Climate Change Significantly Affects Mental Health, Especially Among Younger Adults

More than half of adults (55%) believe climate change is impacting Americans’ mental health, while four in 10 adults say they have personally experienced effects on their mental health, according to a new APA Healthy Minds poll, conducted by Morning Consult on behalf of APA.

More than one-third of poll respondents (35%) worry about climate change on a weekly basis, indicating that for many, this is a persistent source of stress.

Among 10 areas of life possibly affected by climate change, respondents rated their own mental health as the most impacted. A total of 18% said climate change was having a significant impact on their mental health, with 26% saying it was having somewhat of an impact. Other categories noted by at least 40% of respondents included “access to food,” “your physical health,” and “your family.”

The data also highlighted generational and parental divides in perceptions of climate change’s mental health impact. Younger adults ages 18 to 34 were significantly more likely than those 65 or older to report that climate change is affecting their personal mental health (65% versus 30%). Parents (52%) were significantly more likely than non-parents (42%) to report climate change is currently impacting their mental health.

These patterns suggest that those with longer perceived futures—due to either age or the responsibility of raising children—may feel more urgency and emotional burden around climate change, according to an APA statement released in response to the survey.

“As psychiatrists, we see how climate distress and its associated negative emotions affect our patients in various ways, such as grief after a natural disaster or anxiety due to the threat of climate change,” said APA President Theresa Miskimen Rivera, M.D. “These impacts are real; if you’re feeling them, know you’re not alone.”

“Eco-anxiety,” sometimes called climate anxiety, is a chronic fear or worry about the environment and its state, often stemming from concerns about climate change and its impact. Learn more about the connection between climate change and mental health on APA’s website (in English and Spanish).

The Healthy Minds Poll was conducted on March 18-20, 2025, among a sample of 2,208 adults ages 18+ in the United States. Results have a margin of error of plus or minus 2 percentage points.

For related information, see the Psychiatric News article, “What Every Psychiatrist Should Know About the Climate Crisis.”

Also, APA members can check out this month’s free CME course: “Apocalypse Now! Climate Change and its Impact on the Practice of Psychiatry.”

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Screentime Addictive Behaviors in Children Common, Tied to Later Suicidality

There are distinct trajectories of addictive use of social media, mobile phones, and video games in childhood to early adolescence that are linked to suicidality and worse mental health outcomes, according to a study published today in JAMA.

“While most existing research has focused on total screen time, emerging evidence suggests that addictive screen use may be a more salient risk factor for suicidality and mental health in youths,” wrote Yunyu Xiao, Ph.D., of Weill Cornell Medicine, and colleagues. “However, addictive use trajectories among youths have not been well characterized, and how they may relate to suicide-related and mental health outcomes remains largely unknown.”

Xiao and colleagues analyzed data from 4,285 youth enrolled in the longitudinal Adolescent Brain Cognitive Development study. The youth, who were 9 to 10 years old at baseline, completed self-reported surveys on addictive use of social media, mobile phones, and video games (frequency of compulsive use, difficulty disengaging from use, and distress levels when not using) at follow-up years two through four. At year four, children and parents completed assessments of suicidal ideation and behaviors, and parents reported their child’s internalizing (e.g., anxiety, depression) and externalizing (ego, aggression, rule-breaking) symptoms.

The researchers found that nearly half of the participants had high addictive use scores for mobile phones throughout the follow-up, and more than 40% had a high addictive use trajectory for video games. Only 10% of participants had a high addictive use trajectory for social media, but another 31% had addictive use scores that increased over time; 25% of participants also reported an increasing addictive use trajectory for mobile phones.

For both social media and mobile phones, the high and increasing addictive use trajectories were associated with two to three times greater risk of suicidal behaviors and suicidal ideation at year four compared with the low addictive use trajectory. High and increasing addictive use trajectories for social media were further associated with higher internalizing and externalizing symptom scores.

For video games, the high addictive use trajectory was associated with greater risks of suicidal behaviors and suicidal ideation as well as higher internalizing symptoms scores compared with the low addictive use trajectory.

The results underscore “the potential importance of repeated assessment of addictive use of social media and mobile phones among children entering adolescence,” the researchers wrote. “In contrast, video game addictive use followed two trajectories, high and low, which were stable over time, potentially allowing earlier identification of risk without repeated assessment.”

For related information, see the Psychiatric News article “Ask Young Patients About Social Media Use.”

Proposed Medicaid Cuts Would Create Barriers to Care for Millions and Cost Lives

Provisions in H.R. 1 (also known as the One Big Beautiful Bill Act) that aim to cut Medicaid spending threaten several aspects of health—including mental health, according to an analysis in the Annals of Internal Medicine.

Adam Gaffney, M.D., M.P.H., of Cambridge Health Alliance and Harvard Medical School, and colleagues analyzed key provisions of the bill, including:

• Medicaid work requirements mandating that states impose work requirements on nondisabled adults, with specific exemptions
• Reduction of Medicaid provider taxes, which help fund Medicaid by increasing federal assistance via the Federal Medical Assistance Percentage mechanism
• Repeal of a Biden administration rule for Medicaid eligibility determination that simplified enrollment and improved state processes for eligibility determinations (e.g., requiring that states make more efforts to contact beneficiaries before disenrolling them)

Gaffney and colleagues projected the likely effects of these provisions using the House of Representatives Budget Committee’s estimates of savings, analyses by the Congressional Budget Office (CBO), and peer-reviewed studies of the impact of past Medicaid expansions and contractions. After accounting for interactions between provisions, they found that H.R. 1 would:

• Decrease the number of insured adults by 6.8 million
• Decrease the number of adults who self-report good health by 909,720
• Decrease the number of adults who got all needed medical care in the past six months by 1.6 million
• Decrease the number of adults who got all needed medications in the past six months by 1.3 million
• Decrease the number of adults who did not screen positive for depression in the past two weeks by 533,520

Using five different quasi-experimental models, Gaffney and colleagues projected that the bill’s combined Medicaid spending reductions would lead to between 8,241 and 24,604 medically preventable deaths each year.

They added that these estimates may be conservative because they rely on CBO’s assumption that states would replace half of the federal funding shortfall, which would necessitate politically difficult tax increases or cuts to other programs.

“Today, despite its many shortcomings, Medicaid enjoys wide support from the electorate and serves as the foundation of the nation’s health care safety net,” Gaffney and colleagues wrote. “The cuts under consideration, intended to offset the cost of tax cuts that would predominantly benefit wealthier Americans, would strip care from millions and likely lead to thousands of medically preventable deaths.”

For related information, see the Psychiatric News article “Lawmakers Consider Massive Medicaid Cuts.”

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Cannabis Legalization Associated With Increase in Opioid Use Disorder

Legalization of cannabis was associated with small but significant increases in opioid use disorder (OUD) between 2005 and 2022 among patients receiving care in the Veterans Health Administration (VHA), according to a report in JAMA Health Forum. During the same period, states that did not legalize cannabis saw a decrease in OUD.

Zachary Mannes, Ph.D., of Columbia University Irving Medical Center, and colleagues wrote that the results do not support cannabis legalization as a means of reducing the burden of OUD. “These are timely considerations given that the U.S. government has considered cannabis policy reform for the VHA.”

Using VHA electronic health records, the researchers examined yearly state-level rates of OUD among more than 3 million patients who had at least one VHA encounter from January 2005 to December 2022. Patients were considered positive for OUD if they received one or more OUD diagnoses during an outpatient or inpatient encounter at any VA health care facility each year.

Each patient’s state of residence was categorized yearly as having no cannabis laws, medical cannabis laws (MCL), or recreational cannabis laws (RCL). From 2005 to 2022, 37 states and Washington, D.C., enacted an RCL and/or an MCL. (All states with an RCL also enacted an MCL.)

In states that enacted MCL only, OUD prevalence increased among VHA patients from 1.13% in 2005 to 1.19% in 2022, while OUD prevalence decreased from 1.12% to 1.06% in states without cannabis laws. OUD prevalence remained stable in states that enacted an MCL and then an RCL.

Among patients with chronic pain, MCL and RCL enactment was associated with a 0.08% and 0.13% increase in OUD prevalence, respectively. The largest change in OUD prevalence was seen among adults ages 65 to 75 years with chronic pain following RCL enactment—a 0.23% increase. RCL was also associated with a 0.12% increase in OUD prevalence among older adults without chronic pain.

“Cannabis use may be associated with an increased risk of consuming other substances, either by providing more opportunities through access to the same illicit markets or peers who use drugs, or by lowering the threshold for addiction to other substances, including opioids,” the researchers wrote. “Our results should encourage careful regulation of cannabis distribution following legalization and monitoring of OUD symptoms among patients residing in MCL/RCL states, alongside concerted surveillance efforts in older adults who may be particularly susceptible to cannabis and opioid use risks.”

For related information, see the Psychiatric News article “Medical Cannabis Laws Do Not Cut Opioid Death Rates, Study Finds.”

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Stimulant Prescription Via Telehealth Does Not Increase Substance Misuse Risk, Studies Find

Patients who are prescribed stimulants for attention-deficit/hyperactivity disorder (ADHD) via telehealth do not have a greater risk of developing a substance use disorder (SUD) compared with those who receive prescriptions in person, according to a study published this week in The American Journal of Psychiatry (AJP). Patients prescribed via telehealth did have a higher risk of developing a stimulant use disorder, but the authors suggested this may be due to confounding factors.

Vinod Rao, M.D., Ph.D., of Massachusetts General Hospital, and colleagues used electronic health record data to identify 7,944 patients ages 12 and older (57% female, 81% White) who received an initial stimulant prescription for ADHD via telehealth (54% of total) or in-person care (46%) between March 2020 and August 2023.  Overall, 432 patients developed a stimulant use or other SUD.

The patients who initially received their stimulant prescriptions via telehealth did not have a significantly higher risk for developing an SUD. However, those patients were six times more likely than those who received their initial prescription in-person to develop a stimulant use disorder after adjusting for covariates.

“While this finding may be spurious, it may also suggest a bias toward those receiving telehealth care being at higher risk specifically for [stimulant use disorder],” Rao and colleagues wrote. “It may be that in the present analyses, unmeasured patient characteristics associated with a greater likelihood of engaging in telehealth over in-person care (e.g., difficulty accessing reliable transportation) also produce a bias toward the development of [stimulant use disorder].”

This conclusion was supported by a second AJP study published the same day in which Y. Nina Gao, M.D., Ph.D., and Mark Olfson, M.D., M.P.H., of Columbia University, examined data from 63,795 adults who reported having at least one health care visit in the last year in the 2021-2022 National Survey of Drug Use and Health. The survey included information on past-year prescription opioid, benzodiazepine, or stimulant misuse, as well as whether the participants spoke with a health practitioner via telehealth or in-person.

While the unadjusted odds of past-year misuse of prescription opioids, benzodiazepines, and stimulants were between 25% and 46% higher among respondents reporting telehealth use, this association was no longer significant for any of these substances after controlling for participants’ history of misuse of that substance.

“These findings bear on an ongoing policy debate balancing the desire to maintain increased patient access to care while minimizing the potential harms of controlled substance prescribing,” Gao and Olfson wrote. “Although differences in average risk between in-person and telehealth cohorts have sometimes been interpreted negatively as ‘doctor shopping’ (i.e., differential selection across providers), it is important to recognize that some patients with higher risk for substance misuse also struggle to access appropriate general and behavioral health care.”

For related information, see the Psychiatric News Alert “One in 10 Patients Starts Buprenorphine Treatment for OUD via Telehealth.”

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Care Management Improves Outcomes for Adults With First-Time Psychiatric Admission

A brief care management intervention offered to adults following their first psychiatric hospitalization can reduce readmission rates while increasing rates of outpatient aftercare, reports a study published today in Psychiatric Services.

“Although inpatient service is considered a poor outcome of behavioral health care, it provides an opportunity for care management intervention to address medication access, discharge and recovery planning, and connection to aftercare and other resources for continuity of care,” wrote Shari L. Hutchison, M.S., P.M.P., of Community Care in Pittsburgh, and colleagues

While Community Care—a nonprofit behavioral health managed care organization that is part of the University of Pittsburgh Medical Center Insurance Services Division—had already been offering a care management program to Medicaid-enrolled adults with multiple psychiatric admissions, the organization tested an expansion of the intervention to individuals with no prior inpatient history.

Hutchison and colleagues identified 5,140 Medicaid-enrolled adults across 71 facilities in Pennsylvania who had a first-time psychiatric admission in 2022 or 2023. Of this group, 48% received the 10- to 20-minute intervention from a trained care manager, while the remainder did not for various reasons (e.g., coordination issues, early discharge).

Overall, the 30-day psychiatric readmission rate was 9% among those who received the intervention and 11% among those who did not. After adjusting for differences in demographic characteristics and diagnoses between the groups, the researchers calculated that not receiving the intervention increased the odds of readmission by 28%. In addition, 26% of adults who received the care management intervention went to an outpatient appointment within 30 days of discharge, compared with 21% of those who did not.

The reduced readmission rate led to cost savings, with direct expenditures totaling $2.3 million for the intervention group, compared with $2.8 million for the comparison group. The researchers noted that further cost savings from providing this intervention early in an individual’s illness trajectory could be realized in the long term.

“[S]ervices are often prioritized for those with the highest need and costs, such as crisis or residential services targeted to individuals with multiple psychiatric admissions,” the researchers wrote. “Our findings support the necessity of having a diverse array of services within a behavioral health system of care.”

For related information, see the Psychiatric Services article “Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis.”

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Weekly Pill May Replace Daily Medications for Patients With Schizophrenia

A single, long-acting oral capsule can provide patients with schizophrenia or schizoaffective disorder with a stable dose of medication for one week, according to findings of an open-label study from Lyndra Therapeutics published yesterday in Lancet Psychiatry.

“One of the biggest obstacles in the care of people with chronic illnesses in general is that medications are not taken consistently. This leads to worsening symptoms, and in the case of schizophrenia, potential relapse and hospitalization,” study co-author Leslie Citrome, M.D., M.P.H., of New York Medical College, said in a news release. “Having the option to take medication by mouth once a week represents an important option that can assist with adherence for the many patients who would prefer oral medications versus injectable formulations.”

Citrome and colleagues recruited 83 patients with schizophrenia or schizoaffective disorder from five sites across the United States (25% female, average age 49 years, 81% Black or African American). Before starting the open-label study, participants were given daily, immediate-release risperidone (an antipsychotic) for one week. They then received five of the Lyndra Therapeutics devices, each loaded with a weekly dose of risperidone—either 15 mg or 45 mg.

The device—composed of various polymers—has six arms that are folded inside a capsule about the size of a multivitamin. Once it reaches the stomach, the capsule dissolves and the arms spring out. The device is then too large to exit the stomach, so it remains freely floating and slowly releases risperidone. After about a week, the arms break off and the device remnants pass through the digestive tract.

The participants had risperidone levels at or above the minimum therapeutic concentration across the five-week dosing period relative to corresponding daily dose, and well below the peak concentrations of immediate-release risperidone. This suggests stable drug delivery that may reduce the risk of extrapyramidal side effects, the authors wrote. Similarly, participants’ symptoms remained stable throughout the study period, as assessed with the Positive and Negative Syndrome Scale.

There were some gastrointestinal-related adverse events (such as reflux or constipation) during the first week in which participants took the device, but those decreased over time. Females were more likely to report gastrointestinal-related adverse events than males.

“This really demonstrates … what we had hypothesized a decade ago, which is that a single capsule providing a drug depot within the GI tract could be possible,” study co-author Giovanni Traverso, Ph.D., of the Massachusetts Institute of Technology, said in the news release.

For related information, see the Psychiatric News article “Studies Point to Benefits of Early Treatment With Long-Acting Antipsychotics.”

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Noninvasive Electrical Stimulation Improves Fibromyalgia Symptoms

An at-home electrical stimulation intervention, coupled with exercise and pain education, can significantly reduce fibromyalgia-associated pain, according to results of a clinical trial published yesterday in JAMA Network Open.

Wolnei Caumo, M.D., Ph.D., at the Universidade Federal do Rio Grande do Sul in Porto Alegre, Brazil, and colleagues enrolled 112 adult women ages 18 to 65 with fibromyalgia for their clinical study. Half of the women received a home-based transcranial direct current stimulation (tDCS) headset, which has the anode situated over the left dorsolateral prefrontal cortex (DLPFC) and the cathode placed over the right DLPFC and continuously delivers 2 mA of current. The protocol involved five 20-minute stimulation sessions each week for four weeks.

The other half of the participants received a sham headset that appeared the same but only delivered current for 30-second segments at the beginning, middle, and end of the 20-minute session. All participants also received a chronic pain-management package that included a motivational interview, a suite of educational videos, and an exercise program. At the trial’s start, all women received one sham stimulation session to see if they were prone to experiencing a placebo response.

The women reported their Multidimensional Pain Interference Index (MPII) each week during treatment and again at a three-month follow-up. The MPII measures levels of pain across seven daily activities (general activity, walking, work, mood, enjoyment of life, relationships, and sleep).

After four weeks, MPII scores dropped significantly more in the tDCS group than the sham group across the treatment period and follow-up, with slightly greater decreases seen in placebo responders (49.3% reduction) than non-responders (40.6% reduction). Overall, 62.5% of women in the tDCS group cut their MPII scores in half or more, compared with 37.5% of women in the sham group. Further, nearly 85% of women in the tDCS group reported feeling moderately better or much better after four weeks.

The treatment benefits persisted at the three-month follow-up, though overall MPII scores did rise slightly.

For related information, see the American Journal of Psychiatry article “Spaced Transcranial Direct Current Stimulation for Major Depression” and the accompanying editorial “Spaced Transcranial Direct Current Stimulation for Depression: The Road Less Traveled.”

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Frequent Mental Distress Varies by Occupation

People who work in the arts, design, entertainment, sports, and the media have a higher prevalence of frequent mental distress than those in other fields, according to a study published in JAMA Network Open.

Aaron L. Sussell, Ph.D., of the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health, and colleagues analyzed data from the 2015 through 2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys, which included an optional module on industry and occupation. Their sample included 536,279 employed individuals, among whom 469,126 reported their industry or occupation.

The researchers looked at three key measures of mental health among the participants:

• Lifetime depression, defined as a positive response to the BRFSS question “Has a doctor, nurse, or other health professional ever told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?”
• Mentally unhealthy days (MUD), based on responses to the BRFSS question “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”
• Frequent mental distress, defined as a MUD score of 14 or higher.

Overall, 14.2% of participants reported lifetime depression and 9.6% reported frequent mental distress.

To calculate adjusted prevalence ratios for frequent mental distress among various occupations, the researchers chose workers in transportation and material moving as a reference group. The median lifetime depression prevalence in this group is near the median of the occupational groups in the study.

Compared with workers in the reference group, workers in the arts, design, entertainment, sports, and media had 1.32 times the prevalence of frequent mental distress. Workers in food preparation and serving (1.20 times), health care support (1.19 times), and sales and related occupations (1.13 times) also had statistically higher prevalence of frequent mental distress compared with the reference group. Workers in community and social services had the highest adjusted prevalence of depression compared with the reference group (1.47 times), followed by workers in the arts, design, entertainment, sports, and media (1.34 times).

“Workplaces can play a role in identifying and reducing psychosocial hazards and promoting workers’ mental health,” the researchers wrote. “More research is needed to evaluate work-related factors and workplace intervention effectiveness.”

For related information, see the Psychiatric News article “New Instrument Developed to Assess Workplace Depression.”

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Majority of Callers Say 988 Lifeline Saved Their Lives

Almost all the callers who reached out to the National Suicide Prevention Lifeline (now the 988 Suicide and Crisis Lifeline) say their calls helped them, with 88% saying that it stopped them from killing themselves, a study published in Suicide and Life-Threatening Behavior found.

“Suicide continues to be an alarming public health problem in the United States,” wrote Madelyn S. Gould, Ph.D., M.P.H., of Columbia University, and colleagues, noting that age-adjusted suicide rates increased by 30% from 2002 to 2022. “The establishment of the 988 Suicide and Crisis Lifeline is a leading response to this national crisis.”

Gould and colleagues interviewed 437 adults (59% female, 72% between the ages of 18 and 34) who called the Lifeline between April 15, 2020, and August 15, 2021 (the network’s dialing code became 988 in 2022). The callers were identified as suicidal based on their Lifeline counselors’ clinical risk assessments. Callers were interviewed about two weeks after their initial calls to the Lifeline. Interviewers assessed the callers’ demographics, clinical characteristics (including history of suicidal ideation and suicide risk at the time of the call), and perceptions of counselor practices and their calls’ outcomes.

Over half of the callers reported being at least somewhat likely to act on their suicidal thoughts at the time of their call. However, nearly 72% of callers reported that calling the Lifeline helped them a lot, and a further 26% said it helped them a little. Asian callers were significantly less likely than other races to say their call helped them a lot (just 42%), which the researchers said might have been due to increased discrimination faced by Asian Americans during the COVID pandemic, when the interviews took place.

Additionally:

• About 59% of callers said they’d had no thoughts of killing themselves since the call.
• Callers nearly universally said their counselors engaged in Lifeline best practices (fostering engagement/connection, collaborative problem-solving, and safety/assessment management).
• Callers’ perceptions of their counselors’ behaviors were significantly and clinically meaningfully associated with positive call outcomes.

“While it might be expected that callers would rate counselor behaviors favorably on calls they found helpful and effective, it is notable that favorable ratings of the assessed domains of counselor behavior were also associated with lower rates of recurrence of suicidal thoughts,” the researchers wrote. “[O]ur study provides empirical evidence for the effectiveness of Lifeline’s telephone crisis services from the perspective of callers themselves.”

For related information, see the Psychiatric News article “988 Finally Connects Callers to Local Resources.”

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TMS May Be More Effective With Symptom Provocation for OCD, Nicotine Dependence

Individuals with obsessive-compulsive disorder (OCD) or nicotine dependence may have an improved response to transcranial magnetic stimulation (TMS) when their symptoms are provoked through audio and/or visual cues, according to a report published yesterday in JAMA Psychiatry.

Daniel Bello, B.S., of Vanderbilt University Medical Center, and colleagues noted that “provoking symptoms may shift the brain into a state that is more susceptible to the effect of TMS.” For example, the FDA-cleared protocol for smoking cessation involves a five-minute procedure where patients imagine their greatest craving trigger, listen to a recording instructing them to handle a cigarette and lighter, and then view smoking images.

However, most trials using provocation have been small, and there have been no head-to-head comparisons of TMS with or without provocation, the researchers continued. “A major question for TMS treatment remains: does brain state affect clinical response?”

Bello and colleagues compiled data from 71 randomized clinical trials evaluating TMS in adults with OCD (n=44) or nicotine dependence (n=27)—either with or without symptom provocation. Approved TMS protocols for depression do not involve symptom provocation and were not included in the analysis.

For OCD studies, active TMS was associated with better clinical response (improvement on the Yale-Brown Obsessive-Compulsive Scale) than sham stimulation both with and without symptom provocation, though the effect size was larger in trials with provocation (0.51 versus 0.29). For nicotine dependence, however, active TMS was statistically associated with better clinical response (cravings, dependence severity, and/or cigarettes smoked) than sham stimulation only when used with symptom provocation (effect size of 0.56).

“Additional research is warranted to more accurately estimate any added benefit of symptom provocation,” Bello and colleagues wrote. “If beneficial, using symptom provocation with TMS protocols would be broadly accessible and could be readily implemented in TMS clinics across the globe.”

However, they cautioned that provoking symptoms is often uncomfortable for both the patient and the TMS technician and could cause some study participants to drop out or relapse. “Therefore, it is worth empirically determining if symptom provocation is safe and effective before it is applied universally in TMS protocols,” the researchers wrote. “Symptom provocation should be used where effective but avoided when there is no clear benefit.”

For more information, see the Psychiatric News article “From Heretical Idea to Mainstream Psychiatry: Brain Stimulation Has Ridden a Wave.”

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Researchers Look to Unlock GLP-1 Drugs’ Potential in Psychiatry

Researchers are exploring the potential of glucagon-like peptide 1 (GLP-1) receptor agonists to treat neuropsychiatric disorders such as cognitive dysfunction and alcohol use disorder, according to a panel held last week at the American Society of Clinical Psychopharmacology’s annual meeting in Phoenix.

GLP-1 receptor agonists such as semaglutide and tirzepatide mimic the effects of GLP-1, a peptide produced in the intestinal mucosa, and are known for leading to remarkable weight loss in both the general population and individuals with antipsychotic-induced weight gain.

GLP-1 medications do not increase resting metabolic rate or promote physical activity, but “they do have a very robust signal in reducing caloric intake,” explained Rodrigo Mansur, M.D., Ph.D., research scientist, psychiatrist at the University Health Network, and assistant professor of psychiatry at the University of Toronto. “Patients tell us, ‘They reduce feelings of hunger, they promote feelings of satiety.’”

These medications are believed to modulate the rewarding aspects of food—and potentially other substances. A recent Phase 2 trial found that weekly low-dose semaglutide significantly reduced the amount of alcohol consumed by adults with alcohol use disorder during a self-administration task taken after four weeks of treatment, according to panelist Christian Hendershot, Ph.D., a professor of population and public health sciences at Keck School of Medicine at the University of Southern California, who conducted the trial with colleagues.

Research on GLP-1 medications in animal models suggest the compounds also have neuroprotective and anti-inflammatory actions, which has led to expanded research on their potential to treat neuropsychiatric disorders, said Greg Nigel, Ph.D., chief of the drug design and development section at the Intramural Research Program at the National Institute on Aging. GLP-1 receptors are found throughout the brain, and studies are showing they may prove valuable in a host of neurodegenerative disorders that are prevalent in late life, such as Parkinson’s and Alzheimer’s disease.

Mansur discussed a recent randomized trial that he and colleagues undertook to explore semaglutide’s potential for improving executive function in individuals with major depressive disorder (MDD), 80% of whom had a lifetime history of suicidality. Over the 16-week trial, Mansur and colleagues found no difference in executive function scores between the semaglutide and placebo groups. However, the researchers did find a statistical improvement in global cognition for semaglutide compared with placebo—suggesting it may work in other cognitive domains.

For related information, see the Psychiatric News article “Award Winner Describes Efforts to Improve Cognition in People With Bipolar Disorder.”

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Just a Third of SUD Treatment Facilities Offer Perinatal Programs

Less than one-third of facilities that offer treatment for substance use disorder (SUD) or combined SUD and mental health disorders offer a perinatal program, a study in the Journal of Substance Use and Addiction Treatment has found.

Brooke N. Lombardi, Ph.D., M.S.W., of the University of North Carolina at Chapel Hill, and colleagues analyzed data from the 2022 National Substance Use and Mental Health Services Survey, an annual survey of all known public and private SUD and mental health treatment facilities in the United States. The sample consisted of 6,995 facilities providing only SUD treatment (SUD-only) and 9,134 facilities offering combined SUD and mental health treatment.

Overall, only 32.7% of SUD-only facilities and 31.1% of combined facilities reported offering a program or group that is specifically tailored for pregnant/postpartum women.

“While these percentages are relatively low, they represent an increase from those reported in previous research, suggesting that the availability of these essential programs may be growing,” Lombardi and colleagues wrote.

Services that were considered under-provided at these facilities included:

• Detoxification (31.9% of SUD-only, 24.3% of SUD and mental health)
• Integrated primary care (20.9% of SUD-only, 38.4% of SUD and mental health)
• Childcare (11.4% of SUD-only, 7.9% of SUD and mental health)
• Beds for children (8.8% of SUD-only, 4% of SUD and mental health)

However, the researchers noted that more than half of treatment facilities provided other services identified in prior research as particularly important for the perinatal population, including:

• Assistance with accessing social services (80.9% of SUD-only, 80.2% of SUD and mental health)
• Telehealth (75.4% of SUD-only, 87% of SUD and mental health)
• Trauma-related therapy (69.9% of SUD-only, 90.5% of SUD and mental health)
• Transportation assistance (52.2% of SUD-only, 56.3% of SUD and mental health)

Available services were primarily offered in outpatient settings, with less than 25% of facilities providing residential services and less than 10 % offering inpatient care.

“Effective care for perinatal SUDs and [mental health disorders] must extend beyond the provision of behavioral health treatment alone,” the researchers wrote. “To promote the health of both parents and children, facilities must also provide essential medical services such as integrated primary care and detoxification. Additionally, increasing the availability of childcare services and accommodations for clients’ children is crucial for maintaining the integrity of the parent-child relationship.”

For related information, see the Psychiatric News article “It Takes a Village: Mothers With SUDs Often Lack Support in Getting Treatment.”

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ACT-Based Group Therapy Improves Management of Comorbid Asthma and ADHD

A group intervention based on acceptance and commitment therapy can help parents of children with comorbid asthma and attention-deficit/hyperactivity disorder (ADHD) build resilience and self-efficacy—leading to better health outcomes for the children in the long term. These findings were published today in JAMA Pediatrics.

Yuen Yu Chong, Ph.D., of the Chinese University of Hong Kong, and colleagues enrolled 118 parents who had a child between ages 3 and 11 with a diagnosis of asthma and ADHD. Half the parents received usual asthma care, which included regular follow-ups, one group educational session on asthma management, and referrals for ADHD services. The other half received usual care along with six weeks of acceptance and commitment therapy for parenting in asthma management (ACT-PAM); this small-group therapy taught parents how to make action plans to manage their child’s asthma and ADHD using principles such as acceptance, mindfulness, and positive parenting.

Twelve months after the intervention ended, the parents who received ACT-PAM—and their children—showed significant improvements in a variety of measures. Children in the ACT-PAM group had about 67% fewer unscheduled health care visits for asthma exacerbations on average compared with the usual care group (0.5 versus 1.3). “While modest, this reduction is clinically meaningful, particularly for children with ADHD, who face exacerbation risk due to attentional and behavioral challenges,” the researchers wrote.

Parents in ACT-PAM also reported greater reductions in their child’s ADHD symptoms than the usual care group, as well as greater reductions in their own psychological inflexibility and greater confidence in managing their child’s asthma.

“Integrating positive parenting with ACT provided a holistic intervention that improved asthma management, behavioral outcomes, and parental resilience, which are often neglected in traditional single-diagnosis asthma care,” Chong and colleagues wrote. Further, “ACT helped parents shift from experiential avoidance to values-based caregiving, indirectly improving child ADHD outcomes.”

For related information, see the American Journal of Psychotherapy article “Acceptance and Commitment Therapy for Posttraumatic Psychopathology: A Group-Based Telehealth Intervention.”

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Digital CBT Intervention May Improve Insomnia, Depressive Symptoms

Patients with depression and insomnia showed significant improvements after receiving a digital cognitive behavioral therapy (CBT) intervention aimed at treating insomnia. The findings were published this week in Depression and Anxiety.

“Around 85% of patients with depression fulfill the criteria for insomnia disorder, while 93% report experiencing at least some insomnia symptoms, such as difficulties falling or staying asleep,” wrote Jennifer Schuffelen, Ph.D., of Heinrich Heine University in Düsseldorf, Germany, and colleagues.

Schuffelen and colleagues recruited 140 adults (86% female, average age 40 years) with both insomnia disorder and depression. Most participants either were receiving treatment for their depression (psychotherapy or medications) or had received treatment in the past. All participants received care as usual, but half were randomized to also receive digital CBT for insomnia for 12 weeks, while the rest were placed on a waiting list.

The self-guided digital intervention included 10 core modules based off elements of face-to-face CBT, such as psychoeducation, relaxation techniques, bedtime restriction, and cognitive therapy.

Participants who received the intervention showed significant improvements in their depressive symptoms—assessed with the Patient Health Questionnaire-9 (PHQ-9)—at 12 and 24 weeks. After 12 weeks, 30% of the participants in the intervention group could be classified as responders (50% or greater reduction in their PHQ-9 score), compared with only 8.6% in the waitlist group. After 24 weeks, 21.4% of the intervention group and 4.3% of the waitlist group were still considered responders. Participants in the intervention group similarly showed significant reductions in the severity of their self-reported insomnia and fatigue, as well as improvements in their overall well-being.

Even though only 5.7% of participants achieved remission in their depression, “it is nevertheless a promising result that this supposedly treatment-resistant population could achieve symptom remission to a clinically significant extent,” the authors wrote. “Considering that insomnia is often not specifically treated in the presence of depression, there is high potential to improve outcomes in general and speed up the therapeutic process.”

For related information, see the Psychiatric News article “To Lower Suicide Risk, Treat Troubled Sleep.”

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Private Equity Ownership of Psychiatric Hospitals Is Growing; Outcomes Still Unclear

The number of psychiatric hospitals owned by private equity (PE) firms increased from 42 in 2013 to 87 in 2021, according to a survey in JAMA Psychiatry. While PE-owned facilities were associated with lower staff-to-patient ratios, they performed better on some quality measures, including lower reported use of restraints and a higher rate of follow-up visits

Morgan C. Shields, Ph.D., of Brown University, and colleagues noted that PE firms acquire ownership of entities with the goal of increasing value for subsequent resale at a profit. “Maximization of short-term profits may not directly translate into higher quality of care for patients and could even undermine quality,” they wrote. “For example, PE firms may reduce staffing or shift responsibility to clinicians with less expertise, even if existing staffing configurations are associated with better patient outcomes.”

The researchers used industry data (Pitchbook and Irving Levin Associates Health Care M&A database) and online searches to create a database comparing 87 PE-owned and 530 non–PE-owned psychiatric hospitals in 2021. The combined sample encompassed all Medicare-participating freestanding psychiatric hospitals in the United States.

PE ownership was not evenly distributed over the United States; rather, the majority of firms were located in Southern states. In 2021, Texas, Louisiana, and Ohio had the highest number of hospitals owned by PE—19, 16, and nine, respectively. New Mexico had the highest proportion of hospitals (75%) owned by PE.

The researchers assessed quality measures at each hospital such as staffing levels, restraint and seclusion rates, readmission rates, and follow-up rates, among others. PE ownership was associated with fewer staff days per patient day among registered nurses (0.12 versus 0.15) and medical social workers (0.02 versus 0.04) compared with non–PE-owned hospitals. Yet, PE-owned hospitals reported fewer hours of restraint use (0.03 versus 0.24 hours per 1,000 patient hours), lower 30-day readmissions (19.40% versus 20.16%), and higher seven-day (29.34% versus 26.28%) and 30-day (52.92% v 49.08%) follow-up visits.

Shields and colleagues noted that “restraint and seclusion measures are crude and prone to both gaming and error, especially given their self-reported nature,” adding that “follow-up and readmission measures, while intended to reflect hospital performance, are also driven by differences in outpatient environments.”

The researchers said that a new patient experience measure added to CMS’ Inpatient Psychiatric Facility Quality Reporting program could be a more sensitive and meaningful measure of inpatient care quality.

For more information, see the Psychiatric News article “Private Equity’s Inroads Into Mental Health Bring Concern.”

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Suicidal Thoughts, Behaviors Rise in Adolescents; Black Girls Have Highest Risk

Suicidal thoughts and attempts steadily rose among high school students between 2007 and 2021, with similar trends seen in students at low and high risk of suicide, according to a study published today in the American Journal of Psychiatry (AJP). A second AJP study published today revealed that adolescent Black females have significantly higher risks of suicidal ideation compared with their White and/or male peers.

In the first study, Tanner J. Bommersbach, M.D., M.P.H., of the University of Wisconsin, and colleagues analyzed data from 119,654 high school students who completed the biennial Youth Risk Behavior Survey (YRBS) sometime between 2007 and 2021. The researchers analyzed responses to questions about suicidal ideation, plans, and attempts as well as questions about 24 risk factors for suicidality, such as substance use, violence, bullying, low sleep, and high body mass index.

Overall, the percentage of students reporting past-year suicidal ideation rose from 14.4% to 22.1% between 2007 and 2021, while those reporting suicidal plans rose from 11.2% to 17.6% and those reporting suicide attempts rose from 6.9% to 10.1%.

Suicidal thoughts (ideation or planning) and attempts were most common among students with the highest frequency of risk factors. However, percentagewise, the upward trends in suicidal thoughts and attempts did not differ between high-risk students and those with few or no risk behaviors.

“[Our] findings highlight a critical need to more effectively identify individuals in school and health care settings who could escape detection with targeted strategies based on behavioral risks,” Bommersbach and colleagues wrote.

In the second study, Ashley M. Cooper, M.S., M.Phil., of Penn Medicine, and colleagues used data from three studies—the Adolescent Brain Cognitive Development Study, the 2021 YRBS, and the Children’s Hospital of Philadelphia Emergency Department cohort—to compare suicidal ideation and attempts among 38,380 non-Hispanic Black youths and non-Hispanic White youths.

Overall, girls had had 1.75 times the odds of past-year suicide ideation compared with boys and 1.81 times the odds of a past-year suicide attempt. Black youth of any sex had 1.57 times the odds of a past-year suicide attempt compared with White youth, but there were no racial disparities in suicidal ideation. In examining race and sex interactions, the researchers found that Black girls had 1.26 times the odds of suicidal ideation compared with all their peers; there were no significant race and sex disparities for suicide attempts.

The researchers noted several possible causes for the higher risk of suicidal ideation among Black girls, including intimate partner violence, racial discrimination, cyberbullying, and underdiagnosis of depression. “Thus, we urge the clinical and research community alike to increase the number of suicide prevention efforts created for, and disseminated to, Black girls in particular,” they wrote.

For related information, see the Focus article “Youth Suicide.”

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SSRIs and SNRIs May Be Best Frontline Medications for Anxiety in Older Adults

Antidepressants may be the preferred choice to treat anxiety in older adults, according to the results of a meta-analysis published in the Lancet Psychiatry. Further, selective serotonin reuptake inhibitors (SSRIs) may produce more pronounced symptom improvements than serotonin norepinephrine reuptake inhibitors (SNRIs), though both types have similar chances of producing anxiety remission.

Sarah E. Neil-Sztramko, Ph.D., of McMaster University in Hamilton, Ontario, and colleagues compiled data from 19 randomized clinical trials assessing anxiety medications in adults ages 60 and older; the combined sample included 2,336 participants (68% female), primarily with generalized anxiety but also some with panic disorder or agoraphobia. Nine of the trials tested antidepressants, four tested benzodiazepines, and the remainder tested quetiapine, pregabalin, or buspirone.

The researchers found that antidepressants as a group were superior to placebo or waitlist control at reducing anxiety symptoms. Overall, 40% of participants taking antidepressants achieved a response (50% or greater reduction in symptoms) or anxiety remission compared with 24% of those on placebo or waitlist. SSRIs produced greater anxiety symptom improvements over control groups compared with SNRIs, though both classes showed similar rates of response and remission.

“In contrast, findings from other drug classes indicated low certainty evidence for the use of quetiapine and buspirone, and very low certainty evidence for pregabalin and benzodiazepines,” Neil-Sztramko and colleagues wrote. “In conjunction with the use of non-pharmacological interventions, our findings indicate antidepressants should be the first-line pharmacological treatment for anxiety disorders and clinically significant anxiety symptoms in older adults, aligning with guidelines for the general adult populations.”

The researchers said that their analysis was limited by the small number of available studies, most of which were published before 2012. The included studies also had fragmented data on side effects and tolerability, so the analysis could not definitively state the safety profile for these medications.

“Despite limitations, this review and meta-analysis has synthesized the best available evidence to help inform clinical guidelines and has drawn attention to the scarcity of recent, high-quality studies, studies of difficult-to-treat anxiety, and pragmatic trials in older adults,” they concluded.

For related information, see the Focus article “Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance.”

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Above Average Social Media Use May Contribute to Depressive Symptoms in Young Adolescents

Higher-than-average social media use as a tween was associated with greater depression the following year, according to a study issued by JAMA Network Open.

“Although correlations between social media use and depressive symptoms have been previously identified, the directionality of this relationship remains unclear,” wrote Jason M. Nagata, M.D., and colleagues. “[Our] findings provide initial evidence of temporal ordering and could suggest that social media use is a potential contributing factor to adolescent depressive symptoms rather than merely a correlate or consequence of such symptoms.”

Nagata and colleagues collected data from the Adolescent Brain Cognitive Development Study, which assessed 11,876 children aged 9 to 10 years on their self-reported social media use and depression symptoms (from the Child Behavior Checklist) at baseline and once a year for three years.

On a within-person basis, youth reporting higher than average social media use at baseline did not have elevated depressive symptoms at year one. However, above average social media use at year one or year two was associated with depressive symptoms the following year. These associations held after accounting for demographic and family-level factors that may influence mental health and social media use, such as parental media monitoring or family conflict.

Depressive symptoms were not associated with later social media use at any of the three intervals

The researchers noted that some adolescents may be more susceptible to negative media effects due to factors like their disposition, self-esteem, developmental stage, and family dynamic. Differential susceptibilities may also explain why some social media may be beneficial for certain individuals while detrimental to others.

“Clinicians should consider inquiring about social media use among children and adolescents, particularly those younger than the recommended age limits (the minimum age requirement for most social media platforms is 13 years), and providing anticipatory guidance as needed,” the researchers wrote. “Interventions that promote mindful, purpose-driven social media use, such as encouraging adolescents to prioritize social connection, may help mitigate negative outcomes and support better mental health.”

For related information, see the Psychiatric News article “Ask Young Patients About Social Media Use” and the Psychiatric News alert “Youth With Internalizing Conditions Spend More Time on Social Media, Feel Lack of Control Online.”

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Adoption of Collaborative Care Spread Dramatically in Recent Years

Adoption of the collaborative care model has expanded dramatically across all major insurance coverage types since the introduction of dedicated billing codes in 2018, according to an analysis performed by Stoddard Davenport, M.P.H., and colleagues at Milliman.

“This expansion is evident through the substantial increase in provider and patient participation, as well as the volume of services provided across Original Medicare, Medicare Advantage, Medicaid and the Children’s Health Insurance Program (CHIP), and commercial markets,” according to the Milliman report, which was commissioned by APA and the Mental Health Policy Institute.

For instance, between 2018 and 2022, the number of patients receiving collaborative care services increased from 4,095 to 21,160 individuals with original Medicare; 2,605 to 20,780 with Medicare Advantage; 3,380 to 30,930 with Medicaid and CHIP; and 1,649 to 27,444 individuals with commercial insurance.

Similarly, between 2018 and 2022, the number of physicians billing for collaborative care increased nationally from 881 to 5,131 for Original Medicare, 568 to 5,660 for Medicare Advantage, 629 to 5,389 for Medicaid and CHIP, and 545 to 3,741for commercial insurance, according to the report.

The researchers compiled their findings using multiple insurance claim datasets available from the Centers for Medicare and Medicaid Services as well as their own proprietary dataset of commercially insured individuals. Collectively, the datasets included the health care encounters of approximately 219 million individuals.

The Milliman analysis noted that while adoption of collaborative care has increased overall, there are significant differences between geographic areas. “Adoption of collaborative care is generally lower in rural areas across all insurance coverage types, and the level of adoption in Medicaid and CHIP is notably higher in states that have activated [collaborative care] codes for their Medicaid plans compared to states that have not,” according to Milliman.

In a statement released by Path Forward, a coalition of organizations dedicated to ensuring equitable access to quality mental health and substance use care, APA CEO and Medical Director Marketa M. Wills, M.D., M.B.A., said: “ Given the ongoing mental health crisis, the opioid epidemic, and high rates of suicide, the widespread implementation of this model is now more essential than ever to reach the growing number of Americans in need of quality mental health services. Simply stated, the more we adopt the Collaborative Care Model, the more patients can access it, and the more lives we will save.”

For more information, see the Psychiatric News article “Collaborative Care Has a Pivotal Role in Digital Health, Experts Say.”

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Hearing-Loss Treatment May Help Preserve Social Connection in Older People

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Older adults with hearing loss who receive treatment may retain greater social connections over time than those who do not receive treatment, according to a study in JAMA Internal Medicine.

Nicholas S. Reed, Au.D., Ph.D., of New York University, and colleagues examined data from 977 adults (mean age of 76.3) with untreated hearing loss and no substantial cognitive impairment. Participants were randomized to two groups: One group received a hearing intervention consisting of four sessions with a certified study audiologist, hearing aids, counseling, and education, with booster visits every six months. The control group received health education consisting of four sessions with a certified educator on chronic disease and disability prevention, including goal-setting, activities, stretching, and counseling. The researchers measured the participants’ social connections and loneliness at baseline, six months, and one, two, and three years.

At baseline, the mean social network size was 22.6 in the intervention group and 22.3 in the control group. After three years, the mean social network size declined to 21.3 in the intervention group and 19.8 in the control group. Adults in the intervention group also retained more social network diversity (number of relationship roles such as parent, child, or neighbor) after three years.

The intervention group’s mean loneliness scores (assessed via the UCLA Loneliness Scale) improved from 32.8 at baseline to 32.3 at three years, whereas the control group’s scores worsened from 32.7 at baseline to 33.5 at three years.

“Given the high prevalence of hearing loss among older adults and already established delivery models, hearing intervention represents a public health target for population-level reductions in social isolation and loneliness,” the researchers wrote, noting that hearing interventions are scalable and low-risk efforts. “Additional efforts to incorporate coverage for hearing care and audiological support services … into Medicare benefits may further help improve access and affordability of hearing care for older adults.”

For related information, see the Psychiatric News article “Special Report: Lifting the Veil on Loneliness and Alienation.”

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Shorter Time Between Antipsychotic Initiation and CSC Referral Improves Outcomes

Individuals with first-episode psychosis who experience a shorter period between first use of an antipsychotic and enrollment in a coordinated specialty care (CSC) program show improved functioning and quality of life at six months, according to a report in Schizophrenia Bulletin.

Hadar Hazan, M.D., of Yale University School of Medicine, and colleagues wrote that shorter duration of untreated psychosis (DUP) has been repeatedly shown to improve patient outcomes. Their study examined both parts of the treatment pathway: the time between the onset of symptoms and first use of antipsychotic medication (termed DUP-Demand) and the time between antipsychotic initiation and CSC enrollment (DUP-Supply). “Much can occur between the first effort to treat psychosis in an emergency room or psychiatric hospital and eventual entry into a local CSC, including multiple help-seeking events that can involve many community stakeholders,” they wrote.

The researchers examined outcomes for 147 first-episode psychosis patients enrolled from 2014 to 2019 in Specialized Treatment in Early Psychosis (STEP), a CSC in New Haven, Connecticut, that ran a dedicated four-year early detection campaign focused on raising public awareness of psychosis, training health professionals to identify symptoms, and streamlining the CSC referral process. STEP patients were compared with 75 patients enrolled in a CSC in Boston with standard early detection protocols.

Average total DUP for patients enrolled in STEP was 5.9 months shorter than those in the CSC with standard detection protocols. This included a 1.3-month reduction in DUP-Demand and a 4.6-month reduction in DUP-Supply.

This time reduction translated into improvements in functional outcomes: At six months, STEP participants showed significantly greater improvements on their Global Assessment of Function and Quality of Life scales than individuals at the comparison CSC. Further analysis showed that shorter DUP-Supply was the primary driver of these improvements, particularly for quality of life; shorter DUP-Demand time was not significantly associated with either improved functioning or improved quality of life.

The authors said these results demonstrate the value of early detection in CSC. “While reducing DUP may not be easy or cheap, the costs of early detection can be offset by reduced hospitalization and may interact with other health-economic benefits of CSC, including reduced criminal justice involvement,” they wrote.

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

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