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

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

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

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

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

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

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

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

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Cyberbullying Linked to Youth Suicidality, Study Shows

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

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

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

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

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

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

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

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

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APA Online Systems Upgrade Coming, Password Reset Required

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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APA Issues Statement Opposing Dobbs v. Jackson Decision

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

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

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

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

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

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

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

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

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

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

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

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

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

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Early Intervention for First-Episode Psychosis Produces Long-Term Benefits, Study Shows

Individuals with first-episode psychosis who participated in a comprehensive, team-based treatment program experienced fewer symptoms, better quality of life, and fewer inpatient hospital days over five years than those who received usual care in the community, according to a report in Schizophrenia Bulletin.

The results were from a five-year follow-up of patients enrolled in NIMH’s Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP). The comprehensive treatment program tested in RAISE was called NAVIGATE, which includes four core interventions: personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported employment and education.

Previous studies found that patients who participated in NAVIGATE showed greater symptom improvements and quality of life compared with those who received standard community care over the first two years of treatment. The new results demonstrate longer-term benefits of NAVIGATE compared with community care, wrote lead author Delbert G. Robinson, M.D., of The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and colleagues.

The researchers compared data on 223 patients at 17 community sites enrolled in NAVIGATE and 181 patients at 17 sites receiving usual care. The primary outcomes were quality of life, as measured by the Heinrichs-Carpenter Quality of Life Scale (QLS); positive and negative symptoms of psychosis, as measured by the Positive and Negative Syndrome Scale (PANSS); and hospital inpatient days.

Assessments occurred every six months; 61% of participants had assessments conducted for at least two years, and 31% had assessments conducted at five years. Overall, the most common causes of dropout recorded by sites were lost to follow-up (34%) followed by declined assessments (10%) and moving out of area (10%), Robinson and colleagues noted.

On average, NAVIGATE participants improved by 7.73 points more than standard care group on PANSS and 13.14 points more than the standard care group on the QLS over the five-year period. They also had 2.53 fewer hospitalization days over five years than those in usual care treatment. The difference in hospitalization days “may be small from an individual perspective but substantial from a policy perspective when considered across many individuals in large scale initiatives,” the researchers wrote.

“[T]he data support long-term benefit of NAVIGATE compared to community care. These benefits are important for making individual decisions about treatment and for policy decisions about program development, implementation, and support.”

For more information, see the Psychiatric News article “Early Psychosis Intervention Shows Robust Real-World Effectiveness.”

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Tackling Overdose Epidemic Will Require Addressing Disparities in SUD Prevention, Care

Despite efforts to address the epidemic of deaths from drug overdose in the United States, drug-overdose deaths are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in the White population.

“Numerous trials have documented the efficacy of medications for opioid use disorder and other SUD interventions. But such treatments are often less available to members of historically marginalized groups than to White patients,” noted Carlos Blanco, M.D., Ph.D., of the National Institute on Drug Abuse (NIDA), Elisabeth U. Kato, M.D., M.R.P., of the Agency for Healthcare Research and Quality, and others in a Perspective piece in the New England Journal of Medicine.

“Ensuring that all people with SUD receive evidence-based treatment will require overcoming barriers to high-quality care, such as lower rates of adequate health insurance among Black, Latinx, and American Indian and Alaska Native populations than among White populations; a dearth of community-based clinicians who treat uninsured and underinsured people; stigma surrounding SUDs; underinvestment by the public sector in historically marginalized communities; and limited access to digital tools in many of these communities,” they continued.

Addressing such disparities also requires research, including studies to further the understanding of the effects of social determinants of health (for example, housing and employment) on patients’ engagement with treatment for substance use disorders and advances in data collection.

The authors wrote, “Ensuring that research reduces disparities will require multiple steps,” including the following:

• Include members of underrepresented groups in the development of preventive interventions and treatments.
• Recruit study participants from historically underrepresented groups, including those with varying levels of education. Ensure that studies are large enough to measure differences in outcomes according to race and ethnic group.
• Establish equitable partnerships with people who have or have had substance use disorders and their families, clinicians, policymakers, payers, and advocates. Share study findings with participating communities.
• Diversify the scientific workforce.
• Measure the effects of policies and interventions on equity.

“Applying an equity lens to efforts to address the worsening overdose epidemic and other SUD-related harms is critical to eliminating racial and ethnic disparities and improving health outcomes,” the authors concluded. “Such an approach could also serve as a framework for narrowing disparities in other patient populations.”

For related information, see the Psychiatric News article “Opioid Overdose Death Rate Rose Faster for People of Color.”

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Mortality Lower With Pimavanserin Than Atypical Antipsychotics in Early Parkinson’s Treatment

Older patients with Parkinson’s disease who take pimavanserin may have a lower risk of death in the first 180 days of taking their medication compared with their peers who take atypical antipsychotics, a study in the American Journal of Psychiatry has found.

“Parkinson’s disease is commonly associated with psychosis, and in patients with Parkinson’s disease, lifetime prevalence of visual hallucinations may approach 50%,” wrote Andrew D. Mosholder, M.D., M.P.H., of the U.S. Food and Drug Administration Center for Drug Evaluation and Research and colleagues. “Pimavanserin, a serotonin 5-HT2 receptor antagonist, is the only drug approved in the United States for treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.”

Mosholder and colleagues examined data from 21,669 Medicare beneficiaries aged 65 years and older with Parkinson’s disease who began taking medications for their condition from April 2016 to March 2019. Of these patients, 3,227 took pimavanserin and 18,442 took atypical antipsychotics. Of those who took atypical antipsychotics, 78% took quetiapine.

During the 360-day follow-up period, 207 patients prescribed pimavanserin and 1,752 patients prescribed atypical antipsychotic died. In the first 180 days of treatment, patients who took pimavanserin had a 35% lower risk of death from any cause compared with patients who took antipsychotics. This translates to the avoidance of one death for every 30 patients treated with pimavanserin rather than atypical antipsychotics. Among patients who took antidementia drugs, those who took pimavanserin had roughly a 50% lower risk of death in the first 180 days of treatment compared with those who took atypical antipsychotics.

After 180 days of treatment, patients who took pimavanserin did not appear to have a lower risk of death. Furthermore, the lower risk of death associated with pimavanserin was not observed in patients who lived in nursing homes.

“Reasons for the discrepancy in results between nursing home and community patients are unclear. One possibility is that high baseline mortality among nursing home residents overwhelms the contributions of Parkinson’s disease psychosis treatments to mortality,” the researchers wrote.

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Visual Hallucinations and the Role of Medications in Parkinson’s Disease: Triggers, Pathophysiology, and Management.”

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Counseling Plus Varenicline May Improve Smoking Cessation Among Black Adults

Black smokers may be more likely to stop smoking if prescribed varenicline in addition to counseling sessions, suggests a report published this week in JAMA.

“Black adults in the US have higher rates of smoking-related morbidity and mortality compared with White adults, despite having comparable smoking prevalence and smoking fewer cigarettes per day,” wrote Lisa Sanderson Cox, Ph.D., of the University of Kansas School of Medicine and colleagues. “Although they report greater interest in quitting, Black smokers are less likely than White smokers to be advised to quit or achieve sustained smoking abstinence and have been underrepresented in tobacco treatment research.”

Cox and colleagues conducted a randomized, double-blind, placebo-controlled trial with 500 participants aged 18 and older at a federally qualified health center in Kansas City, Missouri. Eligible participants identified as African American or Black, smoked at least one cigarette per day for at least 25 of the past 30 days, and were interested in stopping smoking.

Participants were randomly assigned to receive either 1 mg of varenicline twice daily (dosage was gradually increased from 0.5 mg to 1 mg during the first four days of treatment) or a placebo for 12 weeks, with 300 participants assigned to the varenicline group and 200 assigned to the placebo group. Additionally, participants received six cognitive-behavioral counseling sessions and the Kick It at Swope: Stop Smoking Guide, a culturally tailored educational guide used in previous studies with Black smokers. The participants completed assessments at weeks 4, 8, 12, 16, and 26 that asked about past-week tobacco use and adverse side effects. The researchers collected saliva and/or urine samples from the participants to confirm reports of smoking abstinence.

Participants who received varenicline were significantly more likely to be abstinent at week 26 compared with participants who received the placebo (15.7% vs 6.5%). Those who received varenicline were similarly significantly more likely to be abstinent after medication treatment ended at 12 weeks compared with the placebo group (18.7% vs 7%). Varenicline demonstrated significantly greater odds of abstinence for both participants who smoked between one and 10 cigarettes per day and participants who smoked more than 10 cigarettes per day. Adverse events reported by participants were similar in both groups, and no severe adverse events were reported by those receiving varenicline.

“For too long, Black individuals have been disproportionately recruited by the tobacco industry to replenish their customer base, have too infrequently received evidence-based cessation assistance during health care visits, have had especially great difficulty quitting smoking, and have experienced disproportionately high mortality rates due to smoking,” wrote Timothy Baker, Ph.D., of the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health and colleagues in an accompanying commentary. The authors added that the study by Cox and colleagues “offers evidence that cigarette smoking by Black individuals can be addressed more successfully.”

For related information, see the Psychiatric News article “Psychiatrists Hold Key for Helping Patients Quit Tobacco.”

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Americans Anxious Over Current Events, But Most Rate Their Overall Mental Health as Good

Significant percentages of Americans report feeling anxious about current events at home and abroad—especially inflation, gun violence and the Russia-Ukraine war, according to an APA poll released today.

The findings are from APA’s Healthy Minds Monthly Poll, conducted by Morning Consult between May 27 and 29, 2022. The poll included a nationally representative sample of 2,210 adults.

Nearly 8 in 10 Americans (79%) reported feeling very or somewhat anxious about inflation, while 68% reported anxiety about gun violence and 63% reported anxiety about the Russia-Ukraine War. Smaller but still sizeable percentages said they were very or somewhat anxious about climate change (52%), COVID-19 (49%), the future of reproductive rights (48%), the midterm elections (47%), and the future of LGBTQ+ rights (31%).

“It’s not surprising that Americans find the news anxiety-inducing, given everything we are facing as a country at the moment,” said APA President Rebecca Brendel, M.D., J.D. in an APA news release. “It’s obviously important to stay informed, but from time to time you need to take a break, particularly if you find yourself overwhelmed. Watching repeated scenes of violence in a 24/7 news cycle doesn’t help and can even make symptoms worse.”

These concerns varied by demographic group. For instance, women were more likely than men to report feeling anxious about gun violence, the Russia-Ukraine War, climate change, and the future of reproductive and LGBTQ+ rights. White people were more likely than Black or Hispanic people to report anxiety over inflation, and less likely than those of other ethnicities to report anxiety over gun violence. People who identified as LGBTQ+ (62%) and transgender (61%) were nearly twice as likely as adults overall to say they felt anxious about the future of LGBTQ+ rights.

Despite these specific worries, more than a quarter (26%) of those surveyed rated their overall mental health excellent and 46% rated it as good. Younger adults (aged 18 to 35) were more likely to rate their mental health as fair or poor than older adults, and those with an income under $50,000 were more likely to rate their mental health as fair or poor than those earning more income. About half of LGBTQ+ and transgender adults rated their mental health as fair or poor.

The arrival of summer may help to explain the positive feelings about overall mental health, with large percentages saying aspects of summer would improve their mental health, such as spending time outdoors (71%), taking a vacation (67%), longer amounts of daylight (66%), and attending social gatherings (60%).

For some people though summer brings concerns about body image, and 45% said the summer makes them feel pressured to lose weight or change their body.

“It’s good to see some Americans taking positive emotions from summer traditions, during a time when we really need them,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in the release. “But it stands out that half want to change their bodies. For some, that may come from being exposed to images of unattainable ideals on traditional and social media. It’s important to monitor your feelings and actions around these issues and if necessary, seek help.”

For related information, see the Psychiatric News Alert “Americans Have Mixed Feelings About Social Media, APA Poll Finds.”

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Washington Senator Manka Dhingra Honored With APA’s Javits Award

APA has selected Washington State Sen. Manka Dhingra, a democrat representing Washington’s 45th Legislative District, as this year’s winner of the Jacob K. Javits Award for Public Service. The award recognizes Dhingra’s dedication to ensuring patients, families, and communities have access to quality mental health care from well-trained professionals.

The Javits Award honors a federal and/or state public servant who has made outstanding contributions to the profession of psychiatry and mental health advocacy. It was established in 1986 to honor the legacy of Sen. Jacob K. Javits of New York, who was a champion on behalf of people with mental illness. The award was presented to Dhingra at an event jointly hosted by the Washington State Psychiatric Society, the Washington State Medical Association, and NAMI Washington.

“Sen. Dhingra’s relentless advocacy has led to the passage of critical mental health policies benefitting patients throughout the state of Washington,” said APA President Rebecca Brendel, M.D., J.D., in an APA news release. “Her outstanding leadership has helped create a framework for 9-8-8 and the crisis response system in Washington, improve mental health directives, and reform the criminal justice system.”

The first Sikh state legislator elected in the country, Dhingra serves not only as the deputy majority leader of the senate, but also as the senior deputy prosecuting attorney with the King County Prosecuting Attorney’s Office. She is a mental health and crisis intervention professional who has assisted in developing the Regional Mental Health Court, the Veterans Court, and the Community Assessment and Referral for Diversion program. Further, she has provided Crisis Intervention Training for law enforcement officers to increase efficacy and safety when responding to someone experiencing a mental health crisis.

“Psychiatrists simply cannot be as effective as they are without the tireless work of mental health champions like Sen. Dhingra,” said Thomas Soeprono, M.D., president of the Washington State Psychiatric Association, in the release. “She has strengthened community transitions, eased integration with the Involuntary Treatment Act, and established a statewide Office for Behavioral Health Ombuds, all huge accomplishments that empower our work to reach the vulnerable mentally ill.”

This year, Dhingra championed a bill that the governor signed into law, which creates a clear pathway through which a court can direct people with severe mental health disorders to assisted outpatient treatment (AOT). Such treatment puts a judge and a care team in charge of coordinating care using the least restrictive form of treatment necessary, according to a news release from Dhingra’s office. Dhingra is also a supporter of survivors of domestic and sexual violence. Last year she sponsored a bill, which was signed into law, that streamlines the process by which survivors can vacate sentences they received for offenses that occurred as the result of sex trafficking, domestic violence, or sexual assault.

“I am honored and humbled to receive this prestigious award,” said Dhingra. “None of us do this work by ourselves, and I am truly grateful for all the incredible partners who have helped destigmatize mental illness, reduce barriers to access, and bring mental wellness into our lives. While there is much more work to be done, with all your support we can ensure that all Washingtonians receive the services and support they need when they need them.”

For related information, see the Psychiatric News Alert “APA Honors Rep. Bonnie Watson Coleman for Her Work to Improve Mental Health Care.”

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Study Identifies Barriers, Facilitators to African American Parents Seeking MH Care for Children

Many factors influence parents’ abilities to seek help for their children experiencing mental health problems. A report in Psychiatric Services found that African American parents were more likely to postpone seeking professional help for a child experiencing emotional or behavioral problems if they feared the child might be involuntary hospitalized and/or if their health insurance would not cover treatment.

“Barriers to mental health care are greater for African American parents, who are more likely than White parents to experience structural obstacles that hinder timely diagnosis,” wrote Jennifer Richmond, Ph.D., M.S.P.H., of Vanderbilt University Medical Center and colleagues. “African American children are also exposed to systemic racism and other harmful structures in the health care system … As a result, African American children with emotional and behavioral challenges are more often misdiagnosed and less likely to receive early intervention than are White children.”

Richmond and colleagues used data from the Teaching Advocacy Skills for Kids study, which included 289 African American parents living in North Carolina who were raising children with several mental health or developmental challenges. Parents completed a computer-assisted telephone interview upon recruitment to the study. During the interviews, the authors determined whether the parents rapidly sought care (defined as seeking care within 30 days of identifying their child’s need) or deferred care (defined as waiting one year or longer to seek care) for their children after recognizing the children had mental health or developmental challenges.

Parent activation (meaning the parent had the knowledge, skills, and confidence to access and engage in the appropriate services) was assessed using the 13-item parent-focused Patient Activation Measure. The authors also assessed if there were other adults with mental health challenges living in the home; if parents mistrusted doctors; and if they were deterred from getting help for their children for other reasons, including a fear of involuntary hospitalization, lack of health insurance coverage, or not initially finding the children’s behaviors to be bothersome.

About 22% of parents rapidly sought care, while 49% deferred care. Parents were more likely to rapidly seek care if they had higher parent activation scores or if they lived with other adults with mental health challenges. They were less likely to rapidly seek care if their children’s challenges did not initially bother them or if their health insurance would not cover the service. Similarly, they were more likely to defer care if they feared involuntary hospitalization for their children.

Contrary to the authors’ hypothesis, parents were more likely to rapidly seek care for their children if they reported mistrusting doctors. “It is possible that parents who mistrust doctors make different choices for their children than for themselves,” the authors theorized. “For example, parents who mistrust doctors, perhaps because of previous negative health care experiences, may be more motivated to advocate for their child to receive rapid, high-quality care so that their family can avoid further negative experiences.”

For related information, see the Psychiatric Services article “Barriers to Increasing Access to Brief Pediatric Mental Health Treatment From Primary Care.”

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Most Males Who Die by Suicide Have No Known Mental Health Conditions

The majority of boys and men who die by suicide have no known mental health conditions, a study in the American Journal of Preventive Medicine has found.

Katherine A. Fowler, Ph.D., of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) and colleagues analyzed data from the CDC’s National Violent Death Reporting System (NVDRS) for 70,376 males aged 10 years and older who died by suicide between 2016 and 2018. The researchers looked at data from four age groups: adolescents (aged 10 to 17 years), young adults (aged 18 to 34 years), middle-aged adults (aged 35 to 64 years), and older adults (aged 65 years and older). They used the NVDRS definition of a diagnosed mental health problem to determine if males who had died by suicide during the study period had any known mental health conditions. The NVDRS defines “diagnosed mental health problems” as diagnosed disorders and syndromes listed in DSM-5 except for alcohol and other substance use disorders. The definition also includes a history of treatment for a mental health problem, even if the nature of the problem is unclear in the person’s records (for example, the records say the person “was being treated for various psychiatric problems”).

Overall, 60% of males who died by suicide had no known mental health conditions. Across all age groups, firearm suicides were more common among males without known mental health conditions compared with males who had known mental health conditions. Between 32% and 40% of all young and middle-aged adults in the study had a history of problematic substance use. Between 43% and 48% of all young and middle-aged adults tested positive for alcohol at the time of their death.

Relationship problems were common among males who died by suicide, especially among adolescents, young adults, and middle-aged adults with no known mental health conditions. Intimate partner problems were significantly more common for young and middle-aged adults with no known mental health conditions, and family problems were the most common type of problem for adolescents with or without known mental health conditions. Arguments were common across age groups and were significantly more prevalent among young and middle-aged adults without known mental health conditions, particularly among those who died by suicide during an argument.

Fowler and colleagues wrote, “Suicide prevention initiatives for males might benefit from comprehensive approaches focusing on age-specific stressors reported in this study in addition to standard psychiatric markers.”

For related information, see the Psychiatric Services article “Preventing Suicide Through Better Firearm Safety Policy in the United States.”

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Prenatal Exposure to COVID-19 Associated With Neurodevelopmental Disorders in First Year

Infants born to mothers who tested positive for SARS-CoV-2 while pregnant were more likely to be diagnosed with a neurodevelopmental disorder within the first 12 months of life, even after accounting for preterm birth, according to a study published today in JAMA Network Open.

“Our findings identifying an association between prenatal SARS-CoV-2 exposure and neurodevelopmental diagnoses at 12 months are consistent with a large body of literature including human and animal studies linking maternal viral infection and maternal immune activation with offspring neurodevelopmental disorders later in life, some of which can be foreshadowed as early as the first year of life,” wrote Andrea Edlow, M.D., M.Sc., of Massachusetts General Hospital and colleagues.

Edlow and colleagues analyzed electronic health records for 7,772 live births that occurred between March and September 2020 at two academic medical centers and six community hospitals. They identified mothers who tested positive for SARS-CoV-2 during pregnancy and whose offspring were diagnosed with at least one neurodevelopmental disorder within the first 12 months of life. Maternal and offspring records were matched using the Electronic Data Warehouse based on date and time of birth, medical record number, and the offspring’s sex. Neurodevelopmental disorders included developmental disorder of motor function, expressive language disorder, developmental disorder of speech and language, phonological disorder, and unspecified disorders of psychological development.

About 3% of the mothers tested positive for SARS-CoV-2 during pregnancy. These mothers were significantly more likely to give birth before their due dates than unexposed mothers (14.4% vs 8.7%). Over 6% of their offspring received a neurodevelopmental diagnosis within 12 months, compared with 3% of unexposed offspring. After adjusting for preterm birth, offspring of exposed mothers were still more likely to be diagnosed with a neurodevelopmental disorder than unexposed offspring. SARS-CoV-2 infection during the mother’s third trimester was particularly associated with neurodevelopmental disorders in offspring. The majority of neurodevelopmental diagnoses included developmental disorders of motor function or speech and language.

In an accompanying commentary, Torri Metz, M.D., M.S., of the Division of Maternal-Fetal Medicine at the University of Utah Health considered the possibility that the adverse childhood outcomes identified by the study were caused by the virus itself or by societal changes and the stresses that the COVID-19 pandemic caused. “These preliminary data are critically important, yet many questions remain,” Metz wrote. For example, she noted that Edlow’s study does not look at later variants of COVID-19, which may have a different impact on children exposed to the virus during pregnancy.

Metz commented that it is not surprising that the pandemic and exposure to COVID-19 may be linked to neurodevelopmental problems in young children. “As a retrospective cohort study, this publication by Edlow et al can only demonstrate associations, and causality cannot be determined,” Metz continued. “Perhaps the most important question is how do we intervene to help mitigate the adverse effects of the pandemic on young children?”

For related information, see the Psychiatric News article “COVID-19’s Impact on Development Remains Unclear.”

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APA Joins Numerous Organizations in Denouncing Attempts to Link Mental Illness and Gun Violence

APA denounced the “false and harmful attempts to link mental illness and gun violence” in a statement issued yesterday in partnership with 59 other health, mental health, and youth services organizations.

“The horrific school shooting in Uvalde, Texas, that killed 19 children and two adults on May 24th is just one in a long series of mass shootings throughout our country,” APA and its partners said. “These shootings have one thing in common—easy access to weapons that can kill with terrifying efficiency on a massive scale.”

Attempts to connect mental illness to mass shootings are a distraction that inflicts enormous damage by taking attention from solutions that could prevent such events. “This perpetuates a false narrative that encourages stigmatization of and discrimination against the millions of Americans living with mental health conditions who are more likely to be victims of violence than perpetrators of it. In fact, persons with mental illness account for a very small portion of gun violence.”

The statement echoes a statement issued last week by APA imploring Congress to enact legislation that increases research on firearm violence; requires background checks, waiting periods, and safe storage of firearms; and allows physicians to make clinically appropriate inquiries regarding access to firearms.

The joint statement unites a wide range of organizations including the American Academy of Child and Adolescent Psychiatry, the National Association of School Psychologists, the Council of Administrators of Special Education, and the National Center for Learning Disabilities.

APA and the other organizations note that while mental health conditions are common in countries across the globe, the United States is the only country where mass shootings have become disturbingly commonplace. “In fact, firearms are now the leading cause of death for children and adolescents in the United States. Not coincidentally, the U.S. is also alone in making firearms widely available with few restrictions.”

A large majority of adults in the United States experience stress associated with mass shootings, and a third of U.S. adults say that fear of mass shootings stops them from going to certain places and events, the statement points out. “Moreover, research has shown that victims and members of affected communities experience increases in posttraumatic stress symptoms, depression, and other signs of psychological concerns. Other studies have found that, after previous mass shootings, youth felt less safe and more fearful. These findings, many of which are unsurprising, make it all the more important to take urgent action to prevent these shootings, particularly in light of our nation’s ongoing youth mental health crisis.”

The organizations urged bipartisan efforts to improve the country’s mental and substance use system, which will enhance the nation’s well-being and improve or save countless lives. “However, what these reforms alone will not do is address the epidemic of mass shootings. To prevent more carnage, policymakers must act now to address the national crisis of gun violence and work on a bipartisan basis to pass meaningful solutions that promote gun safety in all of our communities.”

For related information, see APA’s Position Statement on Firearm Access, Acts of Violence, and the Relationship to Mental Illness and Mental Health Services and the Psychiatric News article “Researchers Discuss Policy Solutions to Firearm Violence, Suicide.”

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Patients With Schizophrenia Switched Early to LAIs Show Markedly Better Long-Term Outcomes

Patients with schizophrenia who switch from oral antipsychotics to long-acting injectables (LAIs) within the first three years of treatment can reduce their risk of symptom relapse, future rehospitalizations, and mortality. Patients who had been taking oral medications for three years or more prior to switching showed no significant improvements outside of improved medication adherence, according to a study published in the Journal of Clinical Psychiatry. 

“[I]ncreasing evidence suggests that during the early stages of schizophrenia, a critical time when the disease is most treatable, patients may experience more beneficial effects of LAI treatment,” wrote Su-Chen Fang, Ph.D., of Mackay Medical College in New Taipei City, Taiwan, and colleagues. “These real-world data demonstrated that LAIs in the early stage of treatment of hospitalized patients increased disease control and had long-term benefits.”

Fang and colleagues used Taiwan’s national health insurance database to compile data on over 19,000 people aged 16 to 65 who had a schizophrenia diagnosis, were taking oral antipsychotics, and were hospitalized for acute psychosis between 2002 and 2005. They identified 678 patients who were having a psychotic episode and were switched from oral medication to an LAI during hospitalization; they continued to receive the LAI after discharge.

Of these patients, 312 were switched to an LAI within three years of their first oral antipsychotic prescription (early stage), while 366 were switched following three or more years of oral medication use (late stage). All patients were followed up from their date of hospitalization until the end of the study period (December 31, 2015) or death, whichever came first.

As expected, Fang and colleagues found that all patients who switched to LAIs following hospitalization had better medication adherence, as determined by prescription refill data. In addition, those who switched during the early stage of schizophrenia had a 37% reduced risk of psychiatric rehospitalization, a 42% reduced risk of a psychiatric-related emergency room visit, and a 51% reduced risk of mortality compared with patients who stayed on oral medications. For patients who were switched during the late stage of illness, the risk of mortality of emergency room visits did not decrease, and in fact they showed a slightly increased risk of psychiatric rehospitalization compared with patients who stayed on oral medications.

“Patients in the later stages of schizophrenia, especially those who require hospitalization, may represent a group of patients whose condition is unstable,” Fang and colleagues wrote. “This may partly explain the lack of LAI-mediated protective effects in patients who adopted LAIs in the late stage.”

To read more on this topic, see the Psychiatric News story “Real-World Data Show Patients With Schizophrenia Adhere Better to Clozapine and LAIs.”

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Team, But Not Individual, Sports Associated With Improved Mental Well-Being in Youth

Children who participate in team sports have lower levels of depression, anxiety, social problems, and attention problems compared with children who do not participate in team sports, according to a report in PLoS One. Children who participated only in individual sports had more mental and behavioral difficulties compared with those who did not participate in sports, however.

“The results of this study, coupled with previous research findings, suggest that participation in organized team sport may be a useful medium through which to promote child and adolescent mental health,” wrote Matt Hoffman, Ph.D., of California State University, Fullerton, and colleagues. “Efforts to provide children and adolescents with affordable options to join organized team sport leagues/clubs outside of school may require further attention, particularly for families with socioeconomic challenges.”

Hoffman and colleagues analyzed data from the National Institute of Health’s ongoing Adolescent Brain Cognitive Development (ABCD) study, which includes comprehensive data on a broadly representative sample of 11,235 children and adolescents aged 9 to 13 years across the United States. For this study, the researchers divided participants into four groups based on their participation in organized sports either inside or outside of school: Youth who participated in team sports such as volleyball or soccer, youth who participated in individual sports such as tennis or wrestling, youth who participated in both types of sports, and youth who did not participate in organized sports. They then compared the rates of various emotional and behavioral problems among these groups as identified in the parental-rated Child Behavior Checklist (CBCL).

Compared with not participating in sports, participating in team sports was associated with 10% lower scores for anxious behavior, 19% lower scores for withdrawn/depressed behavior, 17% lower scores for social problems, and 12% lower scores for attention problems. Conversely, participating in individual sports was associated with 16% higher scores for anxious/depressed scores, 14% higher scores for withdrawn/depressed behavior, 12% higher scores for social problems, and 14% higher scores for attention problems compared with not participating in sports.

“It is conceivable that children and adolescents competing individually would be keenly aware of the performance expectations (real or perceived) placed on them by their parents/guardians, family, or peers, which could result in pressure to perform well,” Hoffman and colleagues wrote. “Individual sport athletes are also prone to attribute their failures to internal factors, presumably because they do not have teammates with whom they can share the blame for perceived poor performances.” Hoffman and colleagues noted that other studies have shown positive mental benefits for individual sports, so these results require more investigation.

Youth who participated in both team and individual sports had roughly the same scores on the CBCL as those who did not participate in sports. This suggests that the benefits of being on a team and the drawbacks of participating in individual sports cancel each other out, the authors wrote.

For related information, see the Psychiatric News article “Specific Exercise Characteristics Linked to Better Mental Health.”

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APA’s Virtual Annual Meeting Begins Tomorrow!

It’s not too late to register for APA’s virtual Annual Meeting! From Tuesday, June 7, at 11 a.m. ET through Friday, June 10, at 4:15 pm ET, attendees can access 100+ select sessions for up to 16.5 CME. Registrants will also receive access to a complimentary limited On Demand product, which will include the top 20 recorded sessions from the in-person meeting in New Orleans, offering an additional 20 CME. If you attended the New Orleans meeting, you can access the virtual meeting for free.

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Opioids Linked to Increased Dementia Risk in Patients Older Than 75

Patients between 75 and 80 years old who take opioids have an increased risk of dementia, a study in the American Journal of Geriatric Psychiatry has found.

Stephen Z. Levine, Ph.D., of the University of Haifa in Israel and colleagues examined data from 91,307 older people in an Israeli HMO. People in the study were at least 60 years old and had no history of a dementia diagnosis or dementia medication in 2012, and they were followed up for incident dementia between January 2013 and October 2017. The researchers determined opioid exposure based on purchases of opioid medications and classified a person as exposed if the person’s purchase period covered at least 60 days within a 120-day interval.

During the follow-up, 3.1% of the people in the study had been exposed to opioids, and 5.8% of all subjects developed dementia. The researchers examined the relationship between opioid exposure and dementia in people who fell within four age groups: 60-70, 70-75, 75-80, and 80+ years. After accounting for age, sex, and comorbid health conditions, the researchers found an increased risk of dementia in those between 75 and 80. People in this group had a 1.39-fold greater risk of developing dementia compared with those in the same age group who were not exposed to opioids.

“The effect size for opioid exposure observed in the 75 to 80 age group is similar to other potentially modifiable risk factors for dementia, including body mass index and smoking,” Levine and colleagues wrote. “This suggests that opioid exposure from 75-80 years of age may be a clinically relevant modifiable dementia risk factor.

“Policymakers, caregivers, patients, and clinicians may wish to consider that opioid exposure [in individuals] aged 75 to 80 years appears to be associated with an increased dementia risk to balance the potential benefits and adverse side effects of opioid use,” the researchers concluded.

For related information, see the Psychiatric News article “To Improve Safety in Older Patients, Consider Deprescribing.”

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