Friday, April 29, 2022

Symptoms of Eating Disorders More Common in Members of Sexual Minorities

People who are homosexual, bisexual, or unsure of their sexual orientation are more likely than their heterosexual peers to have symptoms of an eating disorder, a study in the International Journal of Eating Disorders has found. The study also suggests that there are differences in symptoms between men and women in this population.

Benjamin F. Shepherd, M.Ed., of Nova Southeastern University in Fort Lauderdale, Fla., and colleagues examined data from approximately 36,000 adults who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Among the participants, 69.5% identified as White; 56.3%, female; 96.2%, heterosexual; 3.2%, lesbian/gay; 1.6%, bisexual; and 0.5% identified as unsure of their sexual orientation. Participants were asked about their lowest adult weight, eating habits, and thoughts about weight and their bodies.

Overall, men who identified as gay/lesbian, bisexual, or unsure of their sexual orientation had 1.76 times the odds of reporting a BMI lower than 18.5 compared with heterosexual men. They also had 4.35 times the odds of fearing weight gain even when at their lowest weight and 3.13 times the odds of experiencing a loss of control when overeating compared with heterosexual men.

Women who identified as gay/lesbian, bisexual, or unsure of their sexual orientation had 2.25 times the odds of reporting ever having a binge-eating episode and 1.58 times the odds of engaging in weekly binge eating for at least three months compared with heterosexual women. Those who had a BMI lower than 18.5 were also more likely to perceive themselves as overweight compared with heterosexual women with a similarly low BMI.

“The incorporation of our findings into clinical work is strongly encouraged,” Shepherd and colleagues wrote. “For example, psychiatric assessments and interventions could be tailored to address the specific eating disorder symptoms and clinical presentations that are more commonly reported among sexual minoritized men and women.”

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Thursday, April 28, 2022

Suicide Rate Among Women Increases When Gun Added to Home

The rate of suicide among women living in previously handgun-free homes increased substantially when a cohabitant acquired a handgun, according to a study published yesterday in JAMA Psychiatry.

“Little is known about how secondhand exposure to firearms affects nonowners, especially with respect to suicide, which is the leading cause of violent death and of death by firearms in the U.S. for both women and men,” Matthew Miller, M.D., M.P.H., of Northeastern University and colleagues wrote. The authors noted that millions of people have purchased guns since the beginning of the COVID-19 pandemic.

Miller and colleagues conducted an observational cohort study involving 9.5 million adult women (average age, 41.6 years) in California who did not own guns. The authors gathered data from the LongSHOT database, which linked lawful handgun transactions from California’s Dealer Record of Sale (DROS) database with the California Statewide Voter Registration Database (SVRD) and all-cause mortality data from the California Death Statistical Master Files. The authors formed households by matching LongSHOT members who resided at the same address during the same period.

All participants resided in households with one, two, or three other adults, none of whom owned handguns at the start of the study. The participants were followed from October 18, 2004, to December 31, 2016, during which time the authors used DROS and SVRD data to determine if a cohabitant had purchased a handgun during the study period.

Over 331,000 women (3.5%) lived with someone who acquired a handgun during the study period. Of the nearly 295,000 women in the study who died during that time, 2,197 of the participants died by suicide, 337 (15%) of which involved a firearm.

The rate of death by suicide among the participants increased significantly after a cohabitant acquired a handgun—48% of suicides involved a firearm. Comparatively, only 14% of suicides among women not residing in a home with a handgun owner were suicides by firearm. The excess rate of firearm suicide among cohabitants of handgun owners was evident shortly after the handgun was purchased, the authors found, and persisted as long as the household contained at least one handgun.

“To our knowledge, this study is the first to estimate the association between secondary exposure to household firearms and the rate of suicide among women who do not own handguns,” the authors concluded. “Our estimate that the rate increased by a relative 50% is a statistic that may be of interest to the millions of women who currently do not own guns but reside with other adults who do, to the gun owners with whom they live, and to the tens of millions of other women who currently live in gun-free homes with other adults who may be thinking about buying a handgun.”

For related information, see the Psychiatric News article “How to Reduce Risk of Suicide by Firearms.”

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Wednesday, April 27, 2022

Relatives of COVID Patients Admitted to ICU May Experience Significant PTSD Symptoms

Nearly two-thirds of adult relatives of people admitted to the intensive care unit (ICU) with COVID-19 continued to experience significant symptoms of posttraumatic stress disorder (PTSD) months later, according to a report in JAMA Internal Medicine.

The study also found that those with significant symptoms of PTSD “more commonly described feelings of distrust and concern about taking clinicians’ information at face value without being present to see for themselves,” wrote Timothy Amass, M.D., Sc.M., of the University of Colorado School of Medicine and colleagues.

“As the COVID-19 pandemic continues to challenge the ability of family members to build bedside relationships with clinicians, this loss of trust may translate to an increase in stress-related disorders. … [E]stablishing rapport with family members in creative and innovative ways may help to offset the physical distance,” they wrote.

The researchers assessed 330 family members of patients admitted to the ICU with COVID-19 at 12 U.S. hospitals in Colorado, Louisiana, Massachusetts, New York, and Washington from February 1 through July 31, 2020. Most of the relatives were children of COVID patients (n=129) or spouses/partners (n=81). The rest were siblings, parents, or other relatives.

Family members were assessed for symptoms of PTSD at three and six months after their relatives’ ICU admission using The Impact of Events Scale (IES). The researchers also invited family members to participate in a follow-up interview during which they were asked to rate their satisfaction with the health care their relative received in the ICU (for example, they were asked “How satisfied were you with the level or amount of health care your family member received in the ICU?” and asked to rate the compassion they felt their family member received in the ICU).

The average IES score at three months was 11.9, with 63.6% of family members having scores of 10 or higher, indicating significant symptoms of PTSD. At the six-month follow-up, the average IES score was 10.1, with 48.4% scoring 10 or higher.

Female family members had an average score 2.6 points higher than male family members, and Hispanic family members scored an average of 2.7 points higher than non-Hispanic family members.

“It is possible that receiving or perceiving fewer acts of compassion may help explain the association of increased IES scores or that bedside exclusion prevented families from engaging in culturally important bedside care rituals,” the researchers wrote. “Prior studies highlight that those identifying as Hispanic are more likely to use touch at the bedside and be involved in patient care and that bedside care rituals may help reduce psychological distress.”

Information from follow-up interviews was collected from 74 family members. “Of those 49 with IES-6 scores of 10 or higher, 18 (36.7%) mentioned distrust, whereas 2 of the 25 (8.0%) with IES-6 scores less than 10 mentioned distrust; Hispanic participants more commonly reported distrust,” they wrote.

Amass and colleagues concluded, “[W]hen patients or families experience loss of control, they may be more prone to develop PTSD … [O]ur results should … alert the health care community to the diverse factors associated with significant psychological distress in family members of patients in the ICU.”

For related information, see the Psychiatric News article “COVID-19 and Psychotherapy: Addressing Blocked Mourning.”

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Tuesday, April 26, 2022

Cigarette Use Fell From 2006 to 2019 Among Those With Depression, Substance Use Disorder

The percentage of adults with major depression and/or substance use disorder who reported smoking cigarettes declined between 2006 and 2019, according to a report published today in JAMA.

“This study shows us that, at a population-level, reductions in tobacco use are achievable for people with psychiatric conditions, and smoking cessation should be prioritized along with treatments for substance use, depression, and other mental health disorders for people who experience them,” Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA) and co-author of the study, said in a news release. “Therapies to help people stop smoking are safe, effective, and may even enhance the long-term success of concurrent treatments for more severe mental health symptoms in individuals with psychiatric disorders by lowering stress, anxiety, depression, and by improving overall mood and quality of life.”

Volkow together with lead author Beth Han, M.D., Ph.D., of NIDA and colleagues analyzed data from adults 18 years and older who participated in the annual National Survey on Drug Use and Health (NSDUH) between 2006 and 2019. As part of the NSDUH, interviewers asked participants about lifetime, past-year, and past-month use of tobacco and alcohol, misuse of prescription opioids, and more. The participants were also asked about any past-year major depressive episode (using DSM-IV criteria) and sociodemographic characteristics (such as age, sex, race and ethnicity, employment status, family income, and more). Han and colleagues specifically focused on data on past-month cigarette use from 558,960 adult participants.

Past-month prevalence of cigarette smoking and any tobacco use were consistently higher among those with a major depressive episode, alcohol use disorder, drug use disorder, substance use disorder, or co-occurring major depressive episode and substance use disorder than among those without the corresponding conditions, Han and colleagues reported. After controlling for sociodemographic characteristics, the researchers found that overall past-month cigarette smoking significantly declined from 2006 to 2019 among those with a major depressive episode (37.3% to 24.2%), substance use disorder (46.5% to 35.8%), or both (50.7% to 37.0%).

Differences in the prevalence of cigarette smoking between adults with a major depressive episode versus those without a major depressive episode also declined for all groups analyzed except for American Indians or and Alaska Natives. “For American Indian or Alaska Native adults, prevalence did not significantly differ between those with vs without [a major depressive episode] during 2006-2012 but was significantly higher for those with [a major depressive episode] during 2013-2019,” Han and colleagues wrote.

Han and colleagues noted several limitations of the study, including that the only non-substance use disorder mental illness measured directly by the NSDUH was major depressive episode and that the data predate the COVID-19 pandemic.

For related information, see the American Journal of Psychiatry article “Efficacy of Combining Varenicline and Naltrexone for Smoking Cessation and Drinking Reduction: A Randomized Clinical Trial.”

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Monday, April 25, 2022

Tailoring Internet CBT for Insomnia to Black Women Found to Increase Therapy Engagement

Offering Black women with insomnia an online cognitive-behavioral therapy program that features Black sleep experts and acknowledges the contexts in which insomnia occurs for some Black women may increase their engagement with therapy and significantly improve sleep, reports a study in JAMA Psychiatry.

“These results showing that it is possible to adapt a proven intervention to significantly increase treatment engagement for a racial minority group are compelling,” wrote Eric S. Zhou, Ph.D., of Harvard Medical School and colleagues. “Improving participation with a treatment as challenging as CBT-I [cognitive-behavioral therapy for insomnia] is no small feat as it requires people to overhaul their sleep patterns, behaviors, and thoughts.”

To test the efficacy of the adapted CBT-I, Zhou and colleagues enrolled 333 Black women with insomnia disorder into a three-armed clinical trial. The average age of the participants was 59.5 years, and they were all participants in the national Black Women’s Health Study (BWHS). This is a study of 59,000 Black women that Boston University began in 1995.

One group of women had access to an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi). The SHUTi program is a six-session program (delivered over six to nine weeks) that incorporates the core elements of CBT-I, including relaxation exercises, avoiding activities in bed other than sleep, and reframing negative thoughts about sleep. The second group of women received an adapted version of SHUTi for Black women (SHUTi-BWHS); this therapy was developed by Zhou and colleagues in collaboration with stakeholders, including three Black women (a Black woman with a history of insomnia and two Black women with experience in clinical trials) as well as a sleep physician from a center that primarily treats racial and ethnic minority groups. The third group (control) was directed to a sleep website that included educational materials as well as basic strategies on improving sleep behavior.

Some adaptations to SHUTi for the SHUTi-BWHS program included replacing all visual content to feature only Black men and women; Black actors were used for patient vignettes, and videos featured Black women sleep physicians who served as the sleep experts in the program content.

After six months, the Black women who received either SHUTi or SHUTi-BWHS reported significantly greater reductions in insomnia (assessed with the Insomnia Severity Index, or ISI) compared with the control group. ISI scores dropped by 10.0 points in the SHUTi group, 9.3 points in the SHUTi-BWHS group, and 3.6 points in the control group. Women in the SHUTi-BWHS group were more likely to complete all six sessions compared with the SHUTi group (78.2% vs. 64.8%, respectively).

“Similar to prior SHUTi trials, there was a direct association between the participants’ level of intervention engagement and their improvement in sleep,” Zhou and colleagues wrote. “At the community level, the scale of public health improvement that is possible with a 13% increase in treatment engagement is immense, especially in a racial group that faces multiple barriers to treatment.”

To read more on this topic, see the American Journal of Psychiatry article “Using Insomnia as a Model for Optimizing Internet-Delivered Psychotherapy.”

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Friday, April 22, 2022

Depression, Anxiety Symptoms in Youth With History of Depression Lessened During Pandemic

Adolescents with a history of depression reported lower depressive and anxiety symptoms in the first year of the COVID-19 pandemic than they did the year before, according to a report published this week in the Journal of the American Academy of Child & Adolescent Psychiatry. Adolescents without a history of depression experienced increasing symptoms of depression over time.

“Our findings are in line with studies on clinically depressed adult populations for whom having a pre-pandemic diagnosis did not predict significantly worsened depressive or anxiety symptoms,” wrote Neda Sadeghi, Ph.D., of the National Institute of Mental Health.

Sadeghi and colleagues analyzed data from the National Institute of Mental Health Characterization and Treatment of Depression (NIMH CAT-D) cohort, an ongoing longitudinal study that began before the pandemic. Participants in the CAT-D study were between the ages of 11 and 17 at the time of enrollment and had either a past or current diagnosis of major depressive disorder (MDD) or subthreshold depression (s-MDD) or no history of depression. Most of the CAT-D participants were from the District of Columbia, Maryland, and Virginia.

All CAT-D participants were seen once a year for a full clinical assessment, and participants in the s-MDD and MDD groups were seen on a regular basis between yearly follow up visits. Adolescent depressive symptoms were measured using either the parent- or youth-reported Mood and Feelings Questionnaire (MFQ), with scores ranging from 0 to 26 (higher score reflects greater depressive symptoms). Adolescent anxiety symptoms were measured using either the parent- or youth-reported Screen for Child Anxiety Related Disorders (SCARED), with scores ranging from 0 to 10 (higher score reflects greater anxiety symptoms). As part of the CAT-D study, adolescents with depression were also offered treatment at NIMH.

In total, 166 adolescents (109 girls and 96 adolescents with depression) had completed at least one assessment for anxiety and/or depression before the pandemic (between March 11, 2019, and March 10, 2020) and at least one assessment for anxiety and/or depression during the pandemic (between March 11, 2020, and March 11, 2021).

Adolescents without a history of depression had a mean depression score of 1.76 before the pandemic compared with 11.16 in adolescents with depression—a 9.40 point difference between the two groups. During the pandemic, the mean depression score of adolescents without a history of depression increased by 1.16 points compared with a slight drop in the mean depression score of 0.89 points in adolescents with depression—a 7.35 point difference between the two groups. A comparison of the groups’ anxiety scores before and during the pandemic revealed similar changes, with a slight increase in anxiety symptoms in the adolescents without a history of depression and a slight decrease in anxiety symptoms in the adolescents with depression.

Sadeghi and colleagues offered several explanations as to why the depressed youth in the study may have experienced a reduction in depression and anxiety symptoms during the pandemic, including that “the general increase in worry in the population might have led adolescents with depression to feel less isolated.” However, they cautioned, “the effects of the pandemic could be worse for adolescents with depression who did not have access to mental health care; whose access to care was even more restricted by the pandemic; or those who, for geographic, ethnic, and socio-economic reasons, are severely underserved.”

For related information, see the Psychiatric News article “Surgeon General Calls for Action to Address Youth Mental Health Crisis.”

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Thursday, April 21, 2022

DSM Cultural Formulation Interview May Improve Patient-Physician Communication, Trust

Mistrust of health care professionals by some groups of patients may lead to treatment disengagement and health disparities. A report in The American Journal of Psychotherapy describes an interview tool used at patient intake that may be able to facilitate communication about differences in cultural backgrounds between patients and their mental health professionals.

“Elevated disengagement from mental health treatment among Black, Indigenous, and people of color (BIPOC) patients may be due in part to their perceptions that providers misunderstand their experience because of differences in cultural background that are not discussed in therapy,” wrote Neil Krishan Aggarwal, M.D., M.A., of Columbia University Medical Center and New York State Psychiatric Institute and colleagues. “Clinicians can use the CFI [Cultural Formulation Interview] to allow BIPOC patients to describe their experiences within the health care system and to anticipate treatment barriers.”

The 16-item CFI was developed by the DSM-5 cross-cultural issues subgroup. Aggarwal and colleagues implemented the CFI at Flushing Hospital Medical Center, a community hospital in the Queens borough of New York City. Patients were eligible if they were between the ages of 18 and 80, spoke English, and were new to the center. As part of the pilot study, two social workers (one man and one woman who identified as non-Latinx White) agreed to start their intake sessions with the CFI. They attended a two-hour training session that consisted of reading the CFI aloud, watching videos illustrating the use of the CFI with a patient, behavioral simulations to practice responding to questions, and a question-and-answer session with researchers. All patients received $30 in compensation for their time.

The authors analyzed patient responses to the CFI’s final question on the patient-professional relationship: “Sometimes doctors and patients misunderstand each other because they come from different backgrounds or have different expectations. Have you been concerned about this and is there anything that we can do to provide you with the care you need?”

Of the 27 participants (11 men and 16 women) who completed the CFI as part of their intake session for care, two identified as non-Latinx White, 14 as Latinx, eight as non-Latinx Black, and three as non-Latinx Asian. Their primary languages were English, Spanish, and Polish. Their intake diagnoses included anxiety, bipolar, adjustment, psychotic, and somatic symptom disorders.

In response to the final question, 12 patients raised concerns about trusting professionals, particularly stemming from religious, racial-ethnic, gender, and socioeconomic differences. Ten patients had no concerns, simply responding “no” to the final question or explaining that they had no concerns about cultural differences. Three were ambivalent about their relationship with mental health professionals, and two patients were unsure about how to answer the question, responding with “I don’t know.”

“Consistent with the CFI’s approach to helping patients co-construct a narrative about their illness and treatment experiences, clinicians can broach this topic during the initial session to encourage solutions and anticipate problems,” the authors concluded. “Delaying discussions of identity differences may reinforce patient mistrust by communicating that therapists do not care about their experiences.”

For related information, see DSM-5® Handbook On The Cultural Formulation Interview from APA Publishing and the Psychiatric Services article “Using the Cultural Formulation Interview to Build Culturally Sensitive Services.”

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Wednesday, April 20, 2022

Study Examines Patient Recovery 10 Years After First-Episode Psychosis

Nearly a third of patients with first-episode psychosis (FEP) had recovered at 10-year follow-up based on a standard clinical definition of recovery, according to a report in Schizophrenia Bulletin. Recovery rates were higher still among FEP patients who had been diagnosed with bipolar spectrum disorder, with 50% meeting the criteria for recovery.

“Clinicians must communicate this to [patients] receiving a psychosis diagnosis as it can contribute to increased hope of recovery and reduced pessimism and stigma, ultimately promoting chances of recovery,” wrote Carmen Sorensen, Ph.D., of the Oslo University Hospital and colleagues.

The study involved patients who had recently experienced a first episode of psychosis between 2004 and 2012 and were recruited for the Thematically Organized Psychosis (TOP) study. As part of the TOP study, patients who met DSM-IV criteria for schizophrenia or bipolar spectrum disorder were evaluated at one- and 10-year follow-ups.

The researchers used a standard clinical definition of recovery focusing on remission of psychotic symptoms and adequate functioning to evaluate 142 patients from the TOP study. Psychotic symptom remission was defined as a score of 3 or less on measures of positive, negative, and disorganized symptoms using the Positive and Negative Symptom Scale (PANSS). Adequate functioning was defined as full-time occupational functioning in terms of work, study, or other (for example, full-time child rearing); social functioning (for example, meeting a friend at least once weekly); and independent living (for example, residing in an unsupervised home and maintaining activities of daily living). They also included 117 age- and gender-matched healthy controls for comparison on measures of functioning.

Of the 142 patients in the analysis, 31.7% met the criteria for clinical recovery at the 10-year follow-up, with 59.9% achieving psychotic symptom remission for at least 12 months and 32.4% achieving adequate functioning. The clinical recovery rate was significantly higher among patients with a bipolar spectrum diagnosis (50.0%) compared with those with a schizophrenia spectrum diagnosis (22.9%). Among the healthy controls, 18.8% did not meet the standard criteria for adequate functioning, “suggesting that these criteria are too strict,” the authors wrote.

When the researchers adjusted the criteria for adequate functioning (for example, part-time instead of full-time work/study/other and having a close friend or confidant instead of weekly contact), they found that the recovery rate in the group of patients increased to 40.8%.

“The increase in recovery rates … with looser criteria illustrates how recovery rates are partially dependent on how they are defined,” the researchers wrote. “This knowledge allows for meaningful conversations with [patients] about the many forms that recovery can take.” The authors also noted that because most of the patients were in remission, treatment should focus early on regaining functioning and employment.

For related information, see the Psychiatric News article “New Network Collects Real-Time Data to Improve Treatment of Early Psychosis.”

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Tuesday, April 19, 2022

Blood Pressure Variability Linked With Depressive Symptoms in Older Adults

Older adults who exhibit significant changes in blood pressure over a year may have a higher risk of depressive symptoms than those whose blood pressure remains consistent, according to a study in the American Journal of Geriatric Psychiatry. In particular, diastolic blood pressure variability (changes in the pressure when the heart relaxes and fills with blood) was associated with greater symptoms of dysphoria, or a general state of unease.

“Importantly, these findings were in a study sample without history of dementia or recent depression, indicating BPV [blood pressure variability] may be related to subthreshold levels of depression in the absence of major neurocognitive dysfunction,” wrote Isabel J. Sible M.A., of the University of Southern California, Jung Y. Jang, Ph.D., of the University of California Irvine, and colleagues.

The researchers analyzed data from 505 older adults aged 55 to 91 who participated in the Alzheimer’s Disease Neuroimaging Initiative (ADNI). As part of the ADNI study, participants underwent three to four blood pressure measurements over 12 months and completed the 15-item Geriatric Depression Scale (GDS-15) at enrollment and follow-up 24 months later. The researchers focused their analysis on the participants who had low depressive symptoms (GDS-15 score of < 6), no history of neurological disease, low risk of cardiovascular disease, and no dementia at the start of the study.

Sible, Jang, and colleagues found that adults with greater variability in diastolic blood pressure readings over 12 months were more likely to have elevated GDS-15 scores at the 24-month follow-up. The association between diastolic blood pressure variability and depression symptoms was similar regardless of whether blood pressure levels were low or high on average.

The researchers also looked at the three subcomponents of the GDS-15 (dysphoria, withdrawal, and life satisfaction) and found that greater diastolic blood pressure variability was specifically linked with increased risk of dysphoria symptoms. There was no association between systolic blood pressure variability and dysphoria, nor did there appear to be any relationship between blood pressure variability and symptoms of withdrawal and life satisfaction.

These “[f]indings add to the limited number of studies investigating visit-to-visit [blood pressure variability] and depression in older adults and improve our understanding of associations with subthreshold levels of depressive symptoms,” Sible, Jang, and colleagues wrote.

To read more on this topic, see the Psychiatric News article “Some Hypertension Medications May Protect Against Depression.”

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Monday, April 18, 2022

Stimulants May Improve Efficacy of rTMS for Patients With Major Depression

Patients with major depressive disorder (MDD) who take psychostimulants may respond better to repetitive transcranial magnetic stimulation (rTMS) than those not taking psychostimulants, suggests a report in Depression & Anxiety.

“These findings suggest a novel pharmacologic augmentation strategy for patients undergoing rTMS treatment of depression,” wrote Scott A. Wilke, M.D., Ph.D., of the Semel Institute for Neuroscience and Human Behavior in Los Angeles and colleagues. “Because many patients have a limited response to rTMS treatment, an augmentation approach to maximize treatment benefit by harnessing psychopharmacology would be a significant advance.”

Wilke and colleagues performed a retrospective study of patients who were treated for nonpsychotic MDD at the UCLA TMS Clinical and Research Service between September 2009 and January 2017. They specifically focused on patients who were taking medications at the time of rTMS treatment and were assessed using the 30-item Inventory of Depressive Symptomatology Self Report (IDS-SR30) periodically over the course of rTMS treatment.

The final analysis included 37 patients taking known dosages of one or more psychostimulants and 53 control patients who were not taking psychostimulants or benzodiazepines. (Patients taking benzodiazepines were excluded from the study because previous research suggests that the medications may reduce the efficacy of rTMS.) The psychostimulant group included 22 patients taking lisdexamfetamine/dextroamphetamine, 9 patients taking methylphenidate/dexmethylphenidate, and 7 patients taking modafinil/armodafinil (one patient was taking two psychostimulants). Patients were treated with up to 30 rTMS sessions over six weeks.

Patients who took psychostimulants had a significantly greater overall clinical improvement on the IDS-SR30 from baseline to the end of the rTMS treatment than those not taking these medications while undergoing rTMS. Patients who took psychostimulants also showed significantly greater improvement in the IDS-SR30 subdomains of sleep and mood/cognition, but not in anxiety/arousal, Wilke and colleagues noted. Additional analysis suggested that smaller doses of lisdexamfetamine/dextroamphetamine were associated with better rTMS treatment outcome.

The authors pointed to several limitations of the study, including the small sample sizes and limited knowledge of how long the patients had been taking the psychostimulants. “Finally, although the findings are suggestive, they are correlative and cannot address causal relationships. Thus, the clinical implications of combining psychostimulants and rTMS are unclear and caution is warranted until prospective trials can establish the safety and efficacy of such interventions,” they wrote.

For related information, see the American Journal of Psychiatry article “Trajectories of Response to Dorsolateral Prefrontal rTMS in Major Depression: A THREE-D Study.”

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Friday, April 15, 2022

Black Veterans Half as Likely as Whites to Receive Prescriptions for Depression

White veterans with depression are twice as likely as their Black peers to receive a prescription for antidepressants in primary care, a study in Psychiatric Services in Advance has found.

“These results underscore the importance of examining patterns of racial disparities in all settings in which mental health care is provided to identify areas for improvement,” wrote Jocelyn E. Remmert, Ph.D., of the Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center in Philadelphia and colleagues.

From January 2015 to December 2020, the researchers collected data from 4,120 Black and 4,372 White adult primary care patients who were referred to an integrated behavioral health program at the medical center. At each patient’s initial assessment, a health technician accessed the patient’s medical record and confirmed the patient’s prescriptions with the patient. Patients were screened for depression symptoms with the 9-item Patient Health Questionnaire (PHQ-9).

After controlling for depression symptoms, demographic characteristics, and other clinical symptoms, the researchers found that White patients were 1.96 times more likely than Black patients to have received an antidepressant prescription at the time of the assessment. Among patients with severe depression, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription.

“These results are particularly notable because, in this sample, Black patients had significantly more severe depression symptoms than White patients, and significantly more Black patients had symptoms of moderate and severe depression,” Remmert and colleagues wrote. “Our results highlight the need for additional studies to understand the scope of racial disparities in mental health treatment broadly and to identify recommendations to improve access to evidence-based mental health treatment for veterans from minority groups in all settings.”

For related information, see the Psychiatric Services article “Improving Black Mental Health: A Collective Call to Action.”

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COVID-19 Public Health Emergency Extended Through
Mid-July

The Department of Health and Human Services has renewed the public health emergency until July 15 due to the continued consequences of COVID-19. States will be given 60 days’ notice before termination of the public health emergency. The public health emergency was initially declared in January 2020, when the coronavirus pandemic began.

Thursday, April 14, 2022

Digital Tool May Improve Cognitive Functioning Among Adults With MDD

Adults who continue to experience symptoms of major depressive disorder (MDD) while taking antidepressants may benefit from playing a video game-based intervention called AKL-T03, according to a study published this week in the American Journal of Psychiatry. Adults with MDD who played AKL-T03 for six weeks showed improvements in sustained attention and cognitive functioning compared with those who played a different video game.

“Society is facing a growing mental health crisis, with depression rates in the U.S. increasing about 20% during the pandemic. While mood symptoms are most often associated with MDD, equally concerning are the frequent associated cognitive impairments,” lead author Richard Keefe, Ph.D., of Duke University Medical Center said in a news release. “More than ever, we need safe and effective ways to support these patients—new tools that can be easily and broadly accessed.” Keefe is a consultant for Akili Interactive, maker of AKL-T03, and he is the co-founder of VeraSci, which provides support for business entities, including Akili.

Keefe and colleagues conducted the Software Treatment for Actively Reducing the Severity of Cognitive Deficits in Major Depressive Disorder (STARS-MDD) study, a randomized, double-blind six-week controlled trial. The participants were between the ages 25 and 55 years; had an MDD diagnosis; scored between 14 and 22 on the 17-item Hamilton Depression Rating Scale during the study’s screening phase and at its start; scored 50 or less on the Brief Assessment of Cognition; were on antidepressant medication for at least eight weeks prior to screening and at the start of the study; and were kept at a stable antidepressant dosage for at least four weeks prior to the start of the study. Participants’ level of sustained attention and inhibitory control were assessed at baseline and after six weeks using the Test of Variables of Attention (TOVA).

Participants were randomized into two groups: one group was given access to the AKL-T03 intervention, and the other group was given access to a word-based video game (control group). The AKL-T03 interface displays two tasks that participants must complete by multitasking. “[U]sers are presented a perceptual discrimination targeting task in which they must respond to the designated stimulus targets and ignore the stimulus distractors (similar to a go/no-go task) and a sensory motor navigation task in which they must continuously adjust their location to interact with or avoid positional targets,” the authors wrote. In the control group, participants played a video game that involved connecting letters in a grid on the screen vertically, horizontally, or diagonally to form as many words as possible. Both the AKL-T03 and control participants were instructed to complete 25 minutes of game play a day, five times a week for six weeks.

There were 37 participants each in the AKL-T03 and control groups. Those in the AKL-T03 group showed a statistically significant improvement in their sustained attention compared with those in the control group on the TOVA. There was no significant difference between the two groups in other measures assessing working memory, processing speed, task switching, depressive symptoms, and other cognitive symptoms.

“AKL-T03 shows promise for reducing cognitive impairment during a current episode of depression,” the authors wrote. “Further research looking at longitudinal data and durability of effect is needed to confirm the hypothesis that cognitive improvements may have an impact on functional outcomes and potentially on future relapses.”

For related information, see the Psychiatric News article “FDA OKs ADHD Video Game Therapy.”

(Image: iStock/PeopleImages)




COVID-19 Public Health Emergency Extended Through Mid-July

The Department of Health and Human Services has renewed the public health emergency until July 15 due to the continued consequences of COVID-19. States will be given 60 days’ notice before termination of the public health emergency. The public health emergency was initially declared in January 2020, when the coronavirus pandemic began.

Wednesday, April 13, 2022

Children at Risk for Schizophrenia Show Early Neurocognitive Deficits

Children with at least one biological parent with schizophrenia show deficits in intelligence, attention, verbal fluency, and other neurocognitive measures from age 7 to 11 years compared with children who do not have a parent with schizophrenia, according to a report in JAMA Psychiatry. These cognitive deficits were not seen in children who had a parent with bipolar disorder.

The findings suggest “that a substantial overlap between schizophrenia and bipolar disorder in clinical characteristics and predisposing genes does not translate to overlapping neurocognitive impairments in their offspring during the ages of 7 and 11 years,” wrote Christina Bruun Knudsen, M.Sc., of the Psychosis Research Unit at Aarhus University in Denmark and colleagues. “These findings may have the potential to inform early intervention programs targeting cognitive impairments in children at [risk] of schizophrenia as these impairments may be susceptible to remediation.”

Knudsen and colleagues compared neurocognitive development in 451 children enrolled in the Danish High Risk and Resilience Study, including 170 children who had a parent with schizophrenia, 103 children who had a parent with bipolar disorder, and 178 children from the general population.

The children were assessed at age 7 and 11 using multiple neurocognitive measures including general intelligence, cognitive processing speed, sustained attention, verbal memory, visual-spatial memory, verbal fluency, and planning and working memory.

Compared with children from the general population, children at risk of developing schizophrenia showed significant neurocognitive impairment in 7 of 24 neurocognitive measures at age 11. Compared with children at risk of developing bipolar disorder, children at risk of schizophrenia had significant neurocognitive impairment in 5 of 24 measures compared with children at risk for bipolar disorder at age 11. Children at risk of bipolar disorder performed similarly on the neurocognitive tests as those from the general population.

“Our study aligns with several others reporting widespread neurocognitive impairments in children of individuals with schizophrenia during childhood and adolescence and in young adult first-degree relatives,” the authors wrote. “Assessments beyond age 11 years are warranted to uncover the expected emergence of neurocognitive impairments in children of parents with bipolar disorder and to identify potentially distinct neurocognitive trajectories in these high-risk groups that may be differentially related to the risk of developing schizophrenia or bipolar disorder later in life.”

For related information, see the Psychiatric News article “Study Sheds Light on Trajectory of Developing Bipolar Disorder.”

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Tuesday, April 12, 2022

APA Awarded Grant to Identify Training Gaps in Perinatal Mental Health Care

APA has launched a new initiative with the goal of better understanding the experiences and attitudes of psychiatrists and mental health professionals around treating pregnant women with mental and substance use disorders.

The Mental Health Needs Assessment in the Management of Perinatal Psychiatric Disorders will identify training gaps among clinicians related to perinatal mental health care; update and expand existing recommendations for the mental health care of pregnant women; develop a perinatal psychiatric care toolkit for clinicians; and formulate educational and training recommendations for mental health clinicians to better serve this population.

The initiative is led by Diana E. Clarke, Ph.D., APA’s managing director of research and senior epidemiologist/research statistician. It is supported by a $447,209 grant from the Centers for Disease Control and Prevention Foundation.

“This is an important initiative, and I am thrilled that representatives from many mental health professional organizations and diverse backgrounds are participating on the panel to ensure a robustly informed process,” Clarke said in a news release. Other organizations involved include the American Psychological Association, American Counseling Association, National Association of Social Workers, and the American Association of Nurse Practitioners.

According to a study published in Psychiatric Services, 51% of pregnant women in the United States who experienced a major depressive episode between 2011 and 2016 did not receive any mental health treatment, and 40% reported perceiving an unmet need for mental health treatment, regardless of whether they had received any mental health treatment. The authors of the Psychiatric Services article noted these gaps in treatment exist despite the availability of safe treatment options and guidelines that call for mental health professionals to monitor the mental health of pregnant women.

As part of the new initiative, APA will perform a needs assessment by convening focus groups of women with mental and substance use disorders before, during, or up to two years following their pregnancies. APA will also survey, hold focus groups, and conduct a panel discussion with mental health professionals who treat pregnant women.

A 20-member advisory panel of psychiatrists and mental health professionals who have expertise in maternal mental health will also inform the project. These experts will provide advice on survey questions, focus group materials, and literature reviews.

“Maternal health, and particularly maternal mental health, is an issue that has taken a back seat for far too long in the United States,” APA President Vivian Pender, M.D., said in the release. “This effort will help us better understand where our opportunities are to ensure pregnant mothers have access to the psychiatric care they need, which will lead to improved mental health outcomes for moms and their babies.”

For related information, see the Psychiatric News article “Pandemic Has Compromised Mental Health of New Moms.”

(Image: iStock/SDI Productions)




Last Chance to Register for Annual Meeting at Advance Registration Rates!

Soledad O’Brien to Present William C. Menninger Memorial Lecture

To save on registration fees for APA’s 2022 Annual Meeting, register before 11:59 p.m. tonight. The meeting is being held in New Orleans from May 21 to 25. Just added to the program is Soledad O’Brien, host of the Sunday morning syndicated political show “Matter of Fact With Soledad O’Brien” and a correspondent on HBO’s “Real Sports With Bryant Gumbel.” A champion of diversity, she gives voice to the underserved through her Emmy-winning reporting and acclaimed documentary series “Black in America” and “Latino in America.”

REGISTER

Monday, April 11, 2022

Mental Health of Rural Veterans May Benefit From Use of Video-Enabled Tablets

Video-enabled tablets may help veterans with mental health conditions who live in rural areas access mental health care, a study in JAMA Network Open suggests. Veterans who received these tablets during the COVID-19 pandemic had increased video mental health service use, more psychotherapy visits, reduced suicidal behaviors, and fewer emergency department visits.

“These findings suggest that the VA and other health systems should consider leveraging video-enabled tablets for improving access to mental health care via telehealth and for preventing suicides among rural residents,” wrote Kritee Gujral, Ph.D., of the VA Palo Alto Health Care System and colleagues.

Gujral and colleagues analyzed data from approximately 472,000 rural veterans who had at least one VA mental health care visit in 2019, including a group of patients identified by the VA as having a high risk of suicide. Veterans were eligible to receive the VA’s video-enabled tablets with data plans if they did not own a device with broadband or cellular internet service, lived far from the VA or had another transportation challenge, and could operate a tablet, the researchers noted. The researchers compared monthly mental health service use for approximately 13,000 patients who received VA tablets between March 16, 2020, and April 30, 2021, with that of more than 458,000 patients who were not issued tablets; they specifically focused on the veterans’ mental health service use for the 10 months before and after the tablets were shipped.

Compared with patients who did not receive tablets, patients who received tablets had 1.8 more psychotherapy visits per year, 3.5 more video psychotherapy visits per year, and 0.7 video medication management visits per year. Patients who received tablets also experienced an overall 20% reduction in the likelihood of an emergency department visit, a 36% reduction in the likelihood of suicide-related emergency department visit, and a 22% reduction in the likelihood of suicidal behaviors. These associations persisted for the group of patients who were at high risk of suicide.

“These results reinforced a previous finding that tablets improved continuity of mental health care and extended prior work by showing tablet-associated reductions in [emergency department] visits and suicide behavior,” Gujral and colleagues concluded.

For related information, see the Psychiatric Services article “Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets.”

(Image: iStock/Caiaimage/Sam Edwards)




Did You Fail to File Report on Provider Relief Funds You Received?

The Health Resources and Services Administration has announced that health care providers who received funds from the Provider Relief Fund program and did not submit their Reporting Period 1 report by the deadline may request to submit a late report, via a DocuSign form, if certain extenuating circumstances exist. The requests must be filed from Monday, April 11, to Friday, April 22, at 11:59 p.m. ET and must attest to a clear, concise explanation regarding the extenuating circumstance; no supporting documentation is required. Those whose request is approved will be notified to complete the Reporting Period 1 report within 10 days. Providers will also have an opportunity to submit a Request to Report Late Due to Extenuating Circumstances for Reporting Period 2. Notification regarding the process to submit the request will be announced in the coming weeks. For more information, call the Provider Support Line at (866) 569-3522; for TTY dial 711. Hours of operation are weekdays from 8 a.m. to 10 p.m. Central Time.

Friday, April 8, 2022

APA Journal Pilots Race, Ethnicity, and Culture Checklist for Submissions, Review of MH Research

“Structural racism … has a long history in medical journals, and Psychiatric Services is no exception,” wrote Psychiatric Services Editor Lisa Dixon, M.D., M.P.H., and colleagues in an editorial published today in the journal. It “affects who runs the journal, who submits and reviews, what topics are emphasized, how the role of racism and ethnoracial categories are conceptualized and included or ignored in analyses and discussions, and what policy and services recommendations are made.”

Since 2020, Psychiatric Services has taken steps to examine the effects of structural racism on the journal and institute changes to address it, including enhancing the diversity of the editorial board and column editors; appointing a 12-member antiracism task force to advise the journal; publishing peer-reviewed articles and commentaries that address racism; and more. Psychiatric Services will now “embark on the next phase of this process, which directly involves the submission and peer-review procedures,” Dixon and colleagues wrote.

As part of a six-month pilot, authors submitting research articles to the journal will be prompted to use a 16-item checklist during the submission process to assess the comprehensiveness and applicability of factors related to race/racialization, ethnicity, and culture (REC) in their mental health research articles. (The checklist that Psychiatric Services will use is a modified version of an REC checklist developed by the Cultural Committee of the Group for the Advancement of Psychiatry, under the leadership of Roberto Lewis-Fernández, M.D., a professor of clinical psychiatry at Columbia University.)

The journal editors will seek feedback from authors and reviewers about the use of the checklist. “Our accumulated experience will be used to guide ongoing use of the checklist and possible expansion to other types of articles. Our experience may also serve as a guide for other journals interested in the use of the checklist,” Dixon and colleagues wrote.

They concluded, “Our aim as a journal is to engage in a continuous process of reevaluation and improvement to produce a corpus of high-quality published work that contributes to the ongoing process of promoting health equity and eliminating the impact of structural racism in mental health services. Implementing the REC Checklist is one more step in this process. We welcome your input and suggestions for additional ways to achieve our goal; comments may be directed to PSCentral@psych.org (subject line: REC Checklist).”

(Image: iStock/Ridofranz)




Did You Fail to File Report on Provider Relief Funds You Received?

The Health Resources and Services Administration has announced that health care providers who received funds from the Provider Relief Fund program and did not submit their Reporting Period 1 report by the deadline may request to submit a late report, via a DocuSign form, if certain extenuating circumstances exist. The requests must be filed from Monday, April 11, to Friday, April 22, at 11:59 p.m. ET and must attest to a clear, concise explanation regarding the extenuating circumstance; no supporting documentation is required. Those whose request is approved will be notified to complete the Reporting Period 1 report within 10 days. Providers will also have an opportunity to submit a Request to Report Late Due to Extenuating Circumstances for Reporting Period 2. Notification regarding the process to submit the request will be announced in the coming weeks. For more information, call the Provider Support Line at (866) 569-3522; for TTY dial 711. Hours of operation are weekdays from 8 a.m. to 10 p.m. Central Time.

Thursday, April 7, 2022

Screening Cancer Patients for Distress May Identify Patients at Higher Risk of Self-Injury

Screening cancer patients for anxiety, depression, and other symptoms of distress may help identify those at heightened risk of nonfatal self-injury, suggests a report in JAMA Oncology.

Cancer patients who scored higher on the Edmonton Symptom Assessment System (ESAS)—a tool that asks patients to score the severity of their symptoms of nausea, pain, depression, well-being, and more—were more likely to experience nonfatal self-injury within six months than those who scored lower on the ESAS.

“Nonfatal self-injury is a … manifestation of severe distress occurring in 3 out of 1,000 patients after cancer diagnosis,” wrote Julie Hallet, M.D., M.Sc., of the University of Toronto and colleagues.

To determine if routine symptom screening of cancer patients might provide clues about those at greatest risk of self-injury, Hallet and colleagues relied on data collected from adults insured through the Ontario Health Insurance Plan (OHIP). The researchers specifically focused on adults aged 18 years and older who were diagnosed with cancer between January 1, 2007, and March 31, 2019, and completed an ESAS assessment within 36 months of their cancer diagnosis.

A total of 806,910 patients, including 408,858 reporting one or more ESAS scores within 36 months of their cancer diagnosis, were included in the analysis; 753 of these patients had a nonfatal self-injury (an emergency department visit with a self-injury of intentional or undetermined intent), including 425 patients who had a recorded ESAS score up to six months prior to the injury.

The researchers compared the ESAS scores of 406 patients who experienced a nonfatal self-injury after their cancer diagnosis with 1,624 patients with cancer who did not experience a nonfatal self-injury. This comparison included how patients scored the nine individual symptoms listed on the ESAS (on a scale of 0 to 10, with 10 being worst) as well as the sum of the individual symptoms together (range: 0 to 90). The researchers defined all symptoms as moderate to severe for patients who scored 4 or higher, except for depression; moderate to severe depression symptoms were defined as a score of 2 or higher.

A higher proportion of patients with nonfatal self-injury reported moderate to severe symptoms on the ESAS than patients without nonfatal self-injury, the authors reported. “The largest absolute differences were observed for anxiety, depression, drowsiness, tiredness, and lack of well-being,” they wrote. These patients also reported higher total scores on the ESAS. Additional analysis revealed that for each increase of 10 points in a patient’s total ESAS score, there was a 51% increase in the odds of nonfatal self-injury in the following 180 days, they added.

“Effective interventions exist to prevent [nonfatal self-injury] in patients with cancer, including psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation, therapeutic walking, and alternative cancer treatment. Support can be implemented via protocols and pathways for integrated psychosocial assessment and interventions triggered when identifying high-risk patients,” Hallet and colleagues wrote. The findings of the study suggest that patients with “moderate to severe anxiety, depression, or shortness of breath or a high [total ESAS] score should be flagged by screening programs and targeted for psychosocial evaluation, support, and longitudinal follow-up.”

For related information, see the Psychiatric News article “Expert’s Corner: Best Practices for Treating Cancer Patients With Psychiatric Symptoms.”

(Image: iStock/Ridofranz)




Did You Fail to File Report on Provider Relief Funds You Received?

The Health Resources and Services Administration has announced that health care providers who received funds from the Provider Relief Fund program and did not submit their Reporting Period 1 report by the deadline may request to submit a late report, via a DocuSign form, if certain extenuating circumstances exist. The requests must be filed from Monday, April 11, to Friday, April 22, at 11:59 p.m. ET and must attest to a clear, concise explanation regarding the extenuating circumstance; no supporting documentation is required. Those whose request is approved will be notified to complete the Reporting Period 1 report within 10 days. Providers will also have an opportunity to submit a Request to Report Late Due to Extenuating Circumstances for Reporting Period 2. Notification regarding the process to submit the request will be announced in the coming weeks. For more information, call the Provider Support Line at (866) 569-3522; for TTY dial 711. Hours of operation are weekdays from 8 a.m. to 10 p.m. Central Time.

Wednesday, April 6, 2022

Discrimination May Contribute to Psychotic-Like Experiences in Childhood, Study Finds

Differences in the reporting of psychotic-like experiences by children of racial and ethnic groups may be in part due to the discrimination they have experienced, suggests a study in the Journal of the Academy of Child & Adolescent Psychiatry. However, a child’s social supports may serve as a buffer against discrimination and protect against psychotic-like experiences.

“Psychotic-like experiences … are common in the general population, with approximately two-thirds of 9- to 12-year-olds reporting at least one [psychotic-like experience],” wrote Nicole R. Karcher, Ph.D., of Washington University School of Medicine and colleagues. “Results from our study indicate a strong link between self-reported [psychotic-like experiences] and factors such as [experience of discrimination], financial adversity, immigration status, English language abilities, and [adverse childhood experiences].”

The researchers analyzed data from 10,839 children aged 9 to 10 years who were participants in the Adolescent Brain Cognitive Development (ABCD) Study. Among the sample, 47.9% were female, 2.2% Asian, 13.9% Black, 19.7% Hispanic, 10.5% Multiracial/Multiethnic, and 53.8% White. (The Multiracial/Multiethnic category included Native American/Alaskan Native, Native Hawaiian or Other Pacific Islander, and those who identified as “Other.”)

As part of the ABCD Study, youth completed the Prodromal Questionnaire-Brief Child Version (PQ-BC), a 21-item questionnaire used to assess psychotic-like experiences over the past month. They also completed the Perceived Discrimination Scale, a 7-item questionnaire that asks participants how often they experienced discrimination over the past 12 months, including how often others behaved unfairly toward their racial/ethnic group and how often they felt not wanted or accepted by other Americans. Additionally, children reported on the number of close friends they had, with the total number serving as a measure of social support. (All data were collected before the COVID-19 pandemic.)

Black, Hispanic, and Multiracial/Multiethnic participants had higher scores on the PQ-BC than Asian or White participants; Black children experienced an average of 8.7 distressing psychotic-like experiences compared with 7.75 for Hispanic children, 6.24 for multiracial children, 5.06 for White children, and 4.3 for Asian children.

Black children also reported greater experiences with discrimination compared with children in every other group, and Hispanic children reported more experiences of discrimination than Asian and White children. The study also revealed that Black and Hispanic children with more social support were less likely to experience psychotic-like experiences, suggesting that social support may be a protective factor.

“Clinicians and researchers who do not consider these external influences when working with individuals from historically marginalized groups run the risk of misattributing the sources of challenges, over-pathologizing, stigmatizing, and ultimately steering clients towards inappropriate treatment,” the authors wrote. “Individual clinicians and researchers can actively seek awareness of their own potential biases.”

For related information, see the Psychiatric News article “Review Examines How Racism May Increase Psychosis Risk.”

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New Version of APA Website Coming Tomorrow!

Check out APA’s updated website tomorrow at psychiatry.org! No downtime is anticipated for the main site, but login via psychiatry.org will not be available tomorrow morning until the new site is live. While much of the site will be familiar, the new version was developed to improve the overall user experience and increase accessibility for individuals with disabilities. Other improvements include a refreshed look, new features, a dynamic search engine that suggests items as you type, and expanded main menu to reduce the number of “clicks” to find information. If you run into any issues on the site, send an email to apa@psych.org and note the issue and the URL of the page.

Tuesday, April 5, 2022

Most Americans Feel Anxious About Climate Change, APA Poll Finds

Almost 60% of adults in the United States agree that climate change is impacting the health of Americans, according to an APA poll released today. More than half of those surveyed reported feeling anxious about the effects of climate change on the planet, with a greater percentage of younger adults expressing concerns about the planet than older adults.

The findings are from APA’s Healthy Minds Monthly, a poll conducted by Morning Consult. The poll was conducted online from March 19 to 21 among a nationally representative sample of 2,210 adults. Data were weighted to approximate a target sample of adults based on gender, educational attainment, age, race, and region

“When you read about an ice shelf the size of the island of Manhattan breaking off Antarctica, it’s a very tangible, dramatic representation of climate change’s impact,” APA President Vivian Pender, M.D., said in a media release. “But there are so many unseen mental health impacts as well, whether it’s in the anxiety over our children and grandchildren’s future, or the trauma to those who are physically displaced by fires or violent storms.”

Additional findings from the poll include the following:

  • Younger adults appear to be more anxious about climate change than older adults: Of those aged 18 to 34, 66% reported feeling anxious about the effects of climate change on the planet compared with 50% of adults 65 years and older. Additionally, 51% of respondents aged 18 to 34 were anxious about the impact of climate change on their mental health compared with 24% of respondents 65 years and older.
  • Adults aged 18 to 34 were also more likely to say they believed climate change was already impacting the mental health of Americans (57%) compared with adults 65 years or older (41%).
  • Women (56%), 18 to 34-year-olds (59%), and Democrats (69%) were especially likely to report feeling anxious when thinking about the possible impact of climate change on future generations. Additionally, respondents in the western United States were more likely than respondents from other regions of the country to feel anxious about the impact climate change could have on future generations.
  • Adults were split on how frequently stories and headlines about climate change affect their mood—with 49% of adults aged 18 to 34 years reporting such stories affect their mood at least some compared with 35% of adults 65 years or older.
  • The majority of those surveyed (53%) reported that they believe that climate change is caused by human activity.

“Climate change is a public health emergency, and we can’t neglect mental health when we call it out,” said APA Committee on Climate Change Chair Elizabeth Haase, M.D. “Our care for the planet is our care for ourselves, and by taking action we help ourselves with its mental health effects.”

For related information, see the Psychiatric Services article “Climate Change and Mental Health: Implications for the Psychiatric Workforce” and the Psychiatric News article “Generation Climate Change: Growing Up With Ecological Grief and Anxiety.” APA also has a video that describes how climate change and related disasters cause anxiety-related responses as well as chronic and severe mental health disorders.

(Image: iStock/leonello)




APA to Launch New Version of Its Website This Week

Over the last two years, APA has worked on a major update of its website to improve its content, search engine, and accessibility for people with disabilities. In addition, the look of the website has been refreshed, and the main menu has been streamlined to reduce the number of “clicks” a user needs to find information.

Website traffic has grown tremendously over the last several years, driving the need to update the site. The number of pageviews has increased from 6.3 million in 2016 (the date of the last website redesign) to 40 million. The updated website will ensure that APA continues to respond to the expanding informational needs of members and provides accurate information about mental health to patients and families.

Monday, April 4, 2022

Medications for Opioid Use Disorder May Reduce Risk of Suicide, Other Deaths

Veterans who take medications for opioid use disorder (OUD) for at least 15 days have more than a 50% decreased risk of dying by suicide compared with those not taking OUD medications, according to a study in the April issue of the American Journal of Psychiatry. Stable use of buprenorphine, in particular, was associated with a 66% reduced risk of suicide mortality compared with no buprenorphine use.

“These results again highlight the importance of providing medication treatment to as many people with opioid use disorder as possible,” wrote Bradley Watts, M.D., M.P.H., of the Geisel School of Medicine at Dartmouth College and colleagues. “Doing so may have broad impacts on health outcomes, including suicide mortality.”

Watts and colleagues analyzed data from the Department of Veterans Affairs (VA) and Centers for Medicare and Medicaid Services for 61,633 patients who received a medication for OUD (buprenorphine, methadone, or naltrexone) between 2003 and 2017. All the patients were tracked for up to five years after their first receipt of medication for OUD, their death, or the end of 2017. The patients were categorized into four groups based on their exposure to medication for OUD: those starting treatment (first 14 days on medication treatment), stopping treatment (first 14 days off medication treatment), stable in medication treatment (15+ days), and stable off medication treatment (15+ days).

Most of the patients were male (92.8%) and White (71.3%), with a mean age of 46.5 years. After adjusting for patient demographics, other mental and physical health diagnoses, and frequency of health care utilization, the researchers found that VA patients on stable medication treatment for OUD had a 55% reduced risk of suicide mortality, a 65% reduced risk of mortality by other external causes (such as an accident or injury), and a 66% reduced risk of death by any cause compared with those not taking medication for OUD. Patients just starting or stopping treatment had no differences in suicide mortality risk compared with those off medication.

When looking at individual OUD medications, Watts and colleagues found that stable buprenorphine use was associated with a reduced risk of death by suicide compared with no buprenorphine use. Methadone use was also associated with reduced suicide mortality, but when health care use and mental health diagnoses were factored in, the association of methadone with decreased risk was no longer significant. “This was largely because those who received methadone had far more mental health contacts,” Watts and colleagues wrote. Naltrexone was not associated with reduced suicide mortality risk in any analysis.

“This finding aligns with emerging evidence that buprenorphine may have rapid antisuicidal properties,” Watts and colleagues continued. “[B]uprenorphine’s unique opioid kappa receptor antagonist properties may be responsible for the effect. We also cannot rule out the possibility that buprenorphine and its associated treatment protocols in the United States are simply better tolerated than the other agents.”

In an accompanying editorial, Larissa J. Mooney, M.D., of the University of California, Los Angeles, wrote: “While the Watts et al. article is a worthwhile contribution to the literature on suicide among individuals with OUD, additional work is needed to delineate prevailing issues in broader samples (i.e., extending beyond the VA system) and in more recent times, considering the impacts of the COVID-19 pandemic, which may persist as factors in overdose and suicide.”

To read more on this topic, see the Psychiatric News article “OUD Overdose, Suicide Risk in Veterans Four Times Higher Without Buprenorphine.”

(Image: iStock/SARINYAPINNGAM)




APA to Launch New Version of Its Website on Thursday, April 7

Over the last two years, APA has worked on a major update of its website to improve its content, search engine, and accessibility for people with disabilities. In addition, the look of the website has been refreshed, and the main menu has been streamlined to reduce the number of “clicks” a user needs to find information.

Website traffic has grown tremendously over the last several years, driving the need to update the site. The number of pageviews has increased from 6.3 million in 2016 (the date of the last website redesign) to 40 million. The updated website will ensure that APA continues to respond to the expanding informational needs of members and provides accurate information about mental health to patients and families.