Placenta Inflammation Linked to Neuropsychiatric Disorders in Children

Children who are born with fetal inflammatory response syndrome are at an increased risk for psychiatric disorders including autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and conduct disorder, according to a study published yesterday in Translational Psychiatry.

Fetal inflammatory response syndrome (FIRS) results from excess activation of the developing fetus’ immune system (caused by infection, damage to the placenta, or other stresses), leading to inflammation of the placenta.

“These results suggest that inflammation of the placenta has a critical role in the pathogenesis of neuropsychiatric disorders during childhood, independent of many potential confounders,” wrote Blake Gibson, M.D., of the University of Pittsburgh School of Medicine and colleagues.

Gibson and colleagues analyzed electronic health record data from a women’s hospital at the University of Pittsburgh Medical Center. They looked specifically at children who were born between January 1, 1999, and April 1, 2018, and met criteria for FIRS. They also randomly selected a subset of children born during the same period for the control group. The control group had either normal placenta reports or no placenta reports at all. (Placentas are not routinely examined after delivery unless there are suspected abnormalities or the newborn has poor health.)

Participants were required to have at least five years of electronic health record follow-up data to enable researchers to capture information about the onset of a psychiatric disorder in the children. Additionally, the researchers examined the mothers’ history of psychiatric disorders and substance use.

A total of 4,861 children with FIRS were included, as well as 31,927 children in the control group. Children born with FIRS were about 20% more likely to be diagnosed with any psychiatric disorder compared with children without FIRS during the follow-up period (average length 7.5 years); this association was significant even after controlling for maternal history of psychiatric disorders, maternal substance use during pregnancy, and maternal lifetime history of suicide attempts. Regarding individual disorders, a significant association was found between FIRS and risk of ADHD, autism spectrum disorder, conduct disorders, and posttraumatic stress disorder.

There was no difference in the mothers’ history of psychiatric disorders among children with and without FIRS, but those with FIRS were significantly more likely to have been exposed to any substance—especially alcohol, cannabis, and nicotine—in utero.

Children who meet criteria for FIRS “should be monitored closely for early identification and treatment,” the authors concluded. “Future studies are needed to identify the biological mechanisms through which inflammation in general and FIRS [specifically] increases risk for neuropsychiatric disorders.”

For related information see the American Journal of Psychiatry article “Guilt by Association: Inflammation and Shared Genetic Risk Between Stress-Related and Immune Disorders”.

(Image: iStock/Diego Cerro Jimenez)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. Watch a short video in which the current editor-in-chief discusses this influential and key position. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

APA Speaks Out Against Supreme Court Ruling on Affirmative Action in Higher Education

In a statement today, APA said that the U.S. Supreme Court’s ruling in Students for Fair Admissions v. President and Fellows of Harvard College and Students for Fair Admissions v. University of North Carolina will “undermine the ability of colleges, universities, and medical schools to build a workforce of health care professionals that can effectively treat the increasingly diverse body of patients they serve.”

In the case, the Supreme Court ruled 6-3 that the admissions programs at Harvard and the University of North Carolina (UNC) that relied in part on racial considerations violate the Constitution’s guarantee of equal protection under the 14th Amendment.

APA argued, however, that the decision will impede progress to achieve health equity in this country. “A holistic race-conscious admissions process is an effective tool in assembling a diverse mental health workforce, which is critical to providing quality mental health care for all and addressing the mental health inequities that marginalized and minoritized individuals experience. Research supports that race concordance between physicians and patients and cultural sensitivity are associated with improved communication and better overall mental health outcomes.”

In July last year, APA Trustees voted to sign on to an amicus brief filed by the Association of American Medical Colleges in support of the UNC and Harvard admissions programs.

The brief stated, “[T]he legacy of American racial injustice has endured longer across the health care and medical-education systems than many might have predicted. As a result … if a program seeks a racially diverse student body with more than token representation, most schools will necessarily continue to rely on the consideration of an applicant’s racial or ethnic background in some cases. And any prohibition on the consideration of race in student admissions will therefore result in a student body with significantly fewer minority students.”

For related information, see the Psychiatric News article “Trustees Act on Amicus Brief in Harvard Case, Multiple Other Issues.”

(Image: iStock)

Medical, Recreational Marijuana Legalization Associated With Higher Rates of Youth Suicide, Study Shows

Female youth aged 12 to 24 and youth of both sexes aged 14 to 16 living in states with legalized medical marijuana or recreational marijuana between 2000 and 2019 had higher rates of death by suicide than youth in states with no such laws, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

These effects remained significant after controlling for a wide array of possible confounding variables and employing statistical analysis to examine the effect of other state-level variables that might influence suicide rates. The findings translate to nearly 5,000 excess suicide deaths of female adolescents and young adults related to medical marijuana and recreational marijuana legalization in the study period, noted lead author Christopher J. Hammond, M.D., Ph.D., of Johns Hopkins University School of Medicine, and colleagues.

“Given dramatic shifts in cannabis policy over the past 20 years, it is important for clinicians and policymakers to understand potential downstream public health outcomes related to changing cannabis policy,” they wrote.

The researchers analyzed data on suicide rates using the 2000-2019 National Vital Statistics System Multiple Cause of Death files for age groups 12-13, 14-16, 17-19, 20-22, and 23-25. Depending on the year of death and state (since many states changed their cannabis laws during this time), the decedents were characterized as having lived in a state with medical marijuana legalization (MML), recreational marijuana legalization (RML), or no marijuana legalization (no ML). By 2019, 23 states had MML, and 10 states and D.C. had RML; all remaining states did not enact marijuana legalization.

The final analysis included 113,512 suicide deaths, corresponding to an unadjusted annual rate of 10.93 per 100,000 people. Hammond and colleagues found that across all ages, female youth who lived in MML and RML states had a 10% and 16% greater risk for suicide, respectively, compared with those who lived in no ML states. There was no elevated suicide risk in male youth overall in RML and MML states, and in fact the analysis suggested a 3% decreased risk of suicide for male youth in effective MML states compared with no ML states.

When examining individual age brackets, the researchers found that male youth aged 14 to 16 living in RML states had a 15% higher risk of suicide compared with male youth in MML states. When data on both sexes were combined, youth aged 14 to 16 in RML states had an increased suicide risk ranging from 9% to 14% compared with same-age youth living in states with MML or no marijuana legalization, respectively.

The authors emphasized that the study is limited in its ability to explain the mechanism for increased youth suicide and marijuana legalization.

“Mechanisms through which MML and RML are related to suicide risk in female youth and younger-aged adolescents warrant further study and should be used to reform cannabis legislation with the goal of mitigating risk for vulnerable subgroups,” they wrote. “Over the past two decades, U.S. cannabis policy has been primarily profit driven. Shift to a public health-centric approach is needed.”

For related information see the Psychiatric News article “Marijuana: Dangerous for Developing Brain”.

(Image: iStock/GoodLifeStudio)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. Watch a short video in which the current editor-in-chief discusses this influential and key position. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

FDA Issues Draft Guidance for Conducting Clinical Trials With Psychedelic Substances

The Food and Drug Administration (FDA) has for the first time issued draft guidance on conducting clinical trials with psychedelic substances such as psilocybin and MDMA (ecstasy).

“Psychedelic drugs show initial promise as potential treatments for mood, anxiety, and substance use disorders. However, these are still investigational products. Sponsors evaluating the therapeutic potential of these drugs should consider their unique characteristics when designing clinical studies,” said Tiffany Farchione, M.D., director of the Division of Psychiatry in the FDA’s Center for Drug Evaluation and Research, in an agency press release.

She added that the guidance outlines some of the unique challenges inherent in designing psychedelic-based clinical trials and should help researchers design studies whose results can support future drug applications.

These are among the many clinical items discussed in the draft guidance:

1. A reminder that psychedelics are still Schedule I controlled substances reflecting a potential for misuse and abuse. Clinical trial researchers should carefully assess and monitor all abuse-related adverse events such as euphoria, hallucinations, and rapid mood swings.
2. The need to clearly describe the experiential changes brought on by these drugs during the informed consent process, such as changes in perception, cognition, and suggestibility that can last for several hours.
3. The importance of carefully observing participants during the entire psychedelic-assisted psychotherapy session. The FDA recommends at least two monitors, with the lead monitor having graduate-level training and clinical experience with psychotherapy.

The FDA guidance further discusses issues related to the manufacture of research psychedelics and conducting preclinical chemistry studies. The FDA recognizes the difficulties in finding suitable placebos for psychedelics and the high risk of bias given the very noticeable changes brought on by these drugs, but it stated in the release that the “evidentiary standard for establishing effectiveness of psychedelic drugs is the same as for all other drugs.”

The FDA invites professional feedback to the draft guidance by August 25 to ensure consideration.

To read more on this topic, see the Psychiatric News article “Psychedelics Legislation Gains Momentum” and the Psychiatric Services article “Ethical and Practical Considerations for the Use of Psychedelics in Psychiatry.”

(Image: iStock/druvo)

Weight-Based Discrimination Linked to Disordered Eating in Sexual Minority Young Adults

Three in ten young adults who identify as members of sexual minorities experience weight-based discrimination and may have a higher risk of disordered eating behaviors as a result, a study in the International Journal of Eating Disorders has found.

“Overall, given the elevated risk of [disordered eating behaviors] among sexual minority adolescents and young adults, the effects of weight-based discrimination must be considered when developing eating disorders prevention efforts and effective clinical care for this underserved population,” wrote Allegra R. Gordon, Sc.D., M.P.H., of Boston University School of Public Health and colleague.

The researchers analyzed data from 1,257 sexual minority women and men aged 18 to 31 years (91% White) who had participated in the U.S. Growing Up Today Study as children and adolescents and responded to a follow-up questionnaire in 2013. Among survey respondents, 47% identified as mostly heterosexual, 14% as gay or lesbian, 9% as bisexual, and 29% as completely heterosexual with a previous sexual minority identity or history of same-gender sexual partners.

Three outcomes were assessed by self-report in 2013 for the previous year: unhealthy weight control behaviors, such as using diet pills, laxatives, or vomiting to lose or to maintain weight; overeating, such as an episode of eating large amounts of food without feeling a loss of control; and binge eating, such as an episode of overeating accompanied by a feeling of loss of control. The participants completed a modified version of the Everyday Discrimination Scale regarding the frequency of types of unfair treatment they experienced. Those who reported experiencing unfair treatment were then asked to identify the reasons for their unfair treatment, such as age, race, sexual orientation, or weight.

Overall, 31% of the participants reported that they had experienced weight-based discrimination. Nine percent reported engaging in unhealthy weight control behaviors, 3% reported overeating, and 6% reported binge eating. Unhealthy weight control behaviors, overeating, and binge eating were two to four times more prevalent among participants who had experienced any weight-based discrimination compared with those who did not experience such discrimination.

“[P]ublic health surveillance surveys should monitor [disordered eating behaviors] and weight-based discrimination as key social stressors with implications for health across the life course,” Gordon and colleagues wrote. “Medical education should be expanded to include the importance of weight-based discrimination as a social determinant of health … with relevance to patients of diverse body sizes, racial/ethnic backgrounds, genders, and sexual orientation identities.”

For related information, see the Psychiatric News article "Binge-Eating Risk Factors In Adolescents Vary by Socioeconomic Status".

(Image: iStock/innovatedcaptures)

AMA Backs Making Overdose Reversal Medications More Accessible in Schools

The American Medical Association (AMA) is encouraging states, communities, and schools to adopt policies that allow naloxone and other overdose reversal medications to be readily accessible to teachers and school staff. Additionally, the AMA is urging states, communities, and schools to “remove barriers to students carrying safe and effective overdose medications.”

The policy was sponsored by the AMA Section Council on Psychiatry, which includes delegates from APA, the American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Psychiatry and the Law, and the American Association for Geriatric Psychiatry.

Psychiatric News was in Chicago last week for the Annual Meeting of the AMA House of Delegates—which brings together physicians, residents, and medical students from across the country and a variety of medical specialties. A report of the House of Delegates discussion regarding overdose reversal medications was published today in Psychiatric News.

“We are facing a national overdose crisis, and it’s affecting our young people at an alarming rate. Just as students carry prescription inhalers to treat an asthma attack, we must destigmatize substance use disorders and treat naloxone as a lifesaving tool,” Bobby Mukkamala, M.D., chair of the AMA Substance Use and Pain Care Task Force, said in an AMA press release.

Speaking on behalf of the AMA Section Council on Psychiatry on the floor of the House, Warren Ng, M.D., president of AACAP, said that allowing students to carry overdose reversal medications can be lifesaving. He cited a 2022 study by the Centers for Disease Control and Prevention showing that among youth aged 10 to 19 years old, overdose deaths increased 109% between July 2019 and December 2021. For many of these deaths, there were people nearby who might have been able to intervene had they had access to lifesaving medication, Ng said.

“The AMA needs to support school districts that are trying to save students’ lives right now,” Ng told the delegates at the meeting.  

Kenneth Certa, M.D., an APA delegate to the section council, told Psychiatric News that the adopted resolution “will embolden school boards to make this change so students will not die on school campuses because no one has the necessary medication to keep them alive until EMS gets there.”

Jerry Halverson, M.D., chair of the Section Council on Psychiatry, said the successful passage of the resolution speaks to the effectiveness of the psychiatric delegation at the AMA. “This resolution was produced by psychiatry, and it took the psychiatrists in the House working together to educate other delegates,” he said. “Now we have a policy that will allow school districts to do something that will save lives.”

Complete coverage of the House of Delegates meeting will appear in the August issue of Psychiatric News. 

(Image: iStock/TW Farlow)

Childhood Cancer Survivors Have Greater Risk of Some Mental Disorders in Adulthood

Children, adolescents, and young adults who survive cancer may be more likely to experience depression, anxiety, and psychotic disorders such as schizophrenia after cancer remission compared with their peers and siblings who did not have cancer, according to a study published today in JAMA Pediatrics.

“It is well established that a diagnosis of cancer and subsequent treatment may be highly traumatizing for all age groups, especially for children in their formative years,” wrote Ainsley Ryan Yan Bin Lee, M.B.B.S., of the Yong Loo Lin School of Medicine at the National University of Singapore and colleagues. “Detecting those [children, adolescents, and young adults with cancer] at a higher risk for prolonged distress by studying the risk and risk factors is crucial to facilitate appropriate and timely psychological interventions.”

Lee and colleagues conducted a systematic review of studies published from 2000 to 2022 in PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central. The studies measured risk and/or severity of depression, anxiety, psychotic disorders, and death by suicide in children, adolescents, and young adults with cancer compared with those who did not have cancer, which could include family members or matched controls. The studies included both patients currently receiving treatment for cancer and cancer survivors. Those actively receiving cancer treatment were no older than 25 years, and those who were cancer survivors received their cancer diagnoses when they were no older than 25 years.

The authors analyzed 52 studies. Youth with cancer had a significantly increased lifetime risk of severe depression symptoms, anxiety, and psychotic disorders compared with both family members and matched controls. Additional findings include the following:

• The risk of severe depression or anxiety symptoms was elevated regardless of the participant’s age at cancer diagnosis.
• Depression severity was elevated in both youth receiving active cancer treatment and cancer survivors.
• Anxiety severity was elevated in youth receiving active cancer treatment, but not in cancer survivors.
• Certain subpopulations of youth with cancer or a history of cancer had a significantly increased risk of suicide mortality, particularly those diagnosed between the ages of 15 and 19 years.
• Several studies found significant associations between lower educational levels and increased risk of mental illness or suicide; lower income and increased risk of depression, anxiety, or both; and partnership status and lower risk of depression and anxiety.

The authors concluded by urging policymakers and health care professionals to be cognizant of vulnerable subgroups who may develop severe psychiatric illnesses following a cancer diagnosis.

“The results of this study offer the interprofessional [children, adolescent, and young adult] oncology community an opportunity: we can put the debate about survivors’ mental health risks to rest,” wrote Abby Rosenberg, M.D., M.S., M.A., and Anna Muriel, M.D., M.P.H., of the Dana-Farber Cancer Institute in Boston in an accompanying commentary. “We can accept that these patients are more likely to suffer from clinically significant depression, anxiety, [and] psychotic disorders, and—in some cases—are at higher risk of death by suicide. We can therefore devote our energies to determining how to meet the needs of each patient in real time, targeting those most at risk.”

For related information, see the Psychiatric News article “Expert’s Corner: Best Practices for Treating Cancer Patients With Psychiatric Symptoms” and the Psychiatric Services article “Impact of Psychiatric Diagnoses and Treatment on Postoperative Outcomes Among Patients Undergoing Surgery for Colorectal Cancer.

(iStock/FatCamera)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Patients Who Take Medication for OUD Found Less Likely to Seek Hospital Care, Study Finds

Medication for opioid use disorder—which include buprenorphine, methadone, and extended-release naltrexone—is known to improve health outcomes in patients with opioid use disorder (OUD). A report published Monday in Psychiatric Services now suggests that patients who take their medication for OUD (MOUD) more frequently are less likely to end up hospitalized or in the emergency room than those who take their MOUD less frequently.

These findings, as reported by Manesh Gopaldas, M.D., of New York State Psychiatric Institute and Columbia University Irving Medical Center and colleagues were based on a secondary analysis of data from a National Institute on Drug Abuse (NIDA) comparative effectiveness trial. In the NIDA trial, individuals seeking treatment for OUD were randomly assigned to receive extended-release naltrexone or buprenorphine-naloxone for 24 weeks. The average age of the 570 participants who received medication was 34 years old; most were male (70%), White (74%), and had completed high school or its equivalent (78%). They were followed for 36 weeks.

Adherence to MOUD was defined as the percentage of days in a month in which a participant took a prescribed medication. The participants were grouped into three levels of adherence: low (less than 20%), medium (20% to 79%), or high (80% or greater).

Gopaldas and colleagues found that those who took their medication 80% or more of the time used inpatient addiction treatment 17.87 fewer days and acute care (such as emergency room) 3.32 fewer days than those who took their MOUD less than 20% of the time. In contrast, those who took their medication 80% or more of the time were more likely to seek care at outpatient settings; for example, those in the high adherence group sought outpatient addiction treatment and other outpatient services 1.28 and 10.45 more days, respectively, than those in the low adherence group. Participants who fell into the medium adherence group were also more likely to seek outpatient treatment (8.90 more days) compared with those in the low adherence group.

Gopaldes and colleagues noted that adherence to medication deteriorated over the course of the study.

“Examining predictors of adherence may be helpful in designing interventions,” they wrote. “Understanding whether negative prognostic indicators (such as severe psychiatric or general medical problems) and indicators of socioeconomic status (such as educational attainment and employment) predict adherence to MOUD, and whether MOUD type and dosage are associated with adherence, would be valuable.”

They concluded, “Our results reinforced the view that greater MOUD adherence is associated with reduced usage of high-cost inpatient addiction treatment and acute care services and increased utilization of outpatient care. Causation cannot be inferred from these data, but the data suggested that interventions that increase MOUD uptake and adherence can reduce health care costs.”

For related information see the Psychiatric News article “Opioid Crisis: Reluctance to Prescribe Lifesaving Medications Must Stop.”

(Image: iStock/LaurenSimmons)

U.S. Preventive Services Task Force Recommends Screening Adults for Anxiety Disorders

The U.S. Preventive Services Task Force (USPSTF) for the first time is recommending that adults under the age of 65 receive screening for anxiety disorders. The final recommendation statement by the USPSTF was published today in JAMA.

“Amid the mental health crisis in the United States, the Task Force worked to provide primary care professionals and their patients with recommendations on evidence-based screening,” task force vice chair Michael Silverstein, M.D., M.P.H., said in a USPSTF Bulletin. “Fortunately, screening all adults for depression, including those who are pregnant and postpartum, and screening adults younger than 65 for anxiety disorders is effective in identifying these conditions so adults can receive the care they need.”

The USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine that makes recommendations about the effectiveness of preventive care services. The current recommendations were based on the findings of a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults aged 19 years and older, including those who were pregnant or postpartum.

In the JAMA report, the USPSTF described a review of 10 studies (n = 6,463) that evaluated the accuracy of screening for anxiety disorders using a variety of assessments in asymptomatic adults aged 19 years or older. The studies included older adults (those 65 years or older), pregnant patients, and participants seen in primary care settings who were evaluated for anxiety using such instruments as the Geriatric Anxiety Scale, the Edinburgh Postnatal Depression Scale anxiety subscale, and the Generalized Anxiety Disorder (GAD) scale.

The task force concluded that while there appears to be a moderate net benefit to screening adults for anxiety disorder, “the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults [defined as those 65 years or older].”

What will happen when a patient screens positive for anxiety? asked Murray B. Stein, M.D., M.P.H., and Linda L. Hill, M.D., M.P.H., both of the University of California, San Diego, in an accompanying editorial. “Further evaluation is required at the point of screening to determine the level of acuity and need for referral or treatment,” they wrote, pointing to the importance of evaluating the patient for suicidality as well as posttraumatic stress disorder.

“The uptake of these new anxiety screening recommendations should provide an impetus and an opportunity for primary care clinicians to become more comfortable with diagnosing and treating anxiety disorders, which may require additional training,” Stein and Hill concluded. “Anxiety disorders can be distressing and disabling, and appropriate recognition and treatment can be life-altering and, in some cases, lifesaving, for patients.”

For related information, see the Psychiatric News article “All Women Should be Screened for Anxiety, Federal Panel Says.”

(Image: iStock/RJohn97)

Depression Risk May Rise During First Two Years of Oral Contraceptive Use

The first two years of oral contraceptive use may raise the risk of depression in women and adolescents compared with their peers who have never used oral contraceptives, a study in Epidemiology and Psychiatric Sciences has found.

Åsa Johansson, Ph.D., of Uppsala University in Sweden and colleagues analyzed data from 264,557 women from the UK Biobank, a population-based cohort that recruited participants aged 37 to 71 years from across the United Kingdom between 2006 and 2010. Among the women in the current study, 80.6% had used oral contraceptives. The median time from first initiation to last use of oral contraceptives was 10 years, and the median age at initiating and discontinuing use was 21 and 32 years, respectively. The incidence of depression was determined via interviews, inpatient hospital data, or primary care data.

Women who used oral contraceptives had a 79% increased risk of depression during their first two years of oral contraceptive use compared with their peers who had never used oral contraceptives. Adolescents—those who began using oral contraceptives at or before the age of 20 years—had a 95% increased risk of depression during their first two years of oral contraceptive use compared with their peers who had never used oral contraceptives. The increased risk of depression associated with oral contraceptive use declined over time, and the lifetime risk of depression was only 5% higher in women who had ever used oral contraceptives compared with those who had never used oral contraceptives.

To capture data from women with symptoms of depression that might not have come to clinical attention, the researchers analyzed data from a subcohort of 82,232 women who completed the online UK Biobank mental health questionnaire. In this secondary analysis, women who used oral contraceptives had twice the risk of having depressive symptoms in the first two years of oral contraceptive use compared with women who had never used oral contraceptives. Women who had begun using oral contraceptives at or before the age of 20 years had 130% higher risk of depressive symptoms during the first two years of oral contraceptive use. Women who began oral contraceptives at age 21 or older had a 92% increased risk of depressive symptoms.

“Our findings support that [oral contraceptive] use is causally associated with an increased risk of depression in adolescents as well as in adults, especially shortly after the initiation,” the researchers wrote. “It is important to emphasize that most women tolerate [oral contraceptives] well without experiencing adverse mood effects, making them a great option for many. However, educating [oral contraceptive] users, screening for depression, informing primary health care practitioners regarding the [oral contraceptive]–depression relationship, and conducting further research to determine the cause of hormone contraceptive–precipitated depression are warranted.”

(Image: iStock/Rattankun Thongbun)

---

Psychiatric News Invites Applications for Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Only 1 in 4 Adolescent Treatment Facilities Offers Buprenorphine for Opioid Use Disorder

Only a quarter of U.S. residential treatment facilities for adolescents offer buprenorphine, and only 11% offer buprenorphine for ongoing treatment, according to a study published this week in JAMA. Buprenorphine is the only medication for opioid use disorder approved by the U.S. Food and Drug Administration for use in those aged 16 to 18 years.

“Residential treatment facilities provide an opportunity to reach young people with a range of evidence-based supports at a pivotal time in their lives, and it is crucial that buprenorphine is made available as one of those options,” Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), said in a news release. NIDA supported the study along with the National Center for Advancing Translational Sciences.

Caroline King, Ph.D., M.P.H., of Oregon Health & Science University School of Medicine and colleagues identified all adolescent residential addiction treatment facilities in the United States using the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator and Google advertising data. They conducted “secret shopper” surveys—they called the facilities and said they were seeking care for a 16-year-old who recently experienced a fentanyl overdose. The callers said they were the patient’s aunt or uncle to make calls more plausible if they did not know specific details about the adolescent. Each facility was called up to seven times on different days. The authors asked specific questions about buprenorphine use and open-ended questions about other available treatments, such as whether the facility offered suboxone (a combination of buprenorphine and naloxone) or medications for depression.

King and colleagues were able to confirm that 160 facilities provided residential treatment to patients younger than 18. Of these, 24.4% offered buprenorphine, including through partnerships with outside clinics. This varied by region, with 18% of facilities in the West offering buprenorphine compared with 40% in the Northeast. Additional findings include the following:

• 17 facilities (11%) provided buprenorphine initiation and offered ongoing treatment; 12 facilities (7.5%) offered buprenorphine initiation but discontinued before discharge; and 12 facilities (7.5%) offered buprenorphine to adolescents younger than 16 years.
• 140 facilities (87.5%) of facilities offered medications for psychiatric comorbidities. 
• 86 facilities (53%) reported including families in treatment. 
• Among the 121 facilities that did not offer buprenorphine, 57 (47%) indicated that adolescents who were prescribed buprenorphine by their own clinician could continue receiving it, at least temporarily. 

“The average parent would need to call [nine] facilities on the SAMHSA Treatment Locator list to find one that offered buprenorphine,” the authors wrote. 

“Buprenorphine is the one medication that’s approved for use in adolescents, and it’s underused in facilities taking care of kids with the most severe opioid use disorder,” co-author Todd Korthuis, M.D., M.P.H., head of addiction medicine at Oregon Health & Science University, said in the NIDA release. “It’s a big issue, but it’s something that we can change by supporting these treatment centers with education and technical assistance about buprenorphine, better funding to staff these centers, and by letting the public know that buprenorphine is necessary treatment in healing brains.”

For related information, see the Psychiatric News article “Most Youth With OUD Who Need Medication Treatment Do Not Receive It.” 

(Image: iStock/xijian)

---

Psychiatric News Invites Applications for Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Survey Reveals Stark Difficulty in Obtaining Appointments With Child Psychiatrists

Calls to hundreds of child psychiatrists listed as in-network with Blue Cross–Blue Shield (BCBS) in three major U.S. cities led to appointments for children just 11% of the time, according to the results of a “secret shopper” survey published in Psychiatric Services.

Phone numbers were frequently wrong, many psychiatrists were no longer accepting new patients, and other calls went unanswered. Moreover, the average wait time for a visit was more than a month, and few of the psychiatrists contacted were willing to accept patients who were covered by Medicaid.

“[O]ur results confirm what many already know: In the midst of a mental health crisis, having insurance is not enough to guarantee access to mental health care when it is needed,” wrote Victoria Chen, B.S., B.A., and Christina Aldrich Barrera, M.D., both of Baylor College of Medicine, and colleagues.

The researchers called 322 psychiatrists listed as in-network by Blue Cross-Blue Shield in Chicago, Houston, and Los Angeles and impersonated the parent of a 10-year-old child who had just visited the emergency department for depression. They asked for an appointment using a standardized script that varied only according to how they intended to pay for the services: BCBS, Medicaid, or self-pay.

Calls were made during normal business hours between July 6 and August 4, 2022, and voicemails were left when the office did not pick up the call. If the researchers did not receive a return call with the requested information, they called the office a second time, approximately one week later, and followed the same protocol.

The callers were scheduled for initial appointments with 34 psychiatrists (11% of the sample). A total of 60 (19%) of the telephone numbers in the database were wrong, and 82 psychiatrists (25%) were not accepting new patients. The average time until the first available in-person appointment was 44 days for all cities, and the average time until the first available virtual appointment was 37 days.

The callers who said they would pay out of pocket (44%) or had BCBS insurance (41%) were more likely to get an appointment with a child psychiatrist than those who said they were covered by Medicaid (15%).

“[O]ur difficulty in obtaining an appointment with Medicaid is particularly concerning,” Chen, Barrera, and colleagues wrote. “This difficulty also highlights the stark reality that those who are poor and hope to use public insurance are frequently denied mental health care. Because COVID-19 has disproportionately harmed racial-ethnic minority groups and impoverished populations, our findings represent a double insult and a deepening inequity in access to care.”

For related information, see the Psychiatric News article “‘Ghost Networks’ Put Patients at Risk of Becoming More Ill” and “Updated Milliman Report Finds Worsening Network Adequacy, Psychiatrist Payments.”

(Image: Image: iStock/kali9)

Adverse Childhood Experiences Found to Accelerate Aging

Individuals exposed to a greater number of adverse childhood experiences (ACEs)—for example, violence, abuse, and neglect early in life—may age more rapidly than those with fewer of these experiences early in life, suggests a report published Monday in JAMA Network Open.

The study, which involved data collected from more than 850 middle-aged adults at two time points, found that participants who reported four or more ACEs were likely to have molecular biomarkers that suggested they were older than their chronological ages.

Previous research has suggested that “ACEs may modulate epigenetic pathways associated with biological aging and subsequently health-related outcomes,” wrote Kyeezu Kim, Ph.D., of Northwestern University and colleagues. (Epigenetics is the study of how various factors may cause changes in the way genes are switched on and off without changing the actual DNA sequence.) To investigate the association between ACEs and epigenetic age acceleration over time, the researchers studied data collected as part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

A total of 5,115 male and female participants aged 18 to 30 years who identified as Black or White were enrolled in the CARDIA Study between 1985 and 1986. Over the next 30 years, the participants received eight follow-up visits. At the 15-year follow-up visit, the participants filled out the Childhood Family Environment questionnaire, which asked them to estimate their experiences with negligence, violence, and more prior to age 18. The participants received blood tests at the 15-year follow-up and again at the 20-year follow-up. The researchers then used five epigenetic age calculators (which measure various chemicals and metabolites in blood samples) to measure the epigenetic age of the participants.

Kim and colleagues found that having four or more ACEs was positively associated with epigenetic age acceleration at the 15-year follow-up and the 20-year follow-up, after adjusting for age, sex, socioeconomic status in childhood and adulthood, physical activity, and more.

One epigenetic calculator called GrimAge, for example, revealed “that adults who retrospectively reported having experienced 4 or more ACEs were a mean of 1.52 years older on an epigenetic level than their peers who had experienced fewer than 4 ACEs after adjusting for demographic factors,” wrote Erin C. Dunn, Sc.D., M.P.H., of Massachusetts General Hospital and colleagues in an accompanying editorial. “This suggests that imprints of childhood adversity may be detectable in the epigenome even decades later.”

For related information, see the American Journal of Psychiatry article “Adverse Childhood Experiences: Implications for Offspring Telomere Length and Psychopathology.”

(Image: iStock/digitalgenetics)

School-Based Group Therapy Shows Mental Health Benefits for Teen Girls of Color

Black and Hispanic/Latinx teen girls who participated in a school-based group counseling program for a few months saw mental health improvements, including a reduction in symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, a study in Science Advances has found. The study, which included more than 3,700 girls from 10 Chicago public high schools, also provides evidence that the counseling program—called Working on Womanhood (WOW)—is cost-effective and scalable.

“The burden of mental health is often unseen and overlooked, particularly for young women of color, in part because it is not always associated with externalizing behaviors,” wrote Monica Bhatt, Ph.D., of the University of Chicago and colleagues. “This study marks one of the first studies of adolescent mental health for young women of color [and] ... provides rigorous evidence about how to systematically reduce the prevalence of these challenges at scale through an innovative, group-based, in-school model of therapy.”

The WOW program—which the authors noted was “designed specifically by and for Black and Latinx women”—includes 39 group lessons designed around five themes: self-awareness, emotional intelligence, healthy relationships, visionary goal setting, and leadership. The WOW curriculum incorporates elements of cognitive-behavioral therapy, acceptance and commitment therapy, and narrative therapy. Each group of 10 to 15 high school girls meets with a master-level WOW counselor once a week during an elective period. WOW counselors provide individual therapy and/or refer students for additional services, if needed.

For this study, Bhatt and colleagues enrolled 3,749 girls from 10 public schools located in Chicago’s south or west sides prior to the 2017-2018 academic year; 1,232 of the girls received WOW during the year while 2,517 had access to all standard services and electives. About 85% of students were Black and/or Hispanic/Latinx. About 600 students were randomly selected to fill out a comprehensive baseline survey on mental and physical health measures in the fall of 2017; just over 2,000 were selected for a follow-up survey after May 2018.

Students who participated in the WOW group experienced a 22% drop in PTSD symptom severity, a 14% drop in depression severity, and a 10% drop in anxiety severity, Bhatt and colleagues wrote.

“These benefits were achieved within the challenging real-world environment of 10 Chicago public high schools,” they continued. “At a per-participant cost of $2,300, WOW provides one promising model that can be replicated at scale within resource-challenged public schools across the country.”

For related information, see the Psychiatric News article “Psychiatrists Call for Action After CDC Data Reveal Worsening of Youth Mental Health Crisis” and the Psychiatric Services article “Schools As a Vital Component of the Child and Adolescent Mental Health System.”

(Image: iStock/SDI Productions)

Black Children Less Likely to Receive Adequate Medication for Psychiatric Disorders

Black children are more likely to receive inadequate pharmacotherapy for their mental health conditions than children in other racial groups, a study in Psychiatric Services in Advance has found. The study also suggests that children who have anxiety are more likely to receive inadequate pharmacotherapy than children who have other mental illnesses.

Andrea S. Young, Ph.D., of Johns Hopkins University School of Medicine and colleagues analyzed data from 601 children aged six to 12 years who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. The children and their parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child’s psychiatric symptoms and lifetime mental health services use, respectively. The children’s global functioning was assessed via the Children’s Global Assessment Scale, and mental health service use data were collected by using the Service Assessment for Children and Adolescents.

A child psychiatrist and a child psychologist reviewed the children’s current and past psychiatric diagnoses, medications taken, psychotherapy received, psychiatric inpatient admissions, number of sessions, and duration of each intervention. They independently rated the children’s current pharmacologic and psychotherapy interventions as standard of care, adequate, inadequate, inappropriate, or treatment pending. Treatment ratings were then collapsed into two groups: inadequate (combining inadequate, inappropriate, and treatment pending ratings) and adequate (combining adequate and standard-of-care ratings). Due to limited information about the patients’ experience with psychotherapy, Young and colleagues limited their analyses to medication adequacy.

Overall, only 51% of the children were receiving adequate pharmacotherapy for their mental health conditions. Compared with White children, Black children had 1.84 times the odds of receiving inadequate pharmacotherapy. Black children also had 1.91 times the odds of receiving inadequate pharmacotherapy compared with the combined race group (which included American Indian/Alaska Native, Asian, biracial/multiracial children, and children whose parents chose not to disclose their children’s race).

Young and colleagues also found that children who had anxiety disorders had 1.55 times the odds of receiving inadequate pharmacotherapy compared with children who had other mental disorders. However, children whose caregivers had at least a bachelor’s degree were more likely to receive adequate pharmacotherapy compared with children whose parents had a high school education, general equivalency diploma, or less than a high school education.

“The findings highlight the need for further investigation into the contributors to racial disparities in receiving adequate mental health care and to develop strategies for improving children’s access to mental health care,” Young and colleagues wrote. “The results also underscore a need both for systemic change to reduce barriers and for providers to practice cultural humility in their clinical work.”

For related information, see the Psychiatric Services article “Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders.”

 (Image: iStock/FatCamera)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Americans Agree Cigarettes Are Unsafe, Yet 21% Report Smoking Every Day

More Americans consider cigarettes to be addictive and dangerous than those who express such concerns about cannabis, alcohol, and technology. These were among the latest findings from a national APA poll released today.

“It is clear that we have gotten the message through that cigarettes are dangerous and addictive,” but more can be done to educate Americans about other potentially addictive behaviors, APA President Petros Levounis, M.D., M.A., said in a news release. “For instance, vaping is just as, if not more, addictive than cigarette smoking.”

The poll was conducted by Morning Consult between April 20 and 22 among a sample of 2,201 adults and has a margin of error of plus or minus 2 percentage points.

Most respondents reported that they believe cigarettes (87%), alcohol (84%), prescription opioids (83%), and vapes (81%) are addictive. Only 64% considered cannabis to be addictive. Further, 67% reported daily technology use, 21% reported daily cigarette use, and 13% reported daily cannabis use.

Levounis emphasized that there are safe and effective treatments available to help people with substance use disorders and behavioral addiction. “Addiction treatment works,” he said.

According to the release, APA will soon launch a public awareness initiative on addiction and substance use disorders. The focus will initially be on vaping, then turn to opioids, alcohol, and technology over the next year.

Survey respondents were split on if they consider addiction to be a result of personal weakness (47% reported that they did while 53% reported that they did not). However, 76% consider addictions to be medical disorders, 76% believe they are preventable, and 93% believe they can be treated. Additional findings from the survey include the following:

• 75% believe technology is addictive, and 65% believe it is safe.
• 71% say that if they or someone they know was struggling with an addiction, they would feel knowledgeable about ways to help.
• 58% say they have seen, read, or heard about Narcan and/or naloxone, but only 35% of adults say that, in the case of an opioid overdose, they would know where to find the life-saving medication.

“In 2022, opioids killed more than 100,000 people,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., said in the release. “While it is encouraging that most Americans see substance use disorder as a treatable medical condition, we can do more to ensure that more of us in our communities are aware of and can access naloxone, which saves lives.”

For related information, see the Psychiatric News alert “Americans Feel Worried About Their Safety, APA Poll Finds.”

(Image: iStock/ChrisAt)

MH Symptoms of Survivors of Severe COVID-19 Improve With Follow-Up Care

Veterans who received outpatient care from a clinic that provided psychiatric services after being discharged from the intensive care unit (ICU) for severe COVID-19-related illness showed significant mental health improvements in the months following their discharge. The findings of the small study were published in the May/June issue of the Journal of the Academy of Consultation-Liaison Psychiatry.

More than half of ICU survivors will acquire post-intensive care syndrome (PICS) in the months following hospital discharge, wrote George E. Sayde, M.D., M.P.H., of Tulane University and colleagues. “Within this cohort, the prevalence of posttraumatic stress disorder (PTSD) and depressive symptoms related to the ICU is about 40% and 30%, respectively,” they added.

A PICS outpatient clinic was established in May 2021 within the VA Department of Ambulatory Mental Health in New Orleans, designed to meet the needs of patients who had been hospitalized with critical illnesses related to COVID-19. ICU survivors referred to the PICS clinic received regular multidisciplinary care including psychopharmacology, psychotherapy, case management, and referrals to specialty care, when needed. Patients were screened for symptoms of PTSD, depression, and anxiety at their initial evaluation and then every three months, using the PTSD Checklist (PLC-5), the Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder checklist (GAD-7).

Sayde and colleagues examined data from 77 patients who were identified as high risk of PICS (defined as COVID ICU admission and at least delirium, mechanical ventilation for at least 24 hours, or septic shock); 44 (57%) survived hospitalization. Of the survivors, 21 had at least one follow-up appointment at the PICS clinic.

At the initial evaluation, 66.7% of patients demonstrated clinically meaningful symptoms of PTSD, 38.1% had moderate-to-severe anxiety, and 33.4% had moderate-to-severe depression. At the three-month follow-up, those figures improved: 9.5% of patients still showed significant PTSD symptoms, 4.8% still had moderate-to-severe anxiety, and 4.8% still had moderate-to-severe depression. Additionally, there was a 14.5-point drop in scores for PTSD on the PLC-5 from the initial evaluation to the six-month follow-up.

The authors acknowledged that the small number of patients in the study and the study’s observational nature make it difficult to conclude that the improvement in symptoms is related to care received in the PICS clinic.

“Post-ICU sequelae remain poorly understood, and treatment approaches must be interdisciplinary and individualized,” Sayde and colleagues concluded. “We need more comprehensive, multisite studies that can better characterize patients by their level of risk in developing specific features of PICS to enhance our understanding of post-ICU interventions and improve patient care.”

For related information, see the Psychiatric News article “ICUs Can Result in Long-Lasting Mental Health Problems.”

(Image: iStock/SDI Productions)

Few Mental Health Programs Specifically Geared Toward LGBTQ Youth, Report Finds

Evidence suggests that youth who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are more likely to experience mental health problems than those who identify as heterosexual and cisgender. Yet, a report in JAMA Pediatrics has found that few U.S. mental health facilities that offer services for youth include treatments or groups specifically tailored to LGBTQ youth.

“Compared with heterosexual or cisgender youth, LGBTQ youth have 3 times higher prevalence of depression and anxiety, and 42% have considered suicide,” wrote Kristen R. Choi, Ph.D., R.N., of the University of California, Los Angeles, and colleagues. “Fifty-four percent of LGBTQ youth reported wanting mental health care but not receiving any, partly due to adverse experiences with clinicians and perceptions that clinicians do not understand sexual or gender identity–related mental health needs.”

To determine the availability of LGBTQ mental health services for youth in the United States, Choi and colleagues relied on data collected by the National Mental Health Services Survey. The authors specifically focused on how those surveyed responded to the following question: “Does this facility offer a mental health treatment program or group that is dedicated or designed exclusively for clients [who are] lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ)?” From this information, they calculated the percentage of mental health facilities for youth that offered LGBTQ-specific services in 2020, as well the number of youth mental health facilities with LGBTQ-specific services per 100,000 children, which the authors noted is “a broad indicator of child access to care.”

A total of 12,275 facilities were included in the 2020 sample. Of the 8,077 facilities that offered services for children or youth, 2,294 (28%) offered LGBTQ-specific services in 2020, Choi and colleagues reported. 

“Although some states had relatively high levels of LGBTQ service availability as a percentage of facilities, many of these states had few facilities available to children per capita. Public mental health facilities were less likely to offer LGBTQ-specific mental health services, a concern given that the cost of care is a barrier to services,” the authors concluded. “The [f]indings suggest a need to expand availability of LGBTQ services for youth in underserved geographic areas and in public mental health care.”

For related information, see the Psychiatric News articles “Starting a New Presidential Year With Pride” and “Special Report: Evolving Controversies in the Treatment of Gender Dysphoric/Incongruent Minors.” 

(Image: iStock/SDI Productions)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Study Identifies Risk Factors Linked to Suicide Attempt After Depression Diagnosis

Soldiers who receive a diagnosis of bipolar disorder or traumatic stress on the same day they receive their first diagnosis of depression are more likely to attempt suicide in the next 30 days, according to a report in BMC Psychiatry. However, soldiers who received a diagnosis of depression and a sleep disorder on the same day are much less likely of an imminent suicide attempt.

“Identifying individuals at imminent SA [suicide attempt] risk is a difficult and important clinical task when depression is diagnosed,” wrote Holly Herberman Mash, Ph.D., of the Uniformed Services University of the Health Sciences and colleagues. “This is particularly important in the military, given that suicide has been increasing, despite efforts to reduce its prevalence.”

Mash and colleagues made use of data from the Army Study to Assess Risk and Resilience in Servicemembers (STARRS), which maintains medical and administrative records of over 900,000 enlisted soldiers. For this analysis, they tracked the outcomes of 101,046 active-duty enlisted soldiers (78% male) from 2010 to 2016 with no history of suicidal ideation who received their first official diagnosis of major depressive disorder.

Of this group, 421 soldiers attempted suicide within 30 days of an diagnosis of depression. The researchers examined a host of sociodemographic, job-related, and psychiatric variables to see which ones influenced this risk. Their final model identified several risk factors, including the following:

• Having less than high school education (1.5-fold increased odds)
• Being a combat medic (1.5-fold increased odds)
• Same-day diagnosis of major depression and bipolar disorder (3.1-fold increased odds)
• Same-day diagnosis of major depression and traumatic stress (2.6-fold increased odds)
• History of alcohol use disorder (1.4-fold increased odds)
• History of somatoform/dissociative disorders (1.7-fold increased odds)

The researchers also identified a few traits associated with reduced odds of an imminent suicide attempt, including being married, being in the military for 10 or more years, and being diagnosed with both major depression and a sleep disorder.

“Soldiers with [major depression and no prior suicide ideation] are already identified in the health care system and therefore can be offered evidence-based interventions tailored to their risks,” Mash and colleagues wrote. “The current study findings are important in identifying those at greatest risk and inform timely and appropriate clinical decisions and interventions. [Suicide attempts] might be reduced by as much as one-quarter if we could intervene with this group and reduce their risk from high- to medium-risk level.”

To read more on this topic, see the Psychiatric Services article “Army STARRS Study Finds Risks to Progression From Suicidal Ideation to Attempts..”

(Image: iStock/byMivPiv)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and a curriculum vitae, is July 19, 2023.

LEARN MORE

Physical Restraints Linked to Poorer Outcomes Among Older Patients With Dementia

Older patients with dementia and behavioral disturbances who are physically restrained during hospitalizations spend more days in the hospital and are less likely to be discharged to their home compared with peers who are not physically restrained during hospitalization, a study in the Journal of the American Geriatrics Society has found.

“Multidisciplinary approaches involving all health care team members, in partnership with families, are needed to minimize the use of [physical restraints] and lessen the negative consequences when they are introduced,” wrote Amteshwar Singh, M.D., M.Ed., of the Johns Hopkins University School of Medicine and colleagues.

The researchers analyzed data from 991,605 older patients coded for dementia with behavioral disturbances in the National Inpatient Sample from 2016 to 2020; of this group, 6.5% were physically restrained while they were hospitalized.

Compared with patients who were not restrained, those who had been physically restrained remained hospitalized roughly 2.6 days longer, were 26% less likely to be discharged to home, and accrued an average of $13,150 more hospital charges. Overall, 5.3% of those who had been restrained died while they were hospitalized compared with 4.0% of those who had not. The study also revealed disparities regarding the patients who were restrained: 8.2% of Black patients were restrained compared with 6.2% of White patients.

“Beyond the physical affront, [physical restraints] bring psychological trauma to patients because of the perception of coercion and an assault on their dignity,” Singh and colleagues wrote.

“Ideally, [physical restraints] would never be employed, but each decision to use restraints is context-dependent and must be individualized to ensure the protection of all,” the researchers added. “[E]mploying physical restraints must always be carefully considered and used only after all other measures have been exhausted, given the associations with worse clinical and resource utilization outcomes.”

For related information, see the Psychiatric Services article “APA Resource Document Outlines Principles on Use of Seclusion, Restraint.”

(Image: iStock/bymuratdeniz)

---

Psychiatric News Invites Applications for
Medical Editor-in-Chief

APA members who have administrative experience, are passionate about disseminating news in the field of psychiatry, and are knowledgeable about print and digital communications are invited to apply. The deadline for applications, which should include a vision statement and curriculum vitae, is July 19, 2023.

LEARN MORE

Smoking Cessation Does Not Worsen Mental Health Outcomes, Study Finds

Smoking cessation may be associated with improved mental health outcomes among people with and without psychiatric disorders, according to a study published yesterday in JAMA Network Open.

“Many people who smoke state that they want to quit, but many continue because they report that smoking helps relieve stress and offers other mental health benefits,” wrote Angela Difeng Wu, M.Sc., and Min Gao, Ph.D., of the University of Oxford, and colleagues. “The belief that cigarettes are calming is widespread, and some health professionals may deter people with mental health disorders from trying to stop smoking.”

Wu, Gao, and colleagues used data from the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES), which compared outcomes in people with and without psychiatric disorders who had received either varenicline with nicotine replacement therapy, bupropion, or placebo for smoking cessation. People aged 18 to 75 who smoked 10 or more cigarettes per day during the previous year and were motivated to quit were included. Participants in the EAGLES study received 12 weeks of treatment followed by 12 weeks of follow-up visits that did not include treatment. Smoking cessation was defined as continuous abstinence between weeks nine and 24. Anxiety and depression outcomes were measured with the Hospital Anxiety and Depression Scale (HADS), which was administered at baseline and 11 times during visits between weeks six and 24. HADS includes seven items to assess anxiety and seven to assess depression, with a lower score representing less severe symptoms.

Of 4,260 participants, 2,359 (55%) had a history of mental illness, and 923 (21.7%) were taking psychotropic medication. At the end of the study period, 3,781 participants continued smoking and 479 had stopped. Those who were taking psychotropic medications were significantly more likely to continue smoking at the end of the study period compared with those who were not. Those who stopped smoking had a lower HADS score at week 24 compared with those who continued smoking (for example, anxiety was lower by 0.40 points, while depression was lower by 0.47 points). Those with a history of psychiatric illness who stopped smoking had greater decreases in HADS scores compared with those who did not have a history of psychiatric illness.

“The disparity between smoking cessation rates in people with and without psychiatric disorders is concerning, given that smoking may account for up to two-thirds of the difference in life expectancy between people with a history of psychiatric disorders who smoke vs people who have never smoked,” the authors wrote. “These findings might motivate policy makers and stakeholders to support smoking cessation in people with mental health disorders.”

For related information, see the Psychiatric Services article “Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness.”

(Image: iStock/bymuratdeniz)