Major Depressive Disorder Common in Patients With Hoarding Disorder, Study Finds

Major depressive disorder is the most common comorbid mental illness in people with hoarding disorder, a study in the Journal of Psychiatric Research has found.

Luis Sordo Vieira, Ph.D., of the University of Florida and colleagues examined data from adults who participated in the Brain Health Registry (BHR), a large online research registry that asks participants questions about their medical, psychiatric, and neurological histories and to complete questionnaires about a variety of conditions.

The researchers first focused on 252 BHR participants (average age: 61 years) who received a thorough clinical assessment for psychiatric disorders; of this group 135 participants had hoarding disorder and 117 participants did not. Among participants with hoarding disorder, 61.5% had major depressive disorder, 31.9% had generalized anxiety disorder, and 22.2% had panic disorder, compared with 28.2%, 10.3%, and 9.4%, respectively, of those who did not have hoarding disorder. Furthermore, 34.8% of those with hoarding disorder had both major depressive disorder and an anxiety disorder (including but not limited to generalized anxiety disorder), compared with 12.8% of participants without hoarding disorder. Among those who had hoarding disorder and generalized anxiety disorder specifically, 72% also had major depressive disorder.

The researchers then analyzed the questionnaire responses from the larger BHR sample (15,978 adults; average age: 62 years). As with the 252 participants who received clinical assessments, major depressive disorder and generalized anxiety disorder were the most common comorbid mental health conditions in people with hoarding disorder.

When the researchers analyzed the data further, they found that generalized anxiety disorder did not have a direct relationship with hoarding disorder. Rather, the relationship between generalized anxiety disorder and hoarding disorder was mediated by major depressive disorder.

These findings “may provide hints to the underlying shared biological underpinnings of these disorders,” the researchers wrote.

For related information, see the Psychiatric News article “Hoarding: Ownership Gone Awry.”

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Folic Acid Taken by Prescription May Lower Risk of Suicide

People taking prescription folate may be at a lower risk of suicidal event, suggests a study published in JAMA Psychiatry. Specifically, the researchers found that each month of being prescribed folic acid was associated with an additional 5% decrease in risk of suicide attempt during the 24-month follow-up period.

“The role of folate in depression and cognition has been recognized for more than a decade, leading to recommendations for folate augmentation in patients with low or normal levels at the start of any depression treatment,” wrote Robert Gibbons, Ph.D., of the University of Chicago and colleagues.

Gibbons and colleagues used data from the MarketScan Commercial Claims and Encounters databases, which include inpatient, outpatient, and prescription claims from more than 100 insurers. The authors identified participants aged 18 and older who filled a folic acid prescription from 2012 to 2017. (Forty-eight percent of folic acid prescriptions were for 1 mg/d). They then used the database to identify if participants attempted suicide or intentionally harmed themselves or had any diagnoses relevant to suicide risk or folate deficiency between 2010 and 2018. They repeated a similar analysis of participants who had filled prescriptions of cyanocabalamin, or vitamin B12. (Folic acid is vitamin B9.)

The authors collected data on 866,586 participants, 81.3% of whom were female. During the period when participants were taking folic acid, there were 261 suicidal events, for a rate of 4.73 per 100,000 person-months, and 895 suicidal events during the months when participants were not taking folic acid, for a rate of 10.61 per 100,000 person-months. In the adjusted analysis, there was a 44% reduction in suicidal events among participants taking folic acid.

The authors noted a similar association in women of childbearing age, and age and sex did not moderate the association. They found no association between vitamin B12 and suicidal events.

“The results warrant the conduct of a randomized clinical trial with suicidal ideation and behavior as outcomes of interest,” the authors concluded. “If confirmed, folic acid may be a safe, inexpensive, and widely available treatment for suicidal ideation and behavior.”

For related information, see the Psychiatric News article “Prenatal Folic Acid Associated With Lower Psychosis Risk.”

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Feeling Strong Sense of Purpose May Protect Older Veterans From Mental Illness

Older veterans who say they have a strong sense of purpose in life may be less likely to experience a range of mental disorders compared with those with those lacking such a sense of purpose, according to a report in The American Journal of Geriatric Psychiatry.

Perceived purpose in life refers to the extent to which a person believes that his or her life is motivated by goals and aims that they care about, Ian C. Fischer, Ph.D., of Indiana University-Purdue University at Indianapolis and colleagues wrote. The “[r]esults of this study suggest that existing interventions that have been shown to increase [purpose in life] may have the potential to help mitigate risk for, and alleviate symptoms of, various mental disorders,” they added.

Data were drawn from the National Health and Resilience in Veterans Study (NHRVS), a survey of 4,069 U.S. veterans, the majority of whom were 60 years and older, White, and male. The NHRVS was administered between November 18, 2019, and March 8, 2020, and all participants completed an anonymous, 50-minute, web-based survey. As part of this survey, veterans completed the four-item Purpose in Life Test Short Form and were screened for mental disorders and suicidality.

The researchers broke the participants into three groups: those who endorsed a high purpose in life, average purpose in life, or low purpose in life.

Most participants (71.7%) endorsed average levels of perceived purpose in life; 16% endorsed low purpose in life and 12.4% endorsed high purpose in life. High purpose in life was associated with 42% to 94% reduced odds of screening positive for major depressive, generalized anxiety, posttraumatic stress, and substance use disorders, as well as suicidality, Fischer and colleagues wrote.

“Given the ‘dose-response’ relationship found between purpose in life and a broad range of mental health outcomes, purpose in life may be an important transdiagnostic prevention and treatment target,” they concluded.

For related information, see the Psychiatric News article “Interventions That Promote Wisdom May Help Patients With Psychiatric Conditions.”

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Black Children Less Likely to Report Suicidal Thoughts in Emergency Room, Study Suggests

Black children brought to an emergency department for behavioral issues appear less likely to report suicidal thoughts than children of other races, suggests a report published today in Psychiatric Services. Additionally, Black children were more likely to be brought to the emergency department by police and to be discharged rather than hospitalized for psychiatric care.

Carol Vidal, M.D., Ph.D., of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins and colleagues analyzed electronic medical record data from 504 patients aged 8 to 12 years visiting a pediatric emergency department (ED) with a psychiatric issue in 2019. This “urban pediatric ED, … located in the Mid-Atlantic region, has an estimated annual census of 35,000 patient visits (60% Black, 21% White, 10% Latino/Latina or Hispanic; approximately 60% had public insurance),” Vidal and colleagues wrote.

The researchers examined youth’s responses to the Ask Suicide-Screening Questions tool (ASQ)—a four-item suicide risk screening instrument completed in the ED. They also compared the youth’s demographic data, mode of arrival to the ED, primary ED clinical impression (for instance, suicidal ideations, oppositional defiant disorder or related problems, or depression and anxiety), and more. A total of 398 youth completed the ASQ; of these, 42% reported wishing they were dead, 32% reported feeling they would be better off dead, and 37% reported thinking of killing themselves in the past week. A previous suicide attempt was reported by 28% of the youth.

When the researchers examined the responses by the race of the youth, they found that there was little difference in the percentage of youth who reported a previous suicide attempt (27% of White youth, 28% of Black youth, and 29% of other/multiracial youth). However, Black youth were less likely to report wishing they were dead (35% vs. 57% in White youth and 50% of other/multiracial youth), feeling that they would be better off dead (27% vs. 38% and 50%), and thinking about killing themselves in the past week (33% vs. 47% and 43%) in the past couple weeks. Further analysis revealed that 35% of Black youth were transported to the ED by police compared with 12% of White youth and 15% of other/multiracial youth.

“[N]on-Black preadolescents were three times as likely as Black children to be admitted to inpatient psychiatric care,” Vidal and colleagues continued. “Although racial differences in admission to inpatient psychiatric care could be related to the lower frequency of self-reported suicidal thoughts among Black preadolescents, other patient, parent, and provider factors likely contribute to this disparity, given that Black preadolescents in our sample who reported thoughts of suicide were still less likely to be hospitalized than were non-Black peers with thoughts of suicide.”

While the authors noted several limitations of the study—including its small sample and focus on a single ED—they wrote that the findings point to the need for more research: “Research to better understand racial disparities in suicide risk among preadolescents can inform prevention efforts.”

For related information, see the Psychiatric News article “Study Investigates Link Between Discrimination, ADHD, Suicide.”

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Adults With Child Trauma History Respond to Depression Treatment Similar to Other Adults

Adults with depression and a history of childhood trauma respond as well to medications and psychotherapy as those without childhood trauma, according to a meta-analysis published in Lancet Psychiatry.

“Several individual and meta-analytic studies indicate that a history of childhood trauma is associated with poorer response to first-line depression treatments, suggesting the need for new personalised treatments for patients with major depressive disorder and childhood trauma,” wrote Erika Kuzminskaite, M.S., of Vrije University in the Netherlands and colleagues with the Childhood Trauma Meta-Analysis Study Group. “However, the evidence on poorer treatment outcomes in adults with depression and childhood trauma has not been definitive.”

Kuzminskaite and colleagues collected data from 29 randomized clinical trials testing a medication, psychotherapy, or combination treatment for adults with major depression; all trials included assessments for childhood trauma. The combined samples included 6,830 adults, of whom 62% had reported a history of childhood trauma. Although adults with a history of childhood trauma on average had more severe depressive symptoms at baseline, they had similar symptom improvement following treatment as adults with no trauma history. The findings were consistent regardless of depression type (depression or treatment-resistant depression), treatment type (medication or psychotherapy), or trauma type (emotional, physical, or sexual abuse or neglect).

Kuzminskaite and colleagues noted that previous studies in this area typically looked at treatment response or depression remission as the outcomes. “Subsequently, greater improvement could be required for patients with childhood trauma to meet the definition of remission,” they wrote. “By contrast, we examined depression severity change from baseline to after treatment consistently taking baseline symptoms into account and using depression severity correlations from before and after treatment.”

“This meta-analysis delivers a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms,” wrote Antoine Yrondi, M.D., Ph.D., of the University of Toulouse, France, in an accompanying editorial. “However, physicians should keep in mind that childhood trauma could be associated with clinical features which might make it more difficult to reach complete symptomatic remission of major depressive disorder and, therefore, have an effect on daily functioning.”

For related information, see Prospective Study Delves Deeper Into Mental Health Effects of Childhood Trauma.

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High Rates of Depression, PTSD Persist Five Years After Water Crisis in Flint, Mich.

Five years after the water crisis in Flint, Mich., residents of the community had higher rates of past-year depression and posttraumatic stress disorder (PTSD) compared with the rest of the nation, a study in JAMA Network Open has found. During the crisis, which occurred from 2014 to 2017, many residents were exposed to drinking water with unsafe levels of bacteria, disinfection byproducts, and lead after the city switched its drinking water supply from Detroit’s system to the Flint River.

Aaron Reuben, Ph.D., of Duke University and colleagues analyzed data from a survey of 1,970 adults who lived in Flint during the crisis. The survey was conducted from August 13, 2019, through April 20, 2020. It asked participants about their crisis experiences, their mental health symptoms five years later, and their access to and use of mental health services in the intervening years. Among respondents, 53.5% identified as Black or African American, 42.5% identified as White, and 97.4% identified as non-Hispanic; 56.8% reported earning less than $25,000 a year.

Overall, 22.1% of participants had symptoms of past-year depression, 24.4% had symptoms of past-year PTSD, and 14.0% had symptoms of both conditions. Participants who believed that their or their family’s health was moderately or greatly harmed by the water crisis were 123% more likely than their peers to have symptoms of depression, 66% more likely to have symptoms of PTSD, and 106% more likely to have symptoms of both conditions. Participants who had a history of potentially traumatic events such as a life-threatening illness, serious accident, or previous disaster were 173% more likely than their peers to have symptoms of depression and 355% more likely to have symptoms of PTSD.

“These findings suggest that the water crisis could have exacerbated existing mental health disparities in Flint—a possibility that should be investigated in future studies,” Reuben and colleagues wrote.

Only 34.8% of participants reported ever being offered mental health services to help address their concerns or problems associated with the crisis. About 79% of those who were offered mental health services used them.

The researchers concluded “that (1) there is a large, unmet mental health need in the Flint community 5 years after the onset of the water crisis and (2) this need for mental health services is unlikely to remit without a comprehensive, systematic, and coordinated response from the local, state, and federal governments and public health communities,” the researchers wrote. “These findings suggest that community-level public works environmental disasters have large-scale and lasting psychological sequelae.”

For related information, see the Psychiatric News article “Preparing for Disasters at the Community Level: Prevention and Social Cohesion.”

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APA Invites You to Partner on Perinatal Initiative Funded by CDC Foundation

To address training and knowledge gaps regarding untreated perinatal mental illness, it is important to understand providers’ perspectives about pregnant persons with mental health issues during and after pregnancy. APA has been awarded a grant from the CDC Foundation to conduct a needs assessment of these gaps. APA is seeking 400 providers to take a 30-minute survey and 16 providers to participate in two-hour focus groups. Survey respondents will receive a $30 Amazon gift card, and focus group participants will receive a $450 honorarium. Those interested in participating can register at redcap.link/panpbhp_register.

Telephone Intervention May Reduce Risky Alcohol Consumption

Participating in at least two sessions of a telephone-delivered intervention may help reduce total alcohol consumption, alcohol problem severity, and risky drinking patterns among patients with alcohol use problems, according to a study published yesterday in JAMA Psychiatry.

“Alcohol use disorders are estimated to affect 5.1% of the adult population worldwide,” wrote Dan Lubman, Ph.D., of Monash Addiction Research Centre in Victoria, Australia, and colleagues. “Yet, the magnitude of alcohol consumption and attributable harms remains in sharp contrast to the low rates of treatment use.”

Lubman and colleagues recruited participants aged 18 and older with problem alcohol use from across Australia via social media and clinician referrals. Problem alcohol use was defined as a score of more than 6 for females and more than 7 for males on the Alcohol Use Disorders Identification Test (AUDIT). Possible scores on the AUDIT range from zero to 40. AUDIT also measures hazardous use, harmful use, and dependence symptoms. Participants’ AUDIT scores were assessed at baseline and again three months later.

Participants were randomly assigned to either the intervention group or the active control group. Those in the intervention group received four to six 30- to 50-minute sessions of a telephone-delivered cognitive and behavioral intervention called Ready2Change. After receiving a clinical assessment in the first session, trained counselors introduced the participants in the intervention group to the following practices in session two: keeping a daily alcohol diary; identifying participants’ triggers; assistance managing urges with SOBER breathing (a mindfulness-based practice that includes five steps: stop, observe, breathe, expand, and respond); and establishing a helpful routine. The counselors tailored the remainder of the sessions (offered weekly) to individual participants, based on their reasons for engaging in treatment and challenges they faced. The active control group received alcohol consumption guidelines, stress management pamphlets, and four telephone check-ins that were five minutes or less.

Among 344 participants, two-thirds had AUDIT scores corresponding to the highest category of probable dependence, and only one-third had previously sought treatment for their alcohol use. Sixty-five percent of participants randomized to the intervention group completed the program (defined as participating in at least four sessions), and 80% of participants in the control group completed the program.

The AUDIT scores decreased significantly from baseline to three months in both groups, falling from 21 to 12.8 in the intervention group, and from 22.1 to 14.9 in the active control group. The intervention group showed a significantly greater reduction in hazardous use. When adjusting for exposure to two or more sessions, the researchers found that the intervention group had a greater reduction in their total AUDIT scores compared with the control group.

“The results of this clinical trial support [the] benefits of a telephone-delivered intervention in a general population sample of individuals who do not typically seek treatment for alcohol use problems, despite experiencing high problem severity,” the authors concluded. The “[f]indings demonstrate the potential benefits of this highly scalable telehealth model of alcohol treatment, with potential to reduce the treatment gap for problem alcohol use.”

For related information, see the Psychiatric News article “Pandemic May Be Accelerating Problematic Trends in Alcohol Use.”

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APA Invites You to Partner on Perinatal Initiative Funded by CDC Foundation

To address training and knowledge gaps regarding untreated perinatal mental illness, it is important to understand providers’ perspectives about pregnant persons with mental health issues during and after pregnancy. APA has been awarded a grant from CDC Foundation to conduct a needs assessment of these gaps. APA is seeking 400 providers to take a 30-minute survey and 16 providers to participate in two-hour focus groups. Survey respondents will receive a $30 Amazon gift card, and focus group participants will receive a $450 honorarium. Those interested in participating can register at redcap.link/panpbhp_register.