine, haloperidol, olanzapine, and ziprasidone).

A total of 12,977 unique emergency psychiatric encounters were included in the analysis. The median age of the cohort was 37 years, and 55% of the encounters involved male patients; 6,287 encounters involved Black patients and 5,263 involved White patients. During the study period, 961 (about 7%) encounters involved physical restraint, and 2,047 (about 16%) involved chemical restraint; 797 (83%) encounters involved both physical and chemical restraint. Black patients underwent physical restraint during 8.7% of encounters and chemical restraint during 18.1% of encounters, whereas White patients underwent physical restraint during 5.4% of encounters and chemical restraint during 12.3% of encounters.

Compared with White patients, those who identified as Black, multiracial, or who did not report race were more likely to have been physically or chemically restrained during the emergency department visit, the researchers found. After adjusting for age, sex, ethnicity, height, arrival time to the emergency department, urine drug screen results, peak alcohol concentration, and diagnosis, the association between Black race and restraint remained: Black patients were more likely to be physically (1.35 times the odds) and chemically (1.33 times the odds) restrained than White patients.

“The observational nature of the study limits our ability to make causal claims, but our findings nonetheless suggest ongoing disparities in psychiatric care for Black patients in the prehospital and emergency settings,” Smith and colleagues concluded.

For related information, see the Psychiatric News Alert “Emergency Department Staff More Likely to Restrain Black Children Than White Children, Report Finds.”

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1 in 4 Americans Wants to Improve Their Mental Health in 2022

More than 1 in 4 respondents to an APA poll said that improving their mental health is on their minds for 2022.

Just over one-third of respondents (37%) said they are anxious about their mental health going into the new year. Among those making resolutions focused on mental health, 53% will meditate, 37% plan to see a therapist, 35% will take a break from social media, 32% will journal, 26% will use a mental health app, and 20% plan to see a psychiatrist specifically.

The findings are from APA’s Healthy Minds Monthly, a poll conducted by Morning Consult. The poll was fielded December 6 to 8 among a nationally representative sample of 2,119 adults aged 18 and over.

Respondents were, overall, more likely to grade their mental health as excellent (26%) or good (42%) than fair (22%) or poor (9%). However, compared with White (28%) and Hispanic (35%) adults, adults who are Black (41%) or of another race or ethnicity (42%) were more likely to grade their mental health in 2021 as fair or poor. Nearly half (46%) of adults aged 18 to 34 and mothers (42%) also graded their mental health in 2021 as fair or poor.

“The new calendar year for many symbolizes a time for renewal, for trying new things, and, for some, new beginnings,” APA President Vivian Pender, M.D., said in a media release. “To see 1 in 4 Americans focusing on their mental health in this moment is important and encouraging. What is worrisome, although not unexpected, is the level of variation among demographic groups on their overall level of mental health, and we as psychiatrists need to understand those trends.”

Among the poll’s other findings:

• About 55% of respondents reported feeling somewhat or very anxious about the COVID-19 pandemic, and 58% reported they are somewhat or very anxious about their personal finances. More than half (54%) reported feeling somewhat or very anxious about the uncertainty of 2022.
• 1 in 5 respondents said they anticipate feeling more stress at the start of 2022 than they did at the start of 2021, while 44% said they anticipate feeling about the same, and 27% anticipate feeling less stressed.

Some demographic groups are more likely than others to say they will make a resolution focused on mental health: 18- to 34-year-olds are more than four times as likely to have a mental health–related resolution for 2022 as those 65 and older; Black adults are more likely than those from all other racial and ethnic groups to make one. Mental health resolutions also appear more common among parents than people without children; nearly half of fathers making a mental health resolution plan to take a break from social media.

“It can’t be said enough that there is no health without mental health, and it sounds like a lot of us will be starting the new year with that focus in mind,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A.

APA’s Healthy Minds Monthly tracks timely mental health issues throughout the year. APA also releases its annual Healthy Minds Poll each May in conjunction with Mental Health Awareness Month.

For related information, see the Psychiatric News Alert “APA Poll Reveals COVID-19 and Other Worries During Holiday Festivities.”

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Stigma Surrounding Depression Falls, But Not for Other Mental Health Disorders

Public stigma toward people with depression appears to be decreasing, but not toward people with schizophrenia and/or those with alcohol dependence, suggests a report published today in JAMA Network Open. The findings were based on interviews with adults aged 18 and older living in the continental United States.

“Stigma, the prejudice and discrimination attached to devalued conditions, has been consistently cited as a major obstacle to recovery and quality of life among people with psychiatric disorders,” wrote Bernice A. Pescosolido, Ph.D., of Indiana University and colleagues.

To better understand the nature and magnitude of public stigma over two decades for major mental illnesses, the researchers analyzed data from the 1996, 2006, and 2018 U.S. National Stigma Studies, which are part of the General Social Survey. The participants were randomly assigned to one vignette describing a fictitious person with behaviors meeting DSM-4 criteria for schizophrenia, major depression, or alcohol dependence or a control. During face-to-face interviews, the respondents were asked questions about the person described in the vignette, including those listed below:

• The cause of the behaviors: How likely it is that the person in the vignette is experiencing “a mental illness,” as well as how likely the situation might be caused by “a genetic or inherited problem,” “a chemical imbalance in the brain,” and “his or her own bad character”?
• Social distance: How willing would you be to have the person described in the vignette work closely with you on a job, live next door, spend an evening socializing, marry into the family, and as a friend? How willing would you be to live near a group home that serves the person described in the vignette?
• Dangerousness: How likely is it that the person in the vignette would “do something violent toward other people” and/or “do something violent toward him/herself”?

The responses of 4,129 people (average age 45; 55% women) were included in the analysis. The researchers found that from 1996 to 2006, respondents reported increasing beliefs that schizophrenia, depression, and alcohol dependence are caused by genetics or disruptions in the brain. From 2006 to 2018, there was a significant drop in the percentage of respondents who expressed a desire for social distance from people with depression; however, also during this same period, the percentage of respondents reporting it was likely a person with schizophrenia would do something violent to self or others grew, as did those attributing alcohol dependence to “his or her own bad character.”

There were no significant attitudinal differences among respondents on the basis of race, ethnicity, sex, and education level. However, differences were noted between age groups, with those born before World War II and millennials being more progressive.

“First and foremost, the results of this study suggest that public stigma can change … [but] we must be realistic because societies change slowly, and change efforts must be persistent and sustainable,” Pescosolido and colleagues wrote. “[S]trategies to identify factors associated with the decrease in stigma for depression, to address stagnation or regression in other disorders, and to reach beyond current scientific limits are essential to confront mental illness’s contribution to the global burden of disease and improve population health.”

For related information, see the American Journal of Psychiatry article “Sustained Effect of a Brief Video in Reducing Public Stigma Toward Individuals With Psychosis: A Randomized Controlled Trial of Young Adults.”

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Caplyta Approved for Bipolar Depression in Adults

The U.S. Food and Drug Administration (FDA) has approved the antipsychotic Caplyta (lumateperone) for the treatment of bipolar depression in adults, either as a monotherapy or an adjunct therapy with lithium or valproate. Caplyta, marketed by Intra-Cellular Therapies Inc., is already approved for the treatment of schizophrenia in adults.

The FDA approval was based on positive findings from two six-week, phase 3 trials. The first trial evaluated the effects of 42 mg/day lumateperone monotherapy versus placebo in 381 adults aged 18 to 75 with bipolar I or II depression. The second trial evaluated 28 mg/day or 42/mg day lumateperone versus placebo in 529 adults with bipolar I or II depression who were also taking lithium or valproate.

In both studies, participants taking 42 mg/day lumateperone showed statistically stronger improvements in their depression symptoms after six weeks compared with those taking placebo. In the monotherapy study, which was published in AJP in Advance in September, Montgomery-Åsberg Depression Rating scale (MADRS) scores dropped by an average of 16.7 points after six weeks in the lumateperone group compared with 12.1 points in the placebo group. In the adjunct therapy study, MADRS scores dropped by an average of 16.9 points after six weeks in the lumateperone group compared with 14.5 points in the placebo group. The data suggested that lumateperone was effective at treating both bipolar I and bipolar II depression.

Lumateperone also demonstrated a favorable safety profile in both studies. The most common side effects were sleepiness, dizziness, nausea, and dry mouth. Lumateperone was not associated with any significant issues of weight gain, cardiometabolic problems, or extrapyramidal symptoms.

“The efficacy and favorable safety and tolerability profile make Caplyta an important treatment option for the millions of patients living with bipolar I or II depression and represents a major development for these patients,” said Roger McIntyre, M.D., head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, in a media release. McIntyre has received consulting fees and research support from Intra-Cellular Therapies.

For related information, see the American Journal of Psychiatry articles “Efficacy and Safety of Lumateperone for Major Depressive Episodes Associated With Bipolar I or Bipolar II Disorder: A Phase 3 Randomized Placebo-Controlled Trial” and “Slowly Working Toward More Treatments for Depression in Bipolar II Disorder.”

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Childhood Trauma Linked to First-Episode Psychosis

A history of childhood trauma, including abuse and neglect, is common among patients who experience first-episode psychosis, a study in the Journal of Psychiatric Research suggests.

Judith Usall, Ph.D., of the Institut de Recerca Sant Joan de Déu in Esplugues de Llobregat, Spain, and colleagues examined data from 100 hospitalized patients with first-episode psychosis and 94 volunteers with no history of first-episode psychosis in the PROFEP study. This longitudinal study explores the factors and variables that may influence the development and evolution of patients with first-episode psychosis. All patients were assessed via the Childhood Traumatic Questionnaire, the Positive and Negative Syndrome Scale, the Personal and Social Performance Scale, the Suicide Risk Scale of Plutchik, and the Perceived Stress Scale.

Roughly 61% of patients with first-episode psychosis reported having experienced childhood trauma compared with roughly 17% of people who did not have first-episode psychosis.

The most frequent childhood trauma was emotional abuse: 33% of patients with first-episode psychosis had experienced emotional abuse as children, compared with 10% of people without first-episode psychosis. Among patients with first-episode psychosis, 22% reported physical neglect, 20% reported emotional neglect, and 13% reported physical abuse, compared with 1%, 4%, and 2%, respectively, of people without first-episode psychosis. Patients with first-episode psychosis had fewer years of education, more cannabis use, more perceived stress, and a higher risk of suicide compared with people without first-episode psychosis.

“Our results highlight possible causal links between childhood trauma and subsequent onset of psychosis. However, causal effects should be tested in longitudinal research,” Usall and colleagues wrote. “[E]xploring a history of childhood trauma should be considered when working with patients with [first-episode psychosis] or at ultra-high risk of psychosis.”

For related information, see the Psychiatric Services article “Associations Between Childhood and Adolescence Adversity and Risk for Arrest Among Patients With First-Episode Psychosis.”

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Adolescents’ Substance Use Drops Dramatically, Survey Finds

The percentage of adolescents reporting substance use decreased significantly in 2021, according to the National Institute on Drug Abuse’s Monitoring the Future survey. The drop represents the largest one-year decease in the survey’s 46-year history.  

“We have never seen such dramatic decreases in drug use among teens in just a one-year period. These data are unprecedented and highlight one unexpected potential consequence of the COVID-19 pandemic, which caused seismic shifts in the day-to-day lives of adolescents,” Nora Volkow, M.D., National Institute on Drug Abuse (NIDA) director, said in a news release. 

Conducted by researchers at the University of Michigan, the Monitoring the Future survey asks eighth, 10th, and 12th graders about their substance use in the past 30 days, 12 months, and lifetime. Students took the survey either on a tablet or computer, with 40% responding in school and 60% responding at home while schooling was virtual. Data from 32,260 surveys from students in 319 public and private schools in the United States were included in the final analysis. 

These are the key findings from the survey: 

• The percentage of students reporting using marijuana in all forms in the past year dropped significantly among participants in all three grades, with the greatest decline in 10th graders (from 28.0% reporting past-year marijuana use in 2020 to 17.3% in 2021).
• The percentage of students who reported using alcohol within the past year decreased significantly for 10th and 12th graders (dropping from 40.7% in 2020 to 28.5% in 2021 for 10th graders and 55.3% in 2020 to 46.5% in 2021 for 12th graders). The percentage of eighth graders reporting alcohol use in the past year fell slightly between 2020 and 2021, but it was not a statistically significant decrease. 
• Though vaping continues to be the predominant method of nicotine consumption among adolescents, the percentage of students who reported vaping nicotine within the past year fell significantly for students in all three grades. The greatest drop in nicotine vaping was seen in 10th graders (from 30.7% in 2020 to 19.5% in 2021).

The 2021 survey also asked students about changes in their mental health since the COVID-19 pandemic began. Students in all three grades reported moderate increases in anxiety, depression, sleeping difficulty, loneliness, sadness, and difficulty being interested in normal activities. 

“Moving forward, it will be crucial to identify the pivotal elements of this past year that contributed to decreased drug use—whether related to drug availability, family involvement, differences in peer pressure, or other factors—and harness them to inform future prevention efforts,” Volkow said. 

For related information, see the Psychiatric News article “Long-Term Impact of COVID-19 on Children, Adolescents Constitutes Public Health Emergency.”

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Learn About Candidates in APA’s 2022 Election in Virtual Town Halls

APA members have the opportunity to virtually meet the 2022 candidates during a series of town hall sessions. The last town hall will take place tonight (December 16) at 8 p.m. ET. Each session will include a seven-minute presentation from each candidate on their platform followed by a Q&A.

December 16: Resident-fellow member (RFM) trustee-elect (elected by RFMs)

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Children Conceived With IVF Not at Higher Risk of Poor Psychiatric Health, Report Finds

Adolescents who were conceived using assisted reproductive techniques, such as in-vitro fertilization (IVF), do not appear to be at risk of poor psychiatric health compared with the general population, except for a slightly elevated risk of obsessive-compulsive disorder (OCD), according to a report published today in JAMA Psychiatry.

“Overall, we found that adolescents conceived with [assisted reproductive techniques] had a slightly higher risk of anxiety and antidepressant use but a lower risk of mood disorder and suicidal behavior compared with all other children. Importantly, the observed differences in risk were explained by differences in parental characteristics, including the underlying infertility, rather than the [assisted reproductive techniques] intervention itself,” wrote Chen Wang, M.P.H., of the Karolinska Institutet in Sweden and colleagues.

Assisted reproductive techniques have resulted in more than 9 million births worldwide. However, studies indicate that infants conceived through these techniques are also more likely to be born preterm, have low birth weight, and/or have birth defects compared with spontaneously conceived children. These perinatal complications have been linked to neurocognitive development impairment and mental health problems later in life.

Using Swedish national birth registries, the researchers analyzed data on more than 1.2 million children born between January 1, 1994, and December 31, 2006. Follow-up was completed on December 31, 2018, when participants were 12 to 25 years of age. They compared psychiatric outcomes among children conceived using assisted reproductive techniques with those conceived spontaneously. Clinical diagnoses of mood disorder, including major depression, anxiety, OCD, and/or suicidal behavior, were identified from hospital records and outpatient specialist care. Suicide was identified from death certificates.

A total of 31,565 children (2.6%) were conceived with assisted reproductive techniques. These youth had a 1.35 times higher risk of OCD than youth conceived spontaneously, but the risk was lower (1.10 times higher risk) when adjusting for parental demographics, maternal health conditions, and parental psychiatric conditions. When the comparison was restricted to children of parents with known infertility, however, the children conceived with assisted reproductive techniques were at no greater risk of OCD compared with the others.

Among children born to those without infertility, the estimated incidence of anxiety, attempted or completed suicide, and antidepressant use was 5.6%, 0.9%, and 7.0%, respectively. Among children conceived with assisted reproductive techniques, the corresponding cumulative incidences were comparable or lower across all ages.

Fresh but not frozen embryo transfer was associated with a lower risk of mood disorders when compared with children of parents with infertility who conceived without assisted reproductive techniques, making frozen embryo transfer appear less advantageous in direct comparison with fresh embryo transfer.

“[T]he findings were reassuring with respect to the psychiatric health of adolescents conceived with [assisted reproductive techniques],” Wang and colleagues concluded. “An elevated risk of OCD in the overall comparison with all other adolescents may be explained by differences in parental characteristics, and parental use of [assisted reproductive techniques] could be a candidate in potential screening of this disorder.”

For related information, see the American Journal of Psychiatry article “Psychiatric Aspects of Infertility.”

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Learn About Candidates in APA’s 2022 Election in Virtual Town Halls

APA members have the opportunity to virtually meet the 2022 candidates during a series of town hall sessions. The next town hall will take place tonight (December 15) at 8 p.m. ET. Each session will include a seven-minute presentation from each candidate on their platform followed by a Q&A.

• December 15: Area 6 trustee (elected by Area 6 members)
• December 16: Resident-fellow member (RFM) trustee-elect (elected by RFMs)

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Opioid Prescribing Increased During Early Months of Pandemic, Study Suggests

Treating patients in pain with nonpharmacologic therapy (for example, physical therapy and/or complementary medicine) in place of or in combination with opioid therapy is known to help reduce pain and improve physical function without the risk of addiction. A report in JAMA Network Open now suggests that during the early months of the COVID-19 pandemic, patients in pain were more likely to receive opioids than nonpharmacologic therapy compared with the same period the previous year.

“The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study … may exacerbate the U.S. opioid epidemic,” wrote Byungkyu Lee, Ph.D., of Indiana University Bloomington and colleagues. “[P]olicies that markedly expand the use of nonaddictive treatments, such as physical therapy for chronic pain management, are urgently needed.”

Lee and colleagues studied weekly claims data from 24 million U.S. patients in Optum’s nationwide commercial insurance database from January 1, 2019, through September 31, 2020. The researchers specifically focused their analysis on patients in the database with limb or extremity pain; joint pain and nonsystemic, noninflammatory arthritic disorders; back pain; and neck pain. They compared weekly rates of opioid prescriptions to the patients, the strength and duration of opioid prescriptions, and the use of nonpharmacologic therapy during the pandemic compared with the patterns in 2019.

The sample included over 21.4 million people enrolled in Optum during the first three quarters in 2019 and over 20.7 million people enrolled during the first three quarters of 2020.

“During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, −15.9%),” Lee and colleagues reported. “Patients with pain were more likely to receive opioids (mean difference, 3.5%) and less likely to receive nonpharmacologic therapy (mean difference, −6.0%),” they continued. Opioid prescriptions were also written for longer periods and more potent doses early in the pandemic (defined by authors as the period from mid-March 2020 to July 4, 2020) compared with the same period in 2019. Additional analysis revealed that patients were more likely to have been transitioned from nonpharmacologic therapy to opioid prescriptions for pain management during the COVID-19 pandemic than in the year before.

“We found that under conditions of reduced access to diverse treatment options, practitioners and patients resorted to riskier alternatives to manage acute and chronic pain,” Lee and colleagues concluded. “After the pandemic, nonpharmacologic therapy will likely continue to be inaccessible for many patients because of factors such as cost, underinsurance, lack of transportation, lack of childcare, or inability to take time off work. These barriers disproportionately affect people in rural areas, Black and Latinx patients, gender and sex minorities, and those in disadvantaged socioeconomic groups and thus may contribute to broader disparities in opioid use disorders and overdose.”

For related news, see the Psychiatric News Alert “Drug Overdose Deaths Reach Record High During Pandemic.”

(Image: iStock/FG Trade)

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Learn About Candidates in APA’s 2022 Election in Virtual Town Halls

APA members have the opportunity to virtually meet the 2022 candidates during a series of four town hall sessions. The next town hall will take place tonight (December 14) at 8 p.m. ET. Each session will include a seven-minute presentation from each candidate on their platform followed by a Q&A.

• December 14: Area 3 trustee (elected by Area 3 members)
• December 15: Area 6 trustee (elected by Area 6 members)
• December 16: Resident-fellow member (RFM) trustee-elect (elected by RFMs)

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Older Women With Bipolar Disorder More Likely to Have Physical Comorbidities Than Older Men

Older women with bipolar disorder are more likely than older men with the condition to have respiratory, gastrointestinal, musculoskeletal, and endocrinological comorbidities, a study in the American Journal of Geriatric Psychiatry suggests. The study also found that older men with bipolar are more likely than older men without the condition to have evidence of cardiovascular, renal, and endocrinological diseases.

“Our findings indicate that the health needs of [older adults with bipolar disorder] may vary according to sex and suggest that the health consequences of bipolar disorder may be more prominent in women than men,” wrote Osvaldo P. Almeida, M.D., Ph.D., of the University of Western Australia and colleagues.

The researchers analyzed data from 1,407 adults with bipolar disorder aged 50 to 95 years in the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) database, an international consortium of investigators involved in research on bipolar disorder in older adults.

Compared with older men with bipolar disorder, women with the condition had 1.75 times the odds of having an endocrine disease, 1.7 times the odds of having a musculoskeletal disease, 1.67 times the odds of having a gastrointestinal disease, 1.28 times the odds of having a respiratory disease, and 1.10 times the odds of having a cardiovascular disease.

In a second analysis, the researchers compared data from 622 men aged 65 years or older who did not have bipolar disorder in the Health in Men Study with data from the men with bipolar disorder in the GAGE-BD study. Compared with the older men without bipolar disorder, men with the condition had 8.84 times the odds of having a renal disease, 2.54 times the odds of having an endocrine disease, and 2.41 times the odds of having a cardiovascular disease.

“These findings highlight the need for more detailed studies to better understand the pathways that render [older adults with bipolar disorder] more vulnerable to poor health outcomes, particularly women,” Almeida and colleagues wrote.

For related information, see the American Journal of Psychiatry article “GERI-BD:A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in theTreatment of Mania in Older Patients With Bipolar Disorder.”

(Image: iStock/Cecilie_Arcurs)

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Learn About Candidates in APA’s 2022 Election in Virtual Town Halls

APA members have the opportunity to virtually meet the 2022 candidates during a series of four town hall sessions beginning tonight (December 13) at 8 p.m. ET. Each session will include a seven-minute presentation from each candidate on their platform followed by a Q&A.

• December 13: President-elect, treasurer, and trustee-at-large:
• December 14: Area 3 trustee (elected by Area 3 members)
• December 15: Area 6 trustee (elected by Area 6 members)
• December 16: Resident-fellow member (RFM) trustee-elect (elected by RFMs)

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Tailoring Psychotherapy Intensity to Patients More Effective Than Stepped Care Approach, Study Finds

Personalizing psychotherapy based on each patient’s needs (stratified care) appears to be more effective at reducing depression than starting patients on low-intensity psychotherapy and increasing intensity as needed (stepped care), suggests a study in JAMA Psychiatry.

Jaime Delgadillo, Ph.D., of the University of Sheffield in the United Kingdom and colleagues recruited 30 therapists from four health clinics across Northern England for the study. All the participating therapists were part of the Improving Access to Psychological Therapies program and were qualified to deliver low-intensity psychotherapy, which uses principles of cognitive-behavioral therapy (CBT) to teach patients coping skills, typically in group or guided self-help settings.

Delgadillo and colleagues assigned 15 therapists to provide stepped care, during which patients received up to eight 30-minute low-intensity psychotherapy sessions before determining whether high-intensity psychotherapy was needed. High-intensity interventions—which include CBT, person-centered experiential counseling for depression, and more—tend to be longer (one hour as opposed to 30 minutes) and more individualized than low-intensity interventions. The other 15 therapists used a machine learning program that recommended patients to low- or high-intensity therapy based on their mood symptoms, functional impairment, personality traits, employment, and race/ethnicity.

In total, 951 patients seeking treatment for mental disorders including depression, anxiety, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) were enrolled in the study: 583 in the stratified care group and 368 in the stepped care group. The patients completed anywhere from one to 30 therapy sessions, with an average attendance of 7.1 sessions in the stratified care group and 5.8 sessions in the stepped care group. The patients completed both the 9-item Patient Health Questionnaire for depression (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7) after each session to monitor treatment progress. Disorder-specific measures were unavailable for conditions such as PTSD and OCD, the authors noted.

Overall, 52.3% of the patients who received stratified care achieved a clinically meaningful improvement in their depression (PHQ-9 score of 10 or less and a decrease of at least 6 points) at their last session, compared with 45.1% of the patients who received stepped care. While there was no difference in the anxiety score improvements between the patients in the two groups, a higher percentage of patients in the stratified group achieved what the authors termed “reliable recovery” (which took both GAD-7 scores and PHQ-9 scores into consideration) than those in the stepped care group.

Delgadillo and colleagues estimated the cost of stratified care per patient to be about $332 compared with about $196 for stepped care.

“These findings suggest that stratified care has the potential to improve depression treatment outcomes at a modest incremental cost,” Delgadillo and colleagues wrote.

(Image: iStock/FilippoBacci)

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APA Committee Overseeing Implementation of APA’s Anti-Racist Plan

Last June, the APA Board of Trustees created the Structural Racism Accountability Committee to oversee the implementation of the recommendations of the Presidential Task Force to Address Structural Racism Throughout Psychiatry and continue its work. Much progress has already been accomplished to achieve the overarching goal of ensuring that APA is a diverse, equitable, and inclusive professional organization.

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Surgeon General Calls for Swift Action to Address Youth Mental Health Crisis

The U.S. Surgeon General issued a rare public health advisory this week, calling on the nation to respond to the growing mental health crisis impacting young people that has worsened with the pandemic.

“Recent national surveys of young people have shown alarming increases in the prevalence of certain mental health challenges—in 2019 one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009,” wrote Vivek H. Murthy, M.D., M.B.A., in the advisory. Suicide rates among youth aged 10 to 24 years increased by 57% between 2007 and 2018, and there were more than 6,600 estimated deaths by suicide in 2020 in this age group.

“[T]oo often, young people are bombarded with messages through the media and popular culture that erode their sense of self-worth—telling them they are not good looking enough, popular enough, smart enough, or rich enough,” Murthy wrote. “That comes as progress on legitimate and distressing issues like climate change, income inequality, racial injustice, the opioid epidemic, and gun violence feels too slow.”

Various hypotheses have emerged to explain the trend, with researchers pointing to the growing use of digital media, increasing academic pressure, limited access to mental health care, alcohol and drug use, and broader stressors such as rising income inequality, racism, gun violence, and climate change. The pandemic and its disruptions to life at home and school and in the community have exacerbated these effects on youth. Tragically, more than 140,000 U.S. children have lost a parent or grandparent caregiver to COVID-19 as of June 2021.

Murthy wrote that most importantly youth mental health challenges are treatable and often preventable. “Ensuring healthy children and families will take an all-of-society effort, including policy, institutional, and individual changes in how we view and prioritize mental health,” Murthy wrote. The advisory provides recommendations for health care professionals/organizations, young people and their families, technology and media companies, schools and community organizations, and government.

Gabrielle Shapiro, M.D., chair of APA’s Council on Children, Adolescents, and Their Families and a clinical professor of psychiatry at Icahn School of Medicine at Mount Sinai, said the recent increases in suicidality among young people should serve as “a wake-up call to all of us.” She said more child and adolescent psychiatrists are needed to ensure youth with mental health challenges receive the treatment they need. She called for increased government support for those training to become child and adolescent psychiatrists, including tuition assistance and loan reimbursement.

Shapiro also said that “schools should employ a social and emotional development curriculum for all students, and because of the shortage in mental health providers, offer group therapy—for students who are deemed stable and not acutely dangerous to themselves or others—with licensed providers who are supervised by child and adolescent psychiatrists.” In addition, Shapiro advised parents to supervise their children’s use of technology and social media and place limits on the type and duration of usage, depending on their developmental stage.

The Surgeon General’s advisory gives the following specific recommendations for physicians and other health care professionals and organizations:

• Implement trauma-informed care principles and prevention strategies to improve care for all youth, especially those with a history of adversity.
• Routinely screen children, such as during well-visit appointments, for mental health challenges and risk factors, including adverse childhood experiences.
• Identify and address the mental health needs of parents, caregivers, and other family members.
• Combine the efforts of clinical staff with those of trusted community partners and child-serving systems, such as those in the child welfare system.
• Build multidisciplinary teams to implement services that are tailored to the needs of children and their families and provide culturally appropriate services in multiple languages and delivered by a diverse mental health workforce.

For more information, see the Psychiatric News article “Youth Suicide Rate Increases by Nearly 60%.”

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APA Committee Overseeing Implementation of APA’s Anti-Racist Plan

Last June, the APA Board of Trustees created the Structural Racism Accountability Committee to oversee the implementation of the recommendations of the Presidential Task Force to Address Structural Racism Throughout Psychiatry and continue its work. Much progress has already been accomplished to achieve the overarching goal of ensuring that APA is a diverse, equitable, and inclusive professional organization.

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Reduced Opioid Dispensing Found to Stem Opioid Misuse While Not Increasing Heroin Use

Local changes in opioid-dispensing rates have a direct effect on individuals’ misuse and dependence on prescription opioids, but they do not affect the odds of heroin misuse or dependence, according to a study published today in AJP in Advance.

The results suggest that changes to prescribing patterns may have helped curb the prescription opioid crisis, wrote Mike Vuolo, Ph.D., of Ohio State University and Brian C. Kelly, Ph.D., of Purdue University. However, they continued, “trends in heroin use may be an ancillary component of the opioid crisis rather than directly attributable to patterns of opioid prescribing.”

Vuolo and Kelly analyzed 2006-2016 data from the National Survey on Drug Use and Health, which surveys about 70,000 individuals aged 12 and older annually, as well as CDC data on county-level opioid dispensing. They specifically focused on whether county-level dispensing rates affected respondents’ substance use, frequency of use, and prescription opioid or heroin dependence.

Among the 748,800 respondents, 4.6% reported past-year prescription opioid misuse, and 0.5% reported dependence. Only 0.3% of respondents reported past-year heroin use, 0.2% of whom reported heroin dependence. Average county-level opioid dispensing rates rose from 80.5 per 100 people in 2006 to 96.1 per 100 people in 2012 before the rates began to steadily decline.

The odds of prescription opioid misuse, increased frequency of misuse, and dependence were 7.2%, 3.5%, and 10.4% higher, respectively, for each unit increase in the county-level opioid dispensing rate per 100 people. Similarly, each unit decrease in the county-level opioid dispensing rate was associated with decreases in all three outcomes. There was, however, no significant association between the county-level opioid dispensing rate and the three heroin outcomes.

“Given that many heroin users have transitioned from prescription opioid misuse, there has been a reasonable fear that well-meaning attempts to curb opioid prescriptions could result in additional opioid misusers making this transition,” the authors wrote. “However, we found no evidence that this occurred at the population level, such that efforts should continue to reduce opioid prescription to levels required for patient care without fears that reductions may drive up heroin use.”

For related information, see the Psychiatric News article “Psychiatrists Can Play Vital Role in Stemming Opioid Crisis.”

(Image: iStock/Charday Penn)

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APA Committee Overseeing Implementation of APA’s Anti-Racist Plan

Last June, the APA Board of Trustees created the Structural Racism Accountability Committee to oversee the implementation of the recommendations of the Presidential Task Force to Address Structural Racism Throughout Psychiatry and continue its work. Much progress has already been accomplished to achieve the overarching goal of ensuring that APA is a diverse, equitable, and inclusive professional organization.

LEARN MORE

Erectile Dysfunction Associated With Use of E-Cigarettes, Report Finds

The use of e-cigarettes and other electronic nicotine delivery devices (ENDS) may increase the risk of erectile dysfunction, suggests a report in the American Journal of Preventive Medicine.

Tobacco use is a known risk factor for erectile dysfunction, wrote Omar El-Shahawy, M.D., M.P.H., Ph.D., of New York University Grossman School of Medicine and colleagues. While ENDS are perceived to be less harmful than cigarettes, “many of the newer ENDS devices, coupled with currently available high-nicotine e-liquid concentrations, can effectively deliver higher levels of nicotine than cigarettes,” the researchers noted. “This study highlights a novel finding that ENDS use could have serious implications on men’s sexual health.”

El-Shahawy and colleagues analyzed data collected from December 2016 to January 2018 as part of the Population Assessment of Tobacco or Health (PATH) study—a national longitudinal study of tobacco use and how it affects the health of people in the United States. The researchers specifically focused on male participants 20 years and older who responded to questions about erectile dysfunction; their use of ENDS; current or past history of smoking; and previous diagnoses of diabetes, hypertension, high cholesterol, or cardiovascular disease (congestive heart failure, stroke, myocardial infarction, or other heart condition).

The researchers analyzed two samples for the study: (1) the full sample of nearly 14,000 men and (2) a restricted sample of over 11,000 men aged 20 to 65 who had no history of cardiovascular disease. (Men older than 65 years and those reporting previous history of cardiovascular disease were excluded from the second sample because there is a high prevalence of erectile dysfunction in these groups, the authors noted.)

The prevalence of erectile dysfunction in the samples ranged from 10.2% in the 20- to 65-year-olds with no history of cardiovascular disease to 20.7% in the full sample. Current ENDS use was 5.6% among the restricted sample, with 2.5% reporting current daily use, and 4.8% among the full sample, with 2.1% reporting current daily ENDS use. Men in both samples who currently used ENDS daily were more than twice as likely to report having erectile dysfunction than those who had never used ENDS.

“While ENDS remain under evaluation for harm reduction and smoking-cessation potential, ENDS users should be informed about the possible association between ENDS use and erectile dysfunction,” El-Shahawy and colleagues concluded.

For related information, see the Psychiatric News articles “Vaping-Related Illnesses, Deaths Continue to Climb” and “Surgeon General on Smoking: Most Want to Quit.”

(Image: iStock/danchooalex)

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APA Committee Overseeing Implementation of APA’s Anti-Racist Plan

Last June, the APA Board of Trustees created the Structural Racism Accountability Committee to oversee the implementation of the recommendations of the Presidential Task Force to Address Structural Racism Throughout Psychiatry and continue its work. Much progress has already been accomplished to achieve the overarching goal of ensuring that APA is a diverse, equitable, and inclusive professional organization.

LEARN MORE

Cataract Surgery Linked to Lower Dementia Risk in Older Adults

Older adults who undergo cataract surgery are at lower risk of developing dementia compared with those who do not undergo surgery, reports a study published today in JAMA Internal Medicine. A similar effect was not observed in older adults who received surgery for glaucoma.

“These results have implications for the care of older persons who are uniquely at higher risk for both impaired vision due to cataract and impaired cognition due to neurodegeneration observed in age-related dementia,” wrote Cecilia S. Lee, M.D., M.S., of the University of Washington and colleagues. “Given the substantial degree by which cataract extraction is associated with lower risk of dementia and its persistent effect beyond 10 years, the improvement in quality of life for the affected individuals and their [families] is likely considerable.”

Lee and colleagues assessed data from the Adult Changes in Thought study, an ongoing longitudinal study that monitors the cognitive health of adults 65 and older who are members of Kaiser Permanente Washington. From this sample, they identified 3,038 adults who received a cataract diagnosis before the onset of any dementia; 1,382 underwent cataract surgery and 1,656 did not. The researchers tracked the outcomes of the study participants from the moment of cataract diagnosis until death, study dropout, or their most recent clinical visit.

In total, 853 adults developed dementia during the follow-up. After adjusting for numerous variables (including patient health, as healthier patients at lower risk of dementia might be more willing to undergo surgery), the researchers found that adults who underwent cataract surgery had a 29% reduced risk of dementia compared with those who did not. The reduction was greatest during the first five years after surgery (32% reduced risk), but was maintained more than five years after surgery, the authors noted.

Lee and colleagues conducted a similar assessment using data from 728 adults who received a glaucoma diagnosis before dementia onset. In this population, they found no reduced risk of dementia among the 105 adults who underwent glaucoma surgery.

“Several hypothesized mechanisms may underlie the association between cataract extraction and dementia risk,” Lee and colleagues wrote. “Visual impairment may lead to psychosocial difficulties, withdrawal from social interactions, and reduction in activity or exercise, all of which are associated with cognitive decline. Cataract-related visual impairment may decrease neuronal input, potentially accelerating neurodegeneration or magnifying the effect of neurodegeneration through cortical atrophy. … Finally, compensation for visual input deficit may increase cognitive load and exacerbate cognitive decline.”

For related information, see the Psychiatric News article “Retinal Thickness May Be a Cognitive Biomarker.”

(Image: iStock/Bill Oxford)

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Don’t Miss Your Chance to Submit Ideas for 2022 Annual Meeting Posters

Submit your ideas for new research posters for the 2022 APA Annual Meeting, to be held May 21 to 25 in New Orleans, by Thursday, December 9. The theme of the meeting is “Social Determinants of Mental Health.” To be considered, all abstracts must be submitted through APA’s online abstract submission system.

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Low Thyroid Hormone Levels Linked to Poorer Response to Depression Treatment

Lower levels of certain thyroid hormones may predict a poor treatment response in people hospitalized with depression, a study in the Journal of Affective Disorders suggests.

Zhifen Liu, M.D., of First Hospital of Shanxi Medical University in Taiyuan, China, and colleagues studied data from 2,086 patients who were admitted to the hospital with depression between 2014 and 2020. All patients received thyroid function evaluation—including assessments of serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH)—the morning after they were admitted. The patients’ depression symptoms were measured using the Hamilton Depression Rating Scale (HAM-D). The researchers analyzed changes in the patients’ HAM-D scores from the time of admission to discharge. Treatments during hospitalization varied by patient but included pharmacotherapy, repetitive transcranial magnetic stimulation, and/or psychotherapy.

After controlling for the patients’ age, education level, and other factors, the researchers found that lower levels of FT4 on admission were significantly associated with higher HAM-D scores, and lower levels of FT3 on admission were significantly associated with longer stays in the hospital—even when the levels of these hormones were within the normal range. The researchers also found that higher FT4 levels on admission were associated with greater improvements in HAM-D scores over the course of treatment between admission and discharge.

“[T]his study quantified the effectiveness and contribution of thyroid hormones in predicting the clinical outcomes of depression,” Liu and colleagues wrote. “[F]uture research can confidently explore deeper insights into endocrinology data, especially thyroid hormones, of depressed patients and [explore] more robust prediction models for predicting the response to antidepressant treatment in the real-word setting.”

For related information, see the American Journal of Psychiatry article “Hormonal Treatments for Major Depressive Disorder: State of the Art.”

(Image: iStock/Rasi Bhadramani)

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Don’t Miss Your Chance to Submit Ideas for 2022 Annual Meeting Posters

Submit your ideas for new research posters for the 2022 APA Annual Meeting, to be held May 21 to 25 in New Orleans, by Thursday, December 9. The theme of the meeting is “Social Determinants of Mental Health.” To be considered, all abstracts must be submitted through APA’s online abstract submission system.

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APA Poll Reveals COVID-19 and Other Worries During Holiday Festivities

Forty-one percent of Americans said their level of stress increases during the holidays, compared with just 7% percent who said it diminishes, according to a nationwide poll commissioned by APA.

Top areas of concern were contracting COVID-19 during gatherings (38%) and finding (40%) and affording (46%) gifts. People who are vaccinated are more worried about contracting COVID-19 than those who are not vaccinated (43% vs. 28%). Additionally, nearly half of adults (47%) were anxious about missing family members around the holidays.

The poll, conducted by Morning Consult on behalf of APA, was fielded between November 17 to 21 among a nationally representative sample of 2,119 adults.

“This holiday season, as many are returning to pre-COVID traditions like seeing family and shopping, it’s normal to feel a mixture of emotions,” said APA President Vivian Pender, M.D. “It’s important to take joy in the moments we can and to know that it’s OK not to feel OK. Check in with yourself, and if you’re feeling overwhelmed or anxious, talk to friends or family, and know that help is available.”

Among the poll’s top findings:

• 40% of health care workers are worried about working long hours in the holiday season. 54% of them reported that their stress increases during holidays generally, with 33% anticipating higher stress levels than in 2020.
• Parents said they are particularly worried about the holidays, with nearly half concerned about contracting (48%) or spreading (47%) COVID-19 at gatherings. Mothers are more likely than fathers to worry about affording gifts (61% vs. 47%) and are more likely than fathers to say the level of stress in their life increases during the holidays (53% vs. 39%).
• Younger adults were consistently more likely than older adults to say they are anxious about the holidays, particularly about social and family dynamics.
• Hispanic adults were more likely than those of other racial and ethnic groups to say they anticipate feeling more stress compared with last year.

Despite these worries, the holidays are still associated with positive, festive feelings. In response to an open-ended question—"In a word or two, how would you describe your emotions toward the upcoming holiday season?”—34% of adults said they were “excited,” 15% said they were “happy,” 6% responded with “good,” and 5% responded with “looking forward to it.”

“While we are pleased to be rejoining our families and friends, depending on who you are or where you work, stress may be a bigger factor,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “It’s particularly important in this season of celebrating to remember how hard our health care workforce continues to labor to ensure the rest of us can be safe and that this work has an emotional toll. Remember to protect yourselves and those around you by following health guidelines in these COVID times.”

The interviews were conducted online, and the data were weighted to approximate a target sample of adults based on gender, educational attainment, age, race, and region. Results have a margin of error of plus or minus 2 percentage points.

For related information on Americans’ reaction to the pandemic, see the Psychiatric News article “Pandemic Has Taken Toll on Mental Health of Americans, APA Poll Finds.”

(Image: iStock/Highwaystarz-Photography)

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Make Informed Choice When Voting in APA's 2022 Election

Learn more about the candidates for president-elect, treasurer, trustee at large, Area 3 and 6 trustees, and resident-fellow member trustee-elect in a series of town halls from December 13 to December 16 and submit questions for them to answer.

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