Older racial and ethnic minorities living in the community are less likely to be diagnosed with depression than their white counterparts, but are also less likely to get treated, according to a recent NIMH-funded analysis published online ahead of print December 15, 2011, in the American Journal of Public Health.
Background
Depression is a significant health concern for older adults, regardless of ethnic or racial status. Previous studies have found racial and ethnic differences in the diagnosis and treatment of depression among the general population.
Using 2001-2005 data from the nationally representative Medicare Current Beneficiary Survey (MCBS), Ayse Akincigil Ph.D., of Rutgers University and colleagues examined rates of depression diagnosis and treatment among older adults living in the community. The survey asked questions about health care use and costs, insurance coverage beyond Medicare, access to care, and use of services. Read the rest of this entry »
Additional mental health conditions and developmental disabilities might explain why children might grow out of their autism diagnosis as they age, according to a new study. Researchers at the Johns Hopkins Bloomberg School of Public Health studied more than 1,300 children who had been diagnosed with autism. The disorders varied for autistic children of different ages. In children ages 3 to 5, those with autism were 11 times as likely to have a learning disability and nine times as likely to have a developmental delay as those children who had grown out of an official autism diagnosis. Autistic children ages 6 to 11 were nearly four times as likely to have past speech problems and 3.5 times as likely to have moderate to severe anxiety. (HealthDay News, 1/23/12)
ARLINGTON, Va. (Jan. 20, 2012)—The American Psychiatric Association (APA) has proposed new diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for autism. While final decisions are still months away, the recommendations reflect the work of dozens of the nation’s top scientific and research minds and are supported by more than a decade of intensive study and analysis. The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.
The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors. Read the rest of this entry »
Adolescents who experienced abuse or neglect as children have fewer brain cells than teens that did not experience such maltreatment, a new study finds. Published in the Archives of Pediatric Adolescent Medicine, the study found that adolescents who were exposed to maltreatment as children showed a reduction in gray matter in areas of the brain that control emotions and impulses, though they had not been diagnosed with a psychiatric disorder. It found that the specific brain areas affected may differ according to whether adolescents reported experiencing abuse or neglect, whether the maltreatment was physical or emotional, and whether they were male or female. Experts cautioned that the results of the study were only an association, and longer-term studies were needed. (Yale Daily News, 1/10/12)
Although the number of soldier suicides has stopped rising, there has been an increase in domestic violence and cases of Post-Traumatic Stress Disorder (PTSD), the Army reports. The number of active duty soldiers who took their own life declined by 9 percent from 2010. But violent sex crimes and domestic violence rose more than 20 percent from 2006 to 2010. Cases of child abuse increase 43 percent during the same period. The report also estimates that as many as 472,000 service members have PTSD. And the Army had over 126,000 diagnosed cases of traumatic brain injury from 2000 to 2010. (Los Angeles Times, 1/19/12)
Washington—The American Psychological Association’s (APA) newly released report, Stress in America™: Our Health at Risk, paints a troubling picture of the impact stress has on the health of the country, especially caregivers and people living with a chronic illness such as obesity or depression.
The Stress in America survey, which was conducted online by Harris Interactive on behalf of APA among 1,226 U.S. residents in August and September, showed that many Americans consistently report high levels of stress (22 percent reported extreme stress, an 8, 9 or 10 on a 10-point scale where 1 is little or no stress and 10 is a great deal of stress). While reported average stress levels have dipped slightly since the last survey (5.2 on a 10-point scale vs. 5.4 in 2010) many Americans continue to report that their stress has actually increased over time (39 percent report their stress has increased over the past year and 44 percent say their stress has increased over the past 5 years). Yet stress levels exceed people’s own definition of what is healthy, with the mean rating for stress of 5.2 on a 10-point scale— 1.6 points higher than the stress level Americans reported as healthy.
While 9 in 10 adults believe that stress can contribute to the development of major illnesses, such as heart disease, depression and obesity, a sizeable minority still think that stress has only a slight or no impact on their own physical health (31 percent) and mental health (36 percent). When considered alongside the finding that only 29 percent of adults believe they are doing an excellent or very good job at managing or reducing stress, APA warns that this disconnect is cause for concern.
“America has a choice. We can continue down a well-worn path where stress significantly impacts our physical and mental health, causes undue suffering and drives up health care costs. Or we can get serious about this major public health issue and provide better access to behavioral health care services to help people more effectively manage their stress and prevent and manage chronic disease,” says psychologist Norman B. Anderson, PhD, APA’s CEO and executive vice president. “Various studies have shown that chronic stress is a major driver of chronic illness, which in turn is a major driver of escalating health care costs in this country. It is critical that the entire health community and policymakers recognize the role of stress and unhealthy behaviors in causing and exacerbating chronic health conditions, and support models of care that help people make positive changes.”
Caregivers Under Fire
Millions of Americans provide care for aging or chronically ill family members at home, and that number is expected to grow as the number of older Americans is likely to double by the year 2030, according to the U.S. Department of Health and Human Services. Findings from the Stress in America survey suggest that we may want to pay particular attention to the impact of these responsibilities on caregivers, who report higher levels of stress, poorer health and a greater tendency to engage in unhealthy behaviors to alleviate their stress than the general public.
Caregivers are not only more likely to report stress than other Americans, they also report it at higher levels. On a scale of 1 to 10 where 1 is little or no stress and 10 is a great deal of stress, the mean level of stress reported by caregivers was 6.5 as compared to 5.2 by the general public. Fifty-five percent of caregivers say they feel overwhelmed by the amount of care their aging or chronically ill family member requires. Caregivers are more likely than those in the general population to say they’re doing a poor/fair job practicing healthy behaviors, including managing stress (45 percent vs. 39 percent) and getting enough sleep (42 percent vs. 32 percent).
The latest data also demonstrate that caregivers are more likely than people in the general public to have a chronic illness (82 percent vs. 61 percent), rate their health as fair or poor (34 percent vs. 20 percent), and point to personal health concerns as a significant source of stress (66 percent vs. 53 percent). In addition, caregivers appear to manage stress in less healthy ways than the general population; for example, caregivers are twice as likely to report smoking to manage their stress (20 percent vs. 10 percent).
Stress Linked to Obesity and Depression
The rate of obesity in the United States remains at epidemic proportions. And according to the Centers for Disease Control and Prevention, 1 in 10 American adults suffers from depression. Findings from Stress in America show that many people who suffer from these conditions say that they are unable to take the necessary steps to reduce their stress and therefore engage in unhealthy behaviors.
On a scale of 1 to 10, people living with depression (6.3) or obesity (6.0) report significantly higher average stress levels than the rest of the population (5.2). Those with depression (33 percent) or who are obese (28 percent) are significantly more likely than the general public (21 percent) to say they do not think they are doing enough to manage their stress. As compared to the general public (11 percent), more people who are obese (34 percent) or depressed (22 percent) report that their disabilities or health issues prevent them from making healthy lifestyle changes.
“The Stress in America survey continues to show a nation at a crossroads when it comes to stress and health. We are caught in a vicious cycle where our stress exceeds our own definition of what is healthy, and those who are already living with a chronic illness report even higher levels of stress. Yet we’re ill-equipped to make changes to better manage that stress,” says Dr. Anderson. “Given the persistent nature of our stress and the serious physical health consequences associated with it, stress has the potential to become the country’s next public health crisis.”
To read the full report, view the Stress in America: Our Health at Risk town hall event or to download graphics, visit the Stress in America website.
For additional information on stress and lifestyle and behavior, visit APA’s Help Center and read APA’s Mind/Body Health campaign blog. Join the conversation about stress on Twitter by following @apahelpcenter and #stressAPA.
Methodology
The Stress in America survey was conducted online within the United States by Harris Interactive on behalf of the American Psychological Association between August 11 and September 6, 2011, among 1,226 adults aged 18 and older who reside in the U.S. In addition to the 1,226 interviews among the general population, oversamples of 300 caregivers and 1,221 people living with chronic illnesses were also included in the 2011 research. For the purposes of this report, caregivers are defined as adults currently caring for an aging or chronically ill family member. Chronically ill adults are defined as those with at least one of the following conditions: depression, type 2 diabetes, obesity and heart disease. In the report, the adults comprising this group are labeled as “Chronic Illness.” To read the full methodology; visit the Stress in America website.
Additional contact
Scott Rieder, Vanguard Communications, (202) 248-5476
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 154,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
Harris Interactive is one of the world’s leading custom market research firms, leveraging research, technology, and business acumen to transform relevant insight into actionable foresight. Known widely for the Harris Poll and for pioneering innovative research methodologies, Harris offers expertise in a wide range of industries including healthcare, technology, public affairs, energy, telecommunications, financial services, insurance, media, retail, restaurant, and consumer package goods. Serving clients in over 215 countries and territories through our North American, European, and Asian offices and a network of independent market research firms, Harris specializes in delivering research solutions that help us — and our clients — stay ahead of what’s next. For more information, please visit the Harris Interactive website.
The antipsychotic medication risperidone is more effective for initial treatment of mania in children diagnosed with bipolar disorder compared to other mood stabilizing medications, but it carries the potential for serious metabolic side effects, according to an NIMH-funded study published online ahead of print January 2, 2012, in the Archives of General Psychiatry.
Background
Childhood bipolar disorder is a relatively rare but seriously impairing condition. It is also associated with an increased risk of substance use disorders and suicide. To treat symptoms of mania, a key symptom of the disorder, medications such as mood stabilizers or antipsychotics are often prescribed. However, no prior study has addressed the question of which medication to try first.
In the Treatment of Early Age Mania (TEAM) study, Barbara Geller, M.D., of Washington University in St. Louis, and colleagues randomized 290 children ages 6-15 years diagnosed with bipolar I disorder (having mixed or manic symptoms) to treatment with lithium, divalproex sodium or risperidone for an 8-week trial. None of the children had taken an anti-manic medication before. Lithium has been used to treat bipolar disorder for many years. Divalproex sodium is an anticonvulsant mood stabilizer commonly prescribed to treat bipolar disorder as well. Risperidone is an atypical antipsychotic that has been approved by the U.S. Food and Drug Administration for the treatment of mania in youth age 10 and older.
Results of the Study
After eight weeks, 68.5 percent of the children taking risperidone showed improvement in manic symptoms, compared to 35.6 percent of those taking lithium and 24 percent of those taking divalproex sodium. Overall, 24.7 percent discontinued the trial, but more children taking lithium—32.2 percent—discontinued the trial compared to those taking risperidone (15.7 percent discontinued) or divalproex sodium (26 percent discontinued.)
However, those taking risperidone also gained more weight than those on the other medications—an average of more than 7 lbs compared to around 3 lbs for those taking lithium and 3.7 lbs for those taking divalproex sodium. Those taking risperidone were also more likely to experience other metabolic side effects, such as an increase in cholesterol levels, compared to those on the other medications.
Significance
The researchers concluded that risperidone was significantly more effective than lithium or divalproex sodium for initial treatment of childhood mania. In addition, the children were less likely to discontinue the drug compared to those taking lithium or divalproex sodium, indicating a higher tolerance for it. This finding is consistent with other studies that have compared second-generation antipsychotics like risperidone to placebo in treating childhood mania.
However, the researchers caution that risperidone is associated with adverse metabolic effects that can increase the risk for diabetes and cardiovascular problems. They note that many children responded to low doses of the medication, suggesting that clinicians should be conservative when determining how to dose the medication. A lower dose may minimize the potential for serious side effects. The researchers also caution that because diagnostic measures for childhood bipolar disorder are not always consistent across studies, and because the validity of such a diagnosis in younger children is under debate, TEAM findings may not generalize to patients diagnosed using other measures.
What’s Next
More research is needed to develop safer, more effective interventions for children with early onset bipolar disorder for both initial and longer term treatment.
Reference
Geller B, Luby J, Josh P, Wagner KD, Emslie G, Walkup JT, Axelson DA, Bolhofner K, Robb A, Wolf DV, Riddle MA, Birmaher B, Ryan ND, Severe J, Vitiello B, Tillman R, Lavori P. A randomized controlled trial of risperidone, lithium and divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. Archives of General Psychiatry. Online ahead of print January 2, 2012.
Scientists working in cell culture and in mice have been able to correct the loss of gene activity underlying a rare but severe developmental disorder by turning on a gene that is normally silenced in brain cells. Further testing of the identified compound that activates the gene will determine whether it has potential as a genetically-based treatment for the disorder, Angelman syndrome.
Background
Infants with Angelman syndrome appear normal at birth, but show developmental delays by 6 to 12 months. Features of the disorder include impaired speech, seizures, hyperactivity, and motor difficulties. No effective treatment exists.
In the late 1990s, researchers found that the disorder results from changes or deletions in the maternal gene for the enzyme ubiquitin protein ligase E3A (Ube3a). Most genes are inherited in sets of two, one from the mother and one from the father. In some cases, either the maternal or paternal gene is silenced, or prevented from being translated into protein. This normal silencing based on inheritance from a mother or father is called imprinting. The Ube3a gene is an example of genetic imprinting, as the paternal gene is normally silenced in neurons. With the maternal gene out of action, infants with Angelman syndrome lack the enzyme, leading to changes in the brain that underlie the symptoms of the disorder.
This Study
This research is reported online in the journal Nature, and was carried out by scientists at the University of North Carolina School of Medicine at Chapel Hill, led by the labs of Ben Philpot, Bryan Roth, and Mark Zylka. In an effort to restore the absent Ube3a enzyme in neurons, the research team screened thousands of compounds for their ability to “wake up” the paternal Ube3a gene. The investigators used neurons from genetically engineered mice to test whether compounds could activate the gene; the neurons fluoresce if the paternal Ube3a gene is expressed, or translated into protein. The team screened 2,306 candidate small molecules from multiple molecular libraries. If fluorescence was detected, that meant that the test compound activated the Ube3a gene. The screening and access to the molecular libraries was made possible through NIMH’s Psychoactive Drug Screening Program, funded by contract to perform pharmacological and functional screening of novel compounds. Bryan Roth at UNC Chapel Hill is the project director and a coauthor of the Nature paper.
The investigators found that a class of compounds—topoisomerase inhibitors—could unsilence the paternal gene. They chose one, topotecan, and tested it to see whether it could do the same thing in vivo in a mouse. They administered topotecan directly into the brain and later into spinal fluid; in both cases it was able to activate paternal Ube3a. Activation persisted for 12 weeks after delivery of the compound had stopped.
Significance
“This is the first time anyone has used a small molecule to successfully target activation of a disease-relevant gene,” said senior author Benjamin Philpot. “The work demonstrates that turning on a dormant gene could represent a therapeutic intervention for Angelman syndrome.”
NIMH helped to fund this project and has issued a grant to the UNC team to continue studies of topotecan, initially in mice. Although topotecan is already in use in both children and adults as a cancer chemotherapeutic agent, further testing is essential to determine the dosage of the agent that would be needed to be effective, the best means of administering the medication, and whether side-effects at the necessary dosage level are within a range that make it feasible to use. The authors emphasize that much work remains before this or related agents can or should be used for treatment of this condition.
Reference
Huang, H.-S., Allen, J., Mabb, A., King, I., Miriyala, J., Taylor-Blake, B., Sciaky, N., Dutton, J. Jr., Lee, H.M., Chen, X., Jin, J. Bridges, A., Zylka, M., Roth, B., Philpot, B. Topoisomerase inhibitors unsilence the dormant allele of Ube3a in neurons. Nature. Published online ahead of print December 21, 2011, doi: 10.1038/nature10726.
Teens blogging about social problems, engaging with online community showed significant improvement, according to new research
WASHINGTON—Blogging may have psychological benefits for teens suffering from social anxiety, improving their self-esteem and helping them relate better to their friends, according to new research published by the American Psychological Association.
“Research has shown that writing a personal diary and other forms of expressive writing are a great way to release emotional distress and just feel better,” said the study’s lead author, Meyran Boniel-Nissim, PhD, of the University of Haifa, Israel. “Teens are online anyway, so blogging enables free expression and easy communication with others.”
Maintaining a blog had a stronger positive effect on troubled students’ well-being than merely expressing their social anxieties and concerns in a private diary, according to the article published online in the APA journal Psychological Services®. Opening the blog up to comments from the online community intensified those effects.
“Although cyberbullying and online abuse are extensive and broad, we noted that almost all responses to our participants’ blog messages were supportive and positive in nature,” said the study’s co-author, Azy Barak, PhD. “We weren’t surprised, as we frequently see positive social expressions online in terms of generosity, support and advice.”
The researchers randomly surveyed high school students in Israel, who had agreed to fill out a questionnaire about their feelings on the quality of their social relationships. A total of 161 students — 124 girls and 37 boys, with an average age of 15 — were selected because their scores on the survey showed they all had some level of social anxiety or distress. All the teens reported difficulty making friends or relating to the friends they had. The researchers assessed the teens’ self-esteem, everyday social activities and behaviors before, immediately after and two months after the 10-week experiment.
Four groups of students were assigned to blog. Two of those groups were told to focus their posts on their social problems, with one group opening the posts to comments; the other two groups could write about whatever they wanted and, again, one group opened the blog up to comments. The number and content of comments were not evaluated for this experiment. The students could respond to comments but that was not required. Two more groups acted as controls – either writing a private diary about their social problems or doing nothing. Participants in the writing and blogging groups were told to post messages at least twice a week for 10 weeks.
Four experts, who held master’s or doctoral degrees in counseling and psychology, assessed the bloggers’ social and emotional condition via their blog posts. Students were assessed as having a poor social and emotional state if they wrote extensively about personal problems or bad relationships or showed evidence of low self-esteem, for example.
Self-esteem, social anxiety, emotional distress and the number of positive social behaviors improved significantly for the bloggers when compared to the teens who did nothing and those who wrote private diaries. Bloggers who were instructed to write specifically about their difficulties and whose blogs were open to comments improved the most. All of these results were consistent at the two month follow-up.
The authors conceded that the skewed sex ratio was a limitation to the study. However, the researchers analyzed the results separately by gender and found that boys and girls reacted similarly to the interventions and there were no major differences. However, they say future research should attempt to control for gender.
Article: “The Therapeutic Value of Adolescents’ Blogging About Social-Emotional Difficulties,” Meyran Boniel-Nissim, PhD, and Azy Barak, PhD, University of Haifa; Psychological Services, Online Dec. 21.
Dr. Azy Barak can be contacted by email
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 154,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
A family-centered prevention and intervention program reduced behavioral and drug problems among black high school youths, researchers report. Adolescents enrolled in the Strong African American Families-Teen (SAAF-T) program had significantly lower increases in problematic conduct, substance use, and frequency of depressive symptoms over a 22-month period than a control group, researchers report in the journal Pediatrics. Compared with the control group, those in the SAAF-T group showed a 36 percent decrease in the frequency of conduct problems, a 32 percent decrease in substance use, and a 47 percent decrease in substance use problems. But the control group also reported a 15 percent improvement through an emphasis on nutrition, exercise, and consumer behavior. The researchers said one of the advantages of the SAAF-T program is that it can easily be used by public health agencies and community organizations. (Medage Today, 12/12/11)
Teenage girls who feel depressed are twice as likely to start binge eating as other girls are and girls who engage in binge eating have double the normal risk of symptoms of depression, according to a new study. Researchers analyzed data from nearly 5,000 girls aged 12 to 18 who answered questions in 1999, with follow-up surveys in 2001 and 2003. Reported in the Journal of Adolescent Health, the study found that teens and young women who reported in the first survey that they always or usually felt “down in the dumps” or “depressed” were about twice as likely as others were to start overeating or binge eating during the following two years. (Health Behavior News Service, 12/13/11)
The majority of victims of sexual violence experience serious mental and general health problems that can last a lifetime, according to a government study. The Centers for Disease Control and Prevention reported that victims cite chronic pain, diabetes, asthma, sleep difficulties and poor overall and mental health. The vast majority of women who said they had been victims of sexual violence, rape or stalking reported symptoms of Post-Traumatic Stress Disorder, as did about one-third of the men. Nearly one in five women and one in 71 men in the United States reported being raped at some point in their lives. More than half of the raped women reported being assaulted by an intimate partner. (The New York Times, 12/15/11)
Mental health conditions—along with acute bronchitis, asthma, trauma-related disorders, middle-ear infections—was among the five most commonly treated medical problems among children in 2008, according to the Agency for Healthcare Research Quality. More than 40 percent of the nation’s children age 17 and younger were treated for at least one of those conditions. Mental health conditions were the fifth most commonly treated condition (5 million children) and had the highest treatment cost—an average of $2,483 per child. (HealthDay News, 12/15/11)