Sleep Apnea Linked to Increased Risk of Suicide Attempts

People who are diagnosed with sleep apnea may have an increased risk of dying by suicide, a study in the Journal of Psychiatric Research has found. Sleep apnea is a potentially serious disorder in which breathing repeatedly stops and starts during sleep.

Che-Sheng Chu, M.D., of Kaohsiung Veterans General Hospital in Kaohsiung City, Taiwan, and colleagues examined data from the Taiwan National Health Insurance Research Database. The researchers selected 7,095 adults aged 20 years or older who had been diagnosed with sleep apnea between 1998 and 2010 and 28,380 adults without sleep apnea who were matched based on their age, sex, and comorbidities (such as depressive disorder, diabetes, and/or substance use disorders). They then examined suicide attempts that took place during the follow-up period, which ended December 31, 2011 (all participants were followed up to at least one year after receiving a diagnosis).

Adults with sleep apnea had 4.53 times the risk of carrying out a suicide attempt during the follow-up period compared with those who did not have sleep apnea, after the researchers accounted for demographic data, mental disorders, and physical comorbidities. When the researchers excluded adults with mental disorders, patients with sleep apnea had 4.23 times the risk of carrying out a suicide attempt compared with those who did not have sleep apnea.

During the follow-up period, adults who had sleep apnea also had 3.86 times the risk of repeated suicide attempts compared with those who did not have sleep apnea—a risk that remained about the same when the researchers excluded adults with mental disorders.

The researchers noted several potential reasons for the increased risk of suicide attempts among adults with sleep apnea. For example, studies suggest that people with sleep apnea are more prone to cognitive decline, and people with cognitive impairment have a higher risk of attempting suicide, they wrote. Numerous studies also point to the toll that waking up throughout the night can have on mental health.

“[A]wakening at night leads to a high risk of suicide attempts due to increased utilization of substances, reduced social support, feeling[s] of loneliness, and decreased frontal lobe function,” the researchers wrote. “From clinical and public health perspectives, routine and frequent screening for suicidal ideation is important for patients with sleep apnea. Further studies are necessary to elucidate the pathophysiology of sleep apnea and suicidality.”

For related information, see the American Journal of Psychiatry article “The Evolving Nexus of Sleep and Depression.”

(Image: iStock/yanyong)

---

Ready to Shake Up Mental Health Care? Innovation Lab Is for You!

APA’s Psychiatry Innovation Lab nurtures early-stage ideas and ventures by investing in them with mentorship, education, and collaboration opportunities within the community of mental health innovators. Submit video pitches of ideas that aim to improve mental health care delivery and how psychiatrists diagnose, treat, and manage patients by next Friday, March 31. Four finalists will be selected to pitch their ideas to a panel of judges and audience members at APA’s 2023 Annual Meeting.

LEARN MORE

Antipsychotic Polypharmacy at Higher Doses Does Not Increase Hospitalization Risk, Study Finds

Patients with schizophrenia appear to be at a lower risk of hospitalization for physical health issues when taking high doses of two or more antipsychotic medications concurrently (polypharmacy) than when taking just one antipsychotic medication (monotherapy) at the same dose, according to a study published yesterday in AJP in Advance.

“When patients were treated with high-dose antipsychotic monotherapy …, they had approximately a 20% higher risk of severe cardiovascular outcomes leading to hospitalization compared with periods when the same patients were treated with corresponding high-dose combination therapy,” wrote Heidi Taipale, Ph.D., of the University of Eastern Finland and colleagues.

The study included data collected from 61,889 patients diagnosed with schizophrenia who were alive on January 1, 1996, and had received inpatient care, as documented in Finland’s nationwide Hospital Discharge register. Taipale and colleagues tracked these patients up until December 31, 2017, or until they died, whichever occurred first. They specifically compared the patients’ nonpsychiatric and cardiovascular hospitalizations during periods when they were receiving antipsychotic polypharmacy versus monotherapy. The researchers also compared differences in outcomes according to antipsychotic exposure by further dividing the groups according to the following defined daily doses (DDDs): <0.4, 0.4 to <0.6, 0.6 to <0.9, 0.9 to <1.1, 1.1 to <1.4, 1.4 to <1.6, and ≥1.6. (A DDD of 1.0 reflects the average dose of a medication prescribed to an adult, according to the World Health Organization.)

Here are some of the findings they reported:

• About 46.4% of patients had used high-dose (≥1.6 DDDs/day) monotherapy and 52.6% had used high-dose polypharmacy.
• During the follow-up period (about 15 years), 45,013 patients experienced nonpsychiatric hospitalization and 13,893 experienced cardiovascular hospitalization.
• The risk of nonpsychiatric hospitalization was 13% lower when patients were taking high-dose antipsychotic polypharmacy compared with when taking high-dose monotherapy.
• The risk of cardiovascular hospitalization was 18% lower when patients were taking high-dose antipsychotic polypharmacy compared with when taking high-dose monotherapy.

“Our results on antipsychotic use in a large nationwide cohort over a long follow-up show that antipsychotic polypharmacy is associated with lower risk of hospitalizations for physical health issues than monotherapy in the maintenance treatment of schizophrenia when high total dosage is assessed,” the authors concluded. “The current recommendations of treatment guidelines categorically encouraging use of monotherapy instead of polypharmacy are not based on evidence and should take a more agnostic approach to this issue.”

For related information, see the Psychiatric News article “Two Studies Analyze Add-On Treatments for Schizophrenia.”

(Image: iStock/Hiraman)

---

Ready to Shake Up Mental Health Care? Innovation Lab Is for You!

APA’s Psychiatry Innovation Lab nurtures early-stage ideas and ventures by investing in them with mentorship, education, and collaboration opportunities within the community of mental health innovators. Submit video pitches of ideas that aim to improve mental health care delivery and how psychiatrists diagnose, treat, and manage patients by next Friday, March 31. Four finalists will be selected to pitch their ideas to a panel of judges and audience members at APA’s 2023 Annual Meeting.

LEARN MORE

Parents May Underestimate Frequency of Mental Health Concerns Among College Students

College students are far more likely to report having experienced an eating disorder, depression, or suicidal ideation compared with what parents report knowing about their children’s experiences with mental illness, according to a UnitedHealthcare report published today.

“It may not be surprising that some students and parents have different perceptions of the college experience, but this report demonstrates the need to create environments for ongoing meaningful conversations with these emerging adults,” said Donald Tavakoli, M.D., national medical director for behavioral health with UnitedHealthcare, in a news release.

The 2022 College Student Behavioral Health Report was conducted by YouGov, an international Internet-based market research and data analytics firm. YouGov surveyed 1,034 participants, 506 of whom were current college students, and 528 of whom were the parents of college students. The participants completed online surveys from August 8 to 14, 2022. Most of the students surveyed (85%) reported being enrolled in a health insurance plan.

The survey revealed significant gaps in parents’ understanding of their children’s mental health concerns. For every 10 students who reported seeking help for themselves or a friend in the last year, only eight parents reported they knew their child sought help. The disconnects between students’ experiences and parents’ perception of their child’s mental health include the following:

• 41% of students reported experiencing depression, compared with 22% of parents reporting their child experienced depression.
• 13% of students reported experiencing suicidal ideation or intent, compared with 4% of parents reporting their child experienced suicidal ideation or intent.
• 11% of students reported experiencing an eating disorder, compared with 5% of parents reporting their child experienced an eating disorder.
• 6% of students reported experiencing a substance use disorder (SUD), compared with 4% of parents reporting their child experienced an SUD.

Further, students who did not seek help for their mental health concerns, but said they needed help, reported the following reasons:

• 40% said help was too expensive.
• 28% said it took too long to get an appointment.
• 25% said they did not know where to find mental health resources.
• 20% said they were concerned about their parents finding out.
• 14% said they were concerned about friends or classmates finding out.

Students who reported experiencing a mental health concern during the past year were twice as likely as those who did not to express doubts about graduating on time. Among those who experienced an SUD, 94% expressed doubts about graduating on time, and 88% of those who experienced suicidal ideation or intent expressed such doubts.

“We need to work with students to educate them on their options for mental and behavioral support,” Tavakoli said in the release. “Colleges, parents, health care providers, and health plans all can play a role in supporting navigation to appropriate care.”

For related information, see the Psychiatric News article “College Students Struggle Amid Pandemic’s Uncertainty.”

(Image: iStock/seb_ra)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Breast Cancer in Women With Severe Mental Illness Often Undertreated, Review Suggests

Women with severe mental illness (SMI)—such as schizophrenia, bipolar disorder, or major depression—are less likely to receive recommended treatment for breast cancer than those without SMI, according to a report in Psycho-Oncology.

Prior studies suggest that death from breast cancer is higher among patients with preexisting SMI compared with those without mental illness. Such higher death rates may be the result of reduced access to early cancer screening; delays in seeking cancer care; and/or a lack of collaboration between psychiatrists, primary care physicians, and oncologists, wrote Steve Kisely, M.D., Ph.D., of the University of Queensland in Australia and colleagues.

Curious about the barriers that patients with SMI experience following a breast cancer diagnosis, the authors compiled and reviewed articles that reported data on whether an SMI diagnosis impacted the receipt of guideline-appropriate cancer treatment (for example, surgery, chemotherapy, radiotherapy, and/or adjuvant endocrine therapy) for adult female breast cancer patients.

Kisely and colleagues included 13 studies in the review, which included a total of 299,193 participants. Of these, four studies estimated the odds of receiving guideline-appropriate breast cancer treatment in people with schizophrenia and related psychotic disorders and/or mood disorders; these were included in a meta-analysis.

The pooled data from the four studies showed that patients with SMI were about 17% less likely to receive guideline-recommended cancer treatment than those without SMI. Kisely and colleagues also found “that patients with bipolar disorders, schizophrenia, and other psychotic disorders had a significantly higher risk of delays to starting cancer treatment of 2 months or more after breast cancer diagnosis, and they were less likely to initiate their adjuvant hormonal therapy within 1 year of their diagnosis.”

The authors concluded, “Our results suggest that greater action is needed to improve access to guideline-appropriate care for breast cancer outcomes of psychiatric patients. In the area of colorectal cancer, people with schizophrenia who received case management including education on screening and patient navigation had higher participation rates compared [with] controls who had treatment a usual. This approach might also be applied to breast cancer treatment including the use of navigators, in combination with collaborative care between general practitioners, oncology, and mental health services.”

For related information, see the Psychiatric Services article “Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness.” 

(Image: iStock/Ridofranz)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Postoperative Delirium Associated With Accelerated Cognitive Decline, Study Finds

Older adults who develop delirium after a surgery may experience faster cognitive decline than those who do not develop post-surgery delirium, suggests a report in JAMA Internal Medicine. The findings are based on cognitive data collected up to six years after the participants’ elective surgeries.

“Delirium is recognized as a common and serious disorder and represents the most frequent postoperative complication in older adults,” Zachary J. Kunicki, Ph.D., M.S., M.P.H., of Brown University and colleagues wrote. “With growing recognition of the association of delirium with a higher risk for long-term cognitive decline and dementia, a better understanding of the association between these conditions is greatly needed.”

Kunicki and colleagues analyzed data from the Successful Aging after Elective Surgery (SAGES) cohort, which included 560 adults aged 70 years and older who showed no signs of dementia and were scheduled for an elective surgery. The SAGES participants received daily delirium assessments following surgery until discharge. The researchers then tracked the participants’ cognitive performance using a variety of tests (including tests of attention, memory, and language) 11 times for six years.

Of the 560 participants in the study, 134 (24%) developed delirium following surgery. On average, adults who did and did not develop postoperative delirium experienced similar cognitive trajectories: They had some noticeable cognitive decline in the first month following their surgery, followed by a month of small cognitive improvements, and then stable cognition or minimal decline for about 2.5 years. Between 2.5 years and 6 years, the participants experienced greater cognitive decline.

Across all time points, however, the adults who had postoperative delirium experienced greater cognitive declines than the adults who did not have postoperative delirium. After 72 months, general cognitive performance scores (an average of participants’ cognitive tests) dropped by an average of 5.79 points in the delirium group compared with 3.53 points in the no-delirium group. These findings suggest “delirium was associated with a 40% faster pace of cognitive decline compared with the comparison groups that provide estimates of normal cognitive aging,” the researchers wrote. “[I]t remains uncertain if delirium causes subsequent cognitive decline or if persons with preclinical brain disease are more likely to develop delirium.”

They continued, “While further study is needed, the current study’s results support … the potential importance of delirium prevention in older adults who are undergoing elective surgery.”

To read more about this topic, see the Psychiatric News article “Meta-Analysis Explores Delirium Medication Option.”

(Image: iStock/Pornpak Khunatorn)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

1 in 5 Deaths by Suicide Related to Intimate Partner Problems

One in five deaths by suicide is related to problems with current or former intimate partners such as divorce, separation, romantic breakups, arguments, jealousy, conflicts, and intimate partner violence, a study in the American Journal of Preventive Medicine has found.

Ayana Stanley, Dr.P.H., of the Centers for Disease Control and Prevention Division of Violence Prevention and colleagues analyzed data from the National Violent Death Reporting System for 402,391 adults who died by suicide between 2003 and 2020. They compared the circumstances leading up to suicide deaths related to intimate partner problems with suicide deaths not related to intimate partner problems.

People whose suicide deaths were related to intimate partner problems compared with those who were not had greater odds of the following:

• 6.5 times the odds of having experienced interpersonal violence.
• 4.1 times the odds of having arguments with others such as family, friends, and associates.
• 2.7 times the odds of having a history of suicidal thoughts.
• 2.2 times the odds of interpersonal violence victimization.
• 2.1 times the odds of having a depressed mood.
• 2.0 times the odds of having financial problems.
• 2.0 times the odds of having problematic alcohol use.
• 1.6 times the odds of having recent legal problems.

Aside from problematic alcohol use, there was no significant difference between the two groups regarding problematic substance use.

“[T]he present study underlines the increased association of mental health problems among suicide decedents specifically experiencing [intimate partner problems] compared to those who did not. A partner relationship marked by interpersonal conflict and violence may contribute to or exacerbate mental health problems. Conversely, mental health problems may also contribute to difficulties experienced within an intimate partner relationship,” Stanley and colleagues wrote.

“Additionally, experiencing an acute adverse life event (like deciding to divorce or experiencing intimate partner violence) could contribute to an impulsive suicide attempt among individuals who did not previously have a suicide plan,” the researchers continued. “Thus, monitoring by clinicians, mental health providers, and the helpful connectedness of … family and friends of non-suicidal individuals encountering severe adverse life events is paramount.”

For related information, see the Psychiatric Research & Clinical Practice article “Recent Stressful Experiences and Suicide Risk: Implications for Suicide Prevention and Intervention in U.S. Army Soldiers.”

(Image: iStock/Marta Nogueira)

---

Got an Idea? Submit a Video ‘Elevator Pitch’

The Psychiatry Innovation Lab is a platform to accelerate innovative ideas and ventures that aim to improve the delivery of mental health care. Those interested in participating are asked to submit a video pitch of their idea. These pitch videos, which should feature the problem, the proposal to solve the problem and business model, should be three to five minutes in length. All proposals are due by Friday, March 31. Finalists will present their ideas at the live showcase at APA’s Annual Meeting on Monday, May 22, at the Mental Health Innovation Zone in San Francisco. Awards will be given to the best ideas!

LEARN MORE AND PITCH YOUR IDEA

Certain Patients With OUD Remain at Risk of Overdose After Entering Treatment

Patients who enrolled in a trial of medication treatment for opioid use disorder (OUD) who did not start or complete their assigned medication were at greater risk of experiencing an overdose than those who took their medication, according to a study published in The American Journal of Psychiatry.

“A substantial body of evidence has shown that treatment with medication for opioid use disorder (MOUD) can decrease both overdose risk and all-cause mortality among people with opioid use disorder,” wrote Laura Brandt, Ph.D., of City College of New York and colleagues. “The aim of this study was to estimate the risk of overdose events once a patient is diagnosed with OUD and engaged in MOUD treatment and to test whether the assignment to a medication (methadone, buprenorphine, extended-release naltrexone) influences this risk.”

Brandt and colleagues used data from three large MOUD clinical trials that included 2,199 adult participants with OUD:

• In the first study, participants received outpatient methadone or buprenorphine treatment for 24 weeks. Adverse events such as overdoses were reported weekly.
• For the second study, participants received counseling and buprenorphine for three to four weeks and were followed for an additional four to eight weeks. Those who did not maintain abstinence received buprenorphine treatment for 12 weeks followed by a four-week taper period. Adverse events were reported biweekly.
• Participants in the third study received outpatient buprenorphine or extended-release naltrexone over 24 weeks. Adverse events were reported weekly.

Fifty-seven overdose events occurred in the three studies, experienced by 51 participants. Fifteen overdoses occurred among 283 participants assigned to naltrexone (5.3%), eight among 529 participants assigned to methadone (1.51%), and 16 among 1,387 patients assigned to buprenorphine (1.15%). Nearly 28% of the participants assigned to naltrexone never started the medication, compared with only 2.2% of those assigned to buprenorphine and 1.7% of those assigned to methadone. Those who did not start naltrexone had an overdose rate of 8.9% compared with 3.9% among those who did start the medication.

Overall, the risk of experiencing an overdose was significantly higher among those who never started their assigned medication or who stopped their medication. Further, taking benzodiazepines at baseline was associated with an increased risk of an overdose among participants in all three medication groups.

“Patients should be educated about overdose risk, the protective effect of MOUD, and the danger of discontinuing medication,” the authors concluded. “Benzodiazepine use is also a signal of risk, and patients taking benzodiazepines should be evaluated and treated for mental health problems as part of an effort to wean them off benzodiazepines.”

For related information, see the Psychiatric Services article “Factors Associated With Initial Treatment Choice, Engagement, and Discontinuation for Patients With Opioid Use Disorder.”

(Image: iStock/SDI Productions)

---

Got an Idea? Submit a Video ‘Elevator Pitch’

The Psychiatry Innovation Lab is a platform to accelerate innovative ideas and ventures that aim to improve the delivery of mental health care. Those interested in participating are asked to submit a video pitch of their idea. These pitch videos, which should feature the problem, the proposal to solve the problem and business model, should be three to five minutes in length. All proposals are due by Friday, March 31. Finalists will present their ideas at the live showcase at APA’s Annual Meeting on Monday, May 22, at the Mental Health Innovation Zone in San Francisco. Awards will be given to the best ideas!

LEARN MORE AND PITCH YOUR IDEA

California Insurance Law Linked to Increase in Gender-Affirming Surgery

Individuals with gender dysphoria who lived in California were significantly more likely to undergo gender-affirming surgery following the 2013 implementation of a state law prohibiting insurance discrimination against gender-affirming care compared with those living in Arizona and Washington, where no such law exists. That was the finding from a study of 25,252 transgender and gender-diverse patients in California, Washington, and Arizona that was published yesterday in JAMA.

The increase appeared significant among patients with private insurance or Medicaid, but not patients paying out of pocket.

“The findings suggest that the legislation, which prohibited insurance denial of health care benefits based on patient sex, gender, gender identity, or gender expression, facilitated access to gender-affirming surgery among insured patients with a diagnosis of gender dysphoria,” wrote Anna Schoenbrunner, M.D., of The Ohio State University and colleagues.

The researchers compared the number of gender-affirming surgeries from January 1, 2005, to June 30, 2013 (prior to implementation of California’s Insurance Gender Nondiscrimination Act) and July 1, 2013, to December 31, 2019 (after implementation of the law), for 17,934 individuals with gender dysphoria in California and 7,328 individuals with gender dysphoria in Arizona and Washington.

In California, 2,715 admissions (15.1%) had at least one gender-affirming surgery within the study period. In Arizona and Washington, 203 (2.8%) patients underwent at least one gender-affirming surgery. Patients’ median age at time of surgery was 34 years in California and 39 years in Arizona and Washington; 51.2% identified as female, 46.2% as male, and 2.5% as unknown.

Before the implementation of the Insurance Gender Nondiscrimination Act, 66 California sites performed a median of one gender-affirming procedure per site; after implementation, 106 sites performed a median of two procedures per site. In both Arizona and Washington, the number of sites performing gender-affirming procedures dropped in the same period.

After the implementation of the California law, there was an increase of 5.7 surgeries per quarter in the state compared with 0.41 surgeries per quarter in Arizona and Washington. The law was associated with a 12.1% increase in the probability that a patient with gender dysphoria would receive gender-affirming surgery in California compared with Arizona and Washington.

“These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients,” the authors wrote.

For related information, see the Psychiatric News article “APA Joins Amicus Against Arkansas Law Banning Gender Affirming Therapy.”

(Image: iStock/ArLawKa AungTun)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

COVID-19 Stress During Pregnancy Associated With Worse Postpartum Outcomes

Experiencing high levels of stress during pregnancy is known to place mothers and their infants at risk of mental health problems. A report published today in JAMA Network Open highlights some of the impact that worries about COVID-19 may have had on the mental health of women and their offspring.

In a longitudinal study, Susanne Schweizer, Ph.D., of the University of Cambridge and colleagues found that “COVID-19–related stress was significantly associated with maternal postpartum distress, depression, and GAD [general anxiety disorder] as well as infant negative affectivity, even when controlling for COVID-19 risk reported during the pandemic.”

The results were based on data collected as part of the COVID-19 Risks Across the Lifespan, which included women from Australia, the United Kingdom, and the United States. A total of 318 women who reported being pregnant at the first assessment wave that took place between May 5 and September 30, 2020, and completed follow-up assessments between October 28, 2021, and April 24, 2022, were included in the analysis.

In addition to completing the 8-item Patient Health Questionnaire and the 7-item General Anxiety Disorder scale, the study participants completed the following assessments:

• The 9-item Pandemic Anxiety Scale, which asked participants about their level of agreement with such statements as “I’m worried that I will catch COVID-19.”
• The 10-item Postpartum Distress Measure, which asked participants about their level of agreement with such statements as “I have recurring thoughts about harm coming to my baby, my family, or myself.”
• The 37-item Infant Behavior Questionnaire, which assessed negative affectivity (for example, how teary the baby was at the end of an exciting day), positive affectivity (for example, how much the baby laughed), and more.

Antenatal COVID-19–related stress was significantly associated with depression, general anxiety disorder, and postpartum distress among mothers 8 to 22 months postpartum. Among infants, antenatal COVID-19–related stress was selectively associated with negative affectivity but not positive affectivity or orienting behaviors (for example, spending more than five minutes looking at pictures in books).

“These results echo the findings of others that antenatal stress is detrimental to the postpartum mental health of both mother and child,” Schweizer and colleagues wrote. “More specifically, our findings demonstrate the association of pandemic-related stress with these adverse outcomes, highlighting the need to prioritize mental health care as part of antenatal care guidelines during pandemics.”

For related information, see the Psychiatric News article “Addressing Maternal Mental Health: Progress, Challenges, and Potential Solutions.”

(Image: iStock/fotostorm)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Family Bereavement Program Offers Long-Term Protection Against Depression

Children who experience the death of a parent are known to be at an increased risk of depression and other internalizing problems later in life. A study in the Journal of the American Academy of Child & Adolescent Psychiatry has found that children who together with their families participated in a bereavement program within 2.5 years of the death were less likely to experience depression up to 15 years later.

“The findings from this study have implications for future research on the prevention of depression,” wrote Irwin Sandler, Ph.D., of Arizona State University and colleagues.

Sandler and colleagues enrolled 244 youth aged 8 to 16 who had experienced the death of a parent 3 to 30 months prior to the study and their caregivers for a randomized, controlled trial. A total of 156 families participated in 12 sessions of a family bereavement program or were mailed three age-appropriate books about dealing with grief (literature control).

The family bereavement program included separate group sessions for the children and their caregivers. The caregiver sessions focused on supporting grieving caregivers, strengthening positive parenting techniques such as active listening, and reducing children’s exposure to stressful life events. The youth sessions focused on strengthening positive coping and emotion regulation skills. The children and their caregivers then came together for two joint sessions, where they could together practice their learned skills.

Sandler and colleagues conducted follow-up interviews with the youth to assess grief, intrusive thoughts, internalizing symptoms, depression, and anxiety; these interviews were conducted immediately after the family bereavement or control program, 11 months later, 6 years later, and 15 years later. A total of 186 children (now adults) were still in the trial at the 15-year follow-up.

Between the 6- and 15-year follow-up, 13.46% of the adults who had participated in the family bereavement program as children met the criteria for depression (assessed with the World Health Organization’s World Mental Health Composite International Diagnostic Interview) compared with 28.05% of those in the literature group; 4.81% of the adults who participated in the family bereavement program as children had generalized anxiety disorder as adults compared with 12.20% in the literature group.

After adjusting for multiple variables, Sandler and colleagues calculated that youth who participated in the family bereavement program were 67% less likely to have depression 15 years later compared with youth who had not participated in the program. Youth who participated in the family bereavement program were also less likely to develop anxiety disorders as adults.

“It may [be] that the FBP [family bereavement program] reduces MDD [major depressive disorder] in part through its reduction of negative self-referential processing of the stressors involved in grappling with academic, career, and romantic developmental tasks of early adulthood,” Sandler and colleagues wrote. “Future research is needed to study how preventive interventions such as the FBP may reduce negative self-referential processing as a pathway to the prevention of MDD.”

To read more on this topic, see the American Journal of Psychiatry study “CBT for Prolonged Grief in Children and Adolescents: A Randomized Clinical Trial.”

(Image: iStock/PeopleImages)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Combined Motivational Interviewing, CBT Found to Increase Motivation in People With Schizophrenia

People with schizophrenia are known to experience motivational deficits (for example, defeatist beliefs and social withdrawal) that can hinder their ability to engage in social and occupational activities. A study published yesterday in The American Journal of Psychiatry found that patients who participated in weekly group therapy sessions that combined motivational interviewing and cognitive-behavioral therapy (CBT) for three months experienced greater improvements in motivation and pleasure than those who did not receive the combined therapy.

“While there have been advances in pharmacological interventions for positive symptoms, they have had a minimal impact on daily functional outcomes for those living with the illness,” wrote L. Felice Reddy, Ph.D., of the Department of Veterans Affairs (VA) VISN 22 Mental Illness Research, Education, and Clinical Center in Los Angeles. “Our results are encouraging for psychosocial interventions aiming to improve quality of life for people with schizophrenia and indicate specific directions for future clinical research.”

For the study, Reddy and colleagues recruited adults with schizophrenia from outpatient clinics at the VA Greater Los Angeles Healthcare System. To be included, patients had to be clinically stable (for example, no inpatient hospitalizations during the three months prior to enrollment) and have moderate to severe levels of motivational negative symptoms (defined as a score of 15 or greater out of 36 on the motivation and pleasure subscale of the Clinical Assessment Interview for Negative Symptoms).

A total of 79 patients with schizophrenia experiencing moderate to severe negative symptoms were randomly assigned to one of two groups who received 12, one-hour weekly group therapy sessions:

• One group received integrated motivational interviewing (MI) and CBT: These weekly sessions focused on building motivation for goals; establishing a commitment to change; and resolving ambivalence with CBT-based behavioral activation, problem solving, and cognitive restructuring exercises.
• The other group (control) received mindfulness-based stress reduction therapy: These weekly sessions incorporated short videos, didactics, and experiential practice.

The researchers used several scales to evaluate the participants’ clinical symptoms and functioning three times over the course of the study, which included 12 weeks of active treatment and 12 weeks of follow-up. They also evaluated the participants’ pupillary response, as a biological marker of motivated effort on a cognitive task.

While the MI-CBT group showed significant improvement in motivational negative symptoms after 12 weeks, the active control group did not, Reddy and colleagues reported. At follow-up, participants in the MI-CBT group continued to show improvements in motivation and pleasure from baseline; however, the differences between the MI-CBT and control groups were less than during the active treatment period. Similarly, the MI-CBT group showed an increase in average pupil dilation from baseline to 12 weeks, but the control group did not; however, this effect did not persist over the follow-up period. There were no significant differences between the groups in terms of functioning.

“Evidence for the efficacy of negative symptom interventions is growing, and our results provide additional support,” Reddy and colleagues wrote. “A critical direction for future research is to translate these gains to lasting improvements in daily functioning.”

For related information, see the Psychiatric Services articles “Treatment Implications of Situational Variability in Cognitive and Negative Symptoms of Schizophrenia” and “Six-Month Follow-Up of Recovery-Oriented Cognitive Therapy for Low-Functioning Individuals With Schizophrenia.”

(Image: iStock/SeventyFour)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Risk of Dementia May Be Reduced by Vitamin D Supplementation

Older adults who take vitamin D may be 40% less likely to develop dementia compared with those who do not, according to a study published in Alzheimer’s & Dementia.

“Vitamin D deficiency may be a modifiable risk factor [for dementia] and has been recognized as a widespread health problem, with a worldwide prevalence of up to 1 billion,” wrote Zahinoor Ismail, M.D., of the University of Calgary and colleagues. “Yet, the role of vitamin D supplementation as a potential intervention has been a subject of debate and remains in equipoise.”

Ismail and colleagues used 2005-2021 data from the National Alzheimer’s Coordinating Center (NACC), which includes data on cognitive functioning from participants in the Alzheimer’s Disease Research Center. NACC collects demographic and standardized clinical data annually. Participants who had either normal cognition or mild cognitive impairment at baseline were included in the study. They were then divided into two groups: the vitamin D–exposed group, those who were taking either calcium-vitamin D, cholecalciferol (vitamin D3), or ergocalciferol (vitamin D2) at baseline; and the non-exposed group, those who were not taking vitamin D supplements during the study period (or prior to a dementia diagnosis).

A total of 12,388 participants were included, with 4,637 in the vitamin D–exposed group and 7,751 in the non-exposed group. After five years, 83.6% of those exposed to vitamin D had not developed dementia, compared with 68.4% of those not exposed to vitamin D. After controlling for baseline age, sex, education, race, cognitive diagnosis, depression, and APOE ε4 status (a gene associated with an increased risk of Alzheimer’s), almost 75% of those who developed dementia over 10 years had no exposure to vitamin D prior to their diagnoses. These findings were consistent across all vitamin D formulations included in the study.

Additional findings included the following:

• Women taking vitamin D had lower rates of dementia compared with men taking vitamin D.
• Though mild cognitive impairment at baseline was associated with more dementia diagnoses after five years compared with normal cognition at baseline, exposure to vitamin D was associated with lower odds of developing dementia after five years among both those with mild cognitive impairment and normal cognition at baseline.
• Though a depression diagnosis was associated with a 35% greater incidence of dementia, the study did not identify any significant interaction between depression and vitamin D exposure.

“[O]ur findings implicate vitamin D as a potential agent for dementia prevention and provide additional support for its use in at-risk individuals,” the authors wrote. “Information on dosage of vitamin D supplementation as well as the baseline levels of vitamin D will be essential to further clarify the efficacy and refine the target population for vitamin D supplementation in preventing [Alzheimer’s] and dementia.”

For related information, see the Psychiatric News article “Study Finds Selenium, Vitamin E Do Not Prevent Dementia.”

(Image: iStock/Helin Loik-Tomson)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Entering Treatment After First Episode of Psychosis May Reduce Risk of Self-Harm

Young people who began treatment within 14 days of being diagnosed with first-episode psychosis (FEP) were less likely to deliberately harm themselves than those who did not initiate treatment, according to a report in Psychiatric Services. The findings were based on data collected from Ohio Medicaid claims for more than 6,300 youth with FEP.

“Given the high rates of suicide in this population, our findings suggest a great need for suicide-specific interventions for individuals in the early course of a psychotic disorder,” wrote Heather Wastler, Ph.D., an assistant professor of psychiatry at the Early Psychosis Intervention Center at Ohio State University Medical Center, and colleagues.

Wastler and colleagues focused their analysis on 6,349 adolescents and young adults aged 15 to 24 years who were enrolled in Ohio Medicaid and were diagnosed with FEP between June 30, 2010, and December 31, 2017. They compared deliberate self-harm among those who did and did not initiate treatment after being diagnosed with FEP and among those who engaged or did not engage in treatment after initiation. Treatment initiation was defined as an inpatient admission or at least one psychotherapy session (individual, family, or group), medication management visit, or partial hospitalization within 14 days of an FEP diagnosis. Treatment engagement was defined as at least two of the same forms of treatment within 90 days of treatment initiation.

A total of 4,419 (69.6%) of the youth initiated treatment within 14 days of their FEP diagnosis; 55% of these youth engaged in treatment during the 90-day period. The researchers tracked the outcomes of the youth up to 365 days from the end of the initiation or engagement period, with follow-up ending at the first deliberate self-harm claim, the end of Medicaid enrollment, death, or the end of the study period (December 31, 2017).

A total of 229 individuals deliberately harmed themselves during the follow-up period. Of the 4,419 youth who initiated treatment, 134 (3.0%) deliberately harmed themselves at least once; among the 1,930 youth who did not initiate treatment, 95 (4.9%) deliberately harmed themselves.

“Given the established relationship between positive symptoms and suicide-related outcomes, it’s possible that this initial contact reduces DSH [deliberate self-harm] through the stabilization of psychotic symptoms with antipsychotic medication,” Wastler told Psychiatric News. “Another potential explanation is that providers might deliver brief evidence-based interventions such as crisis response planning, safety planning, or lethal-means counseling during the first treatment contact.”

Among the 2,431 who continued treatment, 64 (2.6%) deliberately harmed themselves during the follow-up period compared with 42 (2.1%) of those who discontinued treatment.

Wastler said that more sessions may be needed to reduce deliberate self-harm. She also noted that other factors, such as the quality of care received or the patients’ motivation for treatment, may have influenced the findings.

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

(Image: iStock/Dziggyfoto)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Experts at AAGP Annual Meeting Offer Tips for Taking Older Patients’ Medication History

Psychiatrists who treat older patients should review their patients’ medications very carefully, particularly when they are seeing a patient for the first time after a referral from a hospital, speakers at the American Association for Geriatric Psychiatry (AAGP) 2023 Annual Meeting in New Orleans said yesterday.

“More than 60% of medication reconciliation errors occur during transitions of care, usually on hospital admission, but then they perpetuate down the line” with each transition, such as from general hospital to psychiatric hospital, or upon discharge to home or another facility, said Paula Lester, M.D., in a presentation titled “Medication Reconciliation: Paperwork Saves Lives.” She is an associate professor of medicine at New York University (NYU) Long Island School of Medicine. “This is even more true for psychiatric patients, especially geriatric psychiatric patients because they have more frequent and longer admissions, and they have more care transitions.”

Lester added that older patients with mental illness often end up being transferred from a general hospital to a psychiatric hospital or vice versa, and that the electronic health record systems may not integrate well with one another. Furthermore, hospitalists in other specialties may be unaware of possible interactions between psychiatric medications and the medications they prescribe, she added.

Mark Shen, Pharm.D., a clinical pharmacist in care transitions at NYU Langone Hospital–Long Island, advised that psychiatrists try to use two sources of information when taking a complete medication history, such as the patient, caregiver, other physicians involved in the patient’s care, or the discharging hospital.

“One source might not be fully correct, and the other source might not be fully correct. It’s up to you to match those two lists together and come up with a list that makes sense,” Shen said.

Shen also suggested asking open-ended questions when speaking with patients, such as the following:

• What medications, including prescription, over the counter, and supplements, do you take?
• What medications do you take each day?
• What medications do you take only sometimes? For what symptoms do you take these medications?
• What medications do you take that are not pills (for example, eye drops, creams, patches, long-acting injectables)?
• What time do you take the medications
• Do you have any issues with unintended effects?

If patients do not take a medication as prescribed, psychiatrists should ask them why, Lester said.

“Sometimes there are good reasons why, [such as] side effects or they’ve taken it before and had a bad experience so they’re afraid of taking it again,” Lester said.

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

(Image: iStock/gorodenkoff)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Older Adults With Resistant Depression May Benefit From Adding Aripiprazole to Antidepressants

Older adults with treatment-resistant depression may experience greater mood improvements when aripiprazole is added to their current antidepressant regimen compared with being switched to bupropion, suggests a study in the New England Journal of Medicine. Older adults who began taking bupropion in combination with their current antidepressants experienced mood improvements as well, but they also reported more falls.

Eric Lenze, M.D., of Washington University School of Medicine in St. Louis and colleagues enrolled 619 adults aged 60 years or older with treatment-resistant depression for this two-stage trial. Treatment-resistant depression was defined as “a lack of remission of major depression after two or more trial uses of antidepressants of adequate dose and duration within the current [depressive] episode,” Lenze and colleagues wrote.

For the first stage, the participants were assigned to start taking aripiprazole in addition their existing medication, start taking bupropion in addition to their existing medication, or switch from their existing medication to bupropion for 10 weeks. Any participants who did not meet the criteria for depression remission (defined as a score of 10 or less on the Montgomery–Åsberg Depression Rating Scale) after 10 weeks were eligible to enter the second stage of the study.

For the second stage, participants were assigned to start taking lithium in addition to their existing medication or switch from their existing medication to nortriptyline for 10 weeks. One hundred twenty-five participants from stage 1 entered stage 2, while an additional 123 adults entered stage 2 directly because they were ineligible for stage 1 (most commonly because they had previously taken and failed to respond to aripiprazole and/or bupropion).

The primary outcome was the change from baseline in participants’ psychological well-being (measure of life satisfaction, positive mood, and a sense of purpose).

After the first 10 weeks, psychological well-being scores improved significantly more among adults who were in the aripiprazole-augmentation or bupropion-augmentation groups compared with those who switched to bupropion. Remission rates were 28.9% among patients in the aripiprazole-augmentation group, 28.2% among those in the bupropion-augmentation group, and 19.3% among those who switched to bupropion. In addition, aripiprazole augmentation was associated with a 40% reduced risk of falling compared with bupropion augmentation.

Participants who entered the second stage of the trial experienced similar levels of psychological improvement after 10 weeks of lithium augmentation or nortriptyline alone, with remission rates of 18.9% and 21.5%, respectively. The rates of falling between the two groups were similar.

“The low incidences of remission in both steps of the trial highlight the challenge of treating depression when previous medications have failed,” Lenze and colleagues wrote.

For related information, see the Psychiatric Services article “Predictors of CNS-Active Medication Use and Polypharmacy Among Homebound Older Adults With Depression.”

(Image: iStock/Fly View Productions)

---

How Will End of PHE Impact You? Practice Management Helpline Wants to Know

The COVID-19 Public Health Emergency (PHE) will end on Thursday, May 11. APA wants to hear from you on how this change might affect your practice and your patients. Please email the Practice Management Helpline at practicemanagement@psych.org with a short description about how the requirement to have an in-person visit with a patient to prescribe controlled substances, the requirement to have a DEA license in any state in which you are prescribing controlled substances, and/or how the controlled substances shortages are affecting your practice. By sharing your story, we may use de-identified information in our advocacy efforts. Please let us know if you would be comfortable if we contacted you for more information.

DEA Proposes Extension of Some Telehealth Prescribing Flexibilities After PHE Ends

The Drug Enforcement Administration (DEA) has proposed rules that if finalized would allow limited flexibilities for prescribing controlled substances without an in-person visit after the public health emergency (PHE) ends on May 11. The public may submit comments on the proposed rules until March 31 at the Federal Register’s website here and here.

During the PHE, a number of restrictions on the use of telehealth were waived so that patients could receive services, including mental health services, without leaving their homes. One of the major flexibilities allows psychiatrists to prescribe controlled substances to patients without an in-person visit. With the end of the PHE, some of those waivers are scheduled to be lifted.

However, on February 24, the DEA released a statement announcing proposed rules that would allow medical practitioners to continue to prescribe via telemedicine in limited circumstances. These include allowing physicians to prescribe a short-term supply (30 days) of Schedule III-V non-narcotic controlled medications and/or buprenorphine for the treatment of opioid use disorder before an in-person exam is required and allowing a referring practitioner to conduct the required in-person exam.

Among the pre-pandemic regulations that will return is a requirement that health care professionals use HIPAA-compliant messaging software for telehealth; under the PHE, physicians and other health care professionals can use popular technology, such as Skype and FaceTime, to conduct telehealth sessions.

The future of telehealth regulations after the end of the PHE is highly variable. For instance, some states and health care plans—recognizing that telehealth has now become a permanent feature of health care—may continue certain flexibilities and coverage; commercial and Medicaid payers may vary widely in their telehealth policies. APA members are urged to follow the APA telepsychiatry blog for up-to-date information about rules; they should also contact the APA Practice Management Helpline, their APA district branch, state medical board, liability insurance carrier, or other trusted resource for information about the status of telehealth coverage for their patients.

In the meantime, telehealth experts advise psychiatrists to work with their patients to begin planning now for how the end of the PHE may affect their care. “As a first step, clinicians should explain to patients that due to new changes in the law, there may be some changes in how [telehealth] versus in-person visits are offered,” John Torous, M.D., chair of APA’s Committee on Mental Health IT, told Psychiatric News. “For practices, now is a good time to make sure you understand new requirements around HIPAA-secure telehealth systems, changes in billing codes, and changes in state licensure issues that could impact which patients you can legally see via telehealth.”

For more information, see the Psychiatric News article “If You Are Treating Patients Virtually, Begin Planning Now for End of COVID-19 PHE.”

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Clinicians Offer Suggestions to Combat Harassment Directed at Gender-Affirming Care Clinics

Clinics and clinicians who provide gender-affirming care to youth have received an onslaught of threats and harassment. In a viewpoint published this week in JAMA Pediatrics, three clinicians whose institutions were recently targeted by harassment campaigns offered recommendations to support patients and clinicians in response to acts of online extremism while also optimizing safety.

In August 2022, social media posts falsely claimed that clinicians at Boston Children’s Hospital performed hysterectomies on minors. A month later, another social media attack claimed that gender-affirming care clinicians at Vanderbilt Children’s Hospital were chemically castrating minors, among other claims. Clinicians at both institutions faced threats, harassment, bomb threats, and hate speech.

“Online extremism and the purposeful spread of misinformation for political gain undermine public trust in health care,” wrote Rishub Das, B.A., of Vanderbilt University School of Medicine; Oren Ganor, M.D., M.Sc., of Boston’s Children Hospital; and Brian Drolet, M.D., of Vanderbilt University Medical Center. “[T]he ways clinicians respond to harassment and hate speech regarding the care they provide have critical impacts on health outcomes, access to care, and patient and physician safety.”

Das, Ganor, and Drolet described both reactive and proactive strategies that clinicians who provide gender-affirming care and their institutions can take to fight misinformation and protect both staff and patients.

Reactive strategies they outlined include the following:

• Make a timely institutional response to misinformation-based threats. “Issuing a clear, official statement that corrects misinformation and directs people to credible sources and evidence within the first hours of a crisis has been shown to elicit greater trust from the public,” the authors wrote.
• Create clear channels through which clinicians and other staff can request that sensitive information (such as email addresses) be deleted from department websites to minimize harassment. But refrain from removing entire web pages or patient resources, even temporarily, so that patients continue to have access to online resources about health care options.
• Connect health care workers who receive online threats to law enforcement for guidance on protecting themselves and their families.
• Conduct patient appointments via telehealth if clinical spaces are at risk.

Additionally, the authors described numerous proactive strategies, including the following:

• Gender-affirming care clinicians should feel empowered to correct misinformation and provide expert medical advice to their peers and other individuals. Further, hospitals should protect these clinicians with internal and public statements of support.
• Systems should be implemented through which health care workers can report and document harassment.
• Professional organizations should continue to address misinformation through evidence-based recommendations and statements, particularly because these organizations can speak on behalf of health care professionals and limit identification of individual clinicians.
• Media relations teams can play an integral role by aggregating and distributing reports of online harassment to law enforcement and reporting individual posts and users.

“Online extremism has caused substantial distress and trauma in health care professionals, patients, and their families,” the authors concluded. “If online extremism in health care is not systematically addressed, clinicians may be unwilling to provide and train in [gender-affirming care], further limiting health care access and leading to worse physical and mental health outcomes for [transgender and gender-diverse] individuals.”

For related information, see the Psychiatric News article “Gender-Affirming Clinics Subject to Onslaught of Threats, Harassment.”

(Image: iStock/Cunaplus_M.Faba)

---

How Will End of PHE Impact You? Practice Management Helpline Wants to Know

The COVID-19 Public Health Emergency (PHE) will end on Thursday, May 11. APA wants to hear from you on how this change might affect your practice and your patients. Please email the Practice Management Helpline at practicemanagement@psych.org with a short description about how the requirement to have an in-person visit with a patient to prescribe controlled substances, the requirement to have a DEA license in any state in which you are prescribing controlled substances, and/or how the controlled substances shortages are affecting your practice. By sharing your story, we may use de-identified information in our advocacy efforts. Please let us know if you would be comfortable if we contacted you for more information.

Pets Have Overwhelming Positive Impact on Mental Health, APA Poll Finds

A strong majority of Americans who have pets regard their pets as part of the family, and most feel that their pets have a positive impact on their mental health, according to the latest findings from APA’s Healthy Minds Monthly Poll.

“People recognize that there is something special about bonds between humans and their pets,” said APA President Rebecca Brendel, M.D., J.D., in a news release. “The animals we bring into our lives and our families play many roles from non-judgmental companions that we love to key partners in reducing our stress and anxiety. Americans clearly recognize that our relationships with our pets can have noticeable benefits for our overall mental health.”

The Healthy Minds Monthly Poll was fielded by Morning Consult from February 10 to 12, with a sample of 2,200 adults. The margin of error was plus or minus two percentage points.

Among the survey respondents, 50% said they had dogs, 35% said they had cats, and 31% said they did not have any pets. Roughly 3% said they had other pets such as birds, fish, turtles, or others.

Among pet owners, 88% said they consider their pets to be part of the family. Furthermore, 86% said their pets have a mostly positive impact on their mental health, including 87% of dog owners, 86% of cat owners, and 62% of other pet owners.

Those who said their pets positively affect their mental health said their pets do so in the following ways:

• Help reduce stress and anxiety (69%).
• Provide unconditional love and support (69%).
• Offer companionship (69%).
• Provide a calming presence (66%).
• Are true friends (63%).

Cat owners were more likely than dog owners to say their pets offer companionship, provide a calming presence, and help reduce stress and anxiety. Dog owners were twice as likely as cat owners to say their pet encourages them to be physically active.

When asked how much they worried about various stressors related to pets, 71% said they worried about their pets aging or passing away, 66% worried about their pet’s health conditions, 58% worried about health care expenses for their pet, and 56% worried about making travel-related arrangements for their pet.

Among respondents who did not own pets, 29% said they could not afford a pet, 22% said they did not have time to take care of a pet, and 11% said they were mourning a deceased pet.

“The benefits of pet ownership to many Americans seem to outweigh the stressors,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “If pets are not an option for your family, but you are seeking that connection, there are many opportunities to volunteer with animals that may also benefit your life.”

APA invites you to share the word and pictures of your pets this month on social media with the hashtag #Paws4MentalHealth. Learn more.

(Image: iStock/GlobalP)

Moderated Online Postpartum Group May Help Moms With Postpartum Depression

Postpartum depression—which can disrupt the forming of bonds between a mother and child—is estimated to impact between 12% and 24% of women following the birth of a child. A study in Pediatrics now suggests that women with postpartum depression who participate in a parenting program via Facebook may experience more rapid symptom improvements than those who do not participate in such a program. However, participation in the parenting program via Facebook may not impact parenting stress or responsiveness.

“Our study is among the first to examine the effects of a parenting program administered through a social media platform,” wrote James P. Guevara, M.D., M.P.H., of Children’s Hospital of Philadelphia and colleagues. “Social media may be an important platform to provide parenting support for women with [postpartum depression] symptoms when in-person participation is difficult … .”

Guevara and colleagues recruited mothers over age 18 years who screened positive for minor to moderate depression symptoms on the Edinburgh Postnatal Depression Scale (EPDS=10-19). To be included in the study, mothers were also required to read and write in English and have access to a smartphone or tablet. Seventy-five women were randomized into one of two groups for the three-month study: One group was invited to participate in the Parenting With Depression secret Facebook group and an online cognitive-behavioral therapy (CBT) program called MoodGym; the other group was invited to participate in MoodGym only. Participants in both groups also received a list of community mental health resources.

The Parenting With Depression intervention consisted of eight weekly topics (for example, psychoeducation and parent-child interactions), released in three separate posts to the Facebook group over the course of the week. The posts included videos, narrated PowerPoint presentations, and written materials. Participants were encouraged to “friend” other group members and respond to their posts. A facilitator reviewed posts, commented on posts, and provided tips for group members.

Study participants were evaluated monthly using the EPDS. Additionally, at the start of the study and again three months later, the participants were assessed on their levels of stress, parent-child interactions, parenting self-esteem, and more. Women whose EPDS scores exceeded 20 or who reported suicidality were contacted by a psychologist to assess risk; those deemed to be at high risk were referred for further care and were excluded from further participation in the study.

Participants assigned to the Facebook group intervention experienced a more rapid decline of depressive symptoms than those assigned to online CBT only, with differences between the two groups emerging at one month. While both groups demonstrated what the authors termed “modest improvements in responsive parenting,” there was no difference between the two groups on this measure over time.

Guevara and colleagues noted that the data were collected during “the height of the COVID-19 pandemic,” which may have led to less engagement with the Facebook group intervention. “Only 9 (28%) of the intervention group participants viewed and posted comments to at least one-third of the weekly content,” they wrote. “[W]e found that women who engaged this much had greater improvements in responsive parenting than those with less engagement. This suggests that passively viewing content is not as helpful as engaging in the exercises and interacting with other participants and the study facilitator.

They concluded, “[G]reater attention to participant engagement and ensuring and accounting for mental health treatment are needed to improve parenting outcomes with social media-based parenting programs.”

For related information, see the Psychiatric News article “Women With Postpartum Depression May Benefit From One-Day Online Workshop.”

(Image: iStock/lakshmiprasad S)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!