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Tag: anxiety

  • Report claims mental health of people in later life has been overshadowed by systemic and interpersonal ageism

    Report claims mental health of people in later life has been overshadowed by systemic and interpersonal ageism

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    A recent Center for Mental Health briefing documents the evidence on the mental health of older people in England and what kind of support they receive.

    Study: Mental Health in Later Life. Image Credit: Andrew Angelov/Shutterstock.com
    Study: Mental Health in Later Life. Image Credit: Andrew Angelov/Shutterstock.com

    About the study

    To better understand the current mental health status of older people residing in the United Kingdom, the Age UK commissioned the Centre for Mental Health to explore the same. As part of this initiative, research was conducted to understand better the mental health status of older people in England. The type of support these people receive and the policies that have been formulated to improve their mental health were analyzed.

    This review highlighted that few studies are being conducted and few policies are being developed to support the mental health of people during their later life. This review focused on the publications and policies on the mental health of older adults in the last five years. Older literature was explored if inadequate evidence on a particular aspect was obtained. This approach helped close the gaps wherever possible.

    A wide gap in research was identified in accordance with the number of studies on the mental health of the younger and older population. It was observed that in the last five years, scientists have primarily conducted research on dementia and coronavirus disease 2019 (COVID-19).

    Older adults and mental health

    The current briefing observed that the UK’s population is rapidly aging. In comparison to the entire population, for older people, mental health has a greater impact on life satisfaction than physical health. A US-based survey on older people revealed that being independent held greater weightage than staying alive or pain reduction. The majority of studies have prioritized the health of older people to uplift their quality of life. These studies show that even though mental health is important for a better quality of life in older groups, it is not prioritized or equally valued.

    It has been observed that the majority of older people from the UK, particularly those who are above 65 years of age, experience significant anxiety and low mood. Around 25% and 40% of people above 65 and 85 years of age, respectively, experience depression in care homes. It has been documented that 1 in 10 people above 75 years of age is diagnosed with clinical depression.

    In 2018, the Faculty of Old Age Psychiatry and the Royal College of Psychiatrists highlighted an increase in hospital admissions due to drug and alcohol abuse in older adults. These people were found to be particularly vulnerable to developing mental health issues and require nursing home care. Older adults living with dementia, poverty, and belonging to minority communities and immigrants are at a higher risk of experiencing adverse mental health conditions.

    Factors that increase later life mental health problems 

    Mental health problems in later life are complex due to age-specific risk factors, such as loneliness and multimorbidity. In addition to frailty due to aging, poverty, prior exposure to traumatic events, and racism also contribute to mental health problems in later life. Food insecurities, bereavement, and physical disabilities also lead to the development of mental health conditions.

    A significant proportion of older people develop long-term conditions (e.g., diabetes) and neurodegenerative conditions (e.g., Alzheimer’s disease) that raise the treatment burden and increase the risk of harmful interactions between different medications. Neuroinflammation can cause chronic pain and depression.

    Interestingly, studies have shown that people belonging to specific demography experience greater mental health issues, which could be due to inadequate mental health services. Older people residing in care homes are also more vulnerable to developing depression, anxiety, and neurodegenerative conditions.

    How to protect older adults from adverse mental health conditions?

    One of the factors that could help prevent mental health issues among older adults is positive relationships. This could include family, friendships, community groups, and social networks. Furthermore, having a meaningful option to work past retirement age and volunteering opportunities will help prevent adverse mental health conditions. It is important for this group of individuals to have a sense of purpose and to have control over life choices.

    In the majority of cases, awareness and open mind to therapies and healthy life behavior to address mental and physical health help prevent adverse outcomes. A healthy diet and regular physical activity have been recommended for a better quality of life.

    Mental health services and policies for older people

    In England, the national policy documents provided little insight into how mental health support should be provided to the older population. The National Institute for Health and Care Excellence (NICE, 2015) provided recommendations regarding the type of intervention that should be provided to prevent mental health problems in older adults.

    The lack of government investment to support older people’s mental health also contributes to their increased prevalence. The notion that mental health issues in older adults are inevitable or untreatable also increases their prevalence. An increase in age-friendly digital options could alleviate some of the key risk factors, such as loneliness, among older people. 

    Not many policies related to mental health care in later life exist. However, the Community Mental Health Framework (NHS England, 2019) provided insights into how severe or complex mental health problems could be met over a long-term plan.

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  • Prenatal exposure to nicotine could increase risk of behavioral disorders in newborns, study finds

    Prenatal exposure to nicotine could increase risk of behavioral disorders in newborns, study finds

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    Although several studies have linked smoking during pregnancy with neurodevelopmental disorders, the results of behavioral experiments in mice prenatally exposed to nicotine have been inconsistent. In a recent study, scientists from Japan developed a deep learning-based framework to automatically observe and classify mice behavior in such experiments, producing more accurate and unbiased results. They show that prenatal exposure to nicotine could increase the risk of autism spectrum- and attention deficit/hyperactivity disorders in newborns.

    The fact that smoking is a risk factor for several diseases, including cancer, stroke, and diabetes, has been known for approximately half a century. However, over the past few decades, scientists have brought to light many of the detrimental effects of smoking during pregnancy, linking this habit to high infant mortality, failed delivery, and low body weight at birth. In addition, recent studies suggest that prenatal nicotine exposure (PNE) may be related to neurodevelopmental disorders, such as attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

    For a long time now, scientists have used animal models (like rodents) to understand how PNE leads to neurodevelopmental disorders. By carefully analyzing the behavior of rodents, they can infer whether PNE is causing neurological changes and the brain regions affected by it; this can later be confirmed through histological analyses.

    Unfortunately, thus far, studies on behavioral changes induced by PNE in mice have shown varied results, some of which are contradictory. Although there could be multiple reasons behind these discrepancies, human error and bias are prime suspects. In general, the assessment of complex animal behaviors, especially social interactions, relies on the efforts of human observers, which introduces a baseline level of subjectivity that is hard to dispel. But what if we can leverage artificial intelligence (AI) to produce more accurate and unbiased results from observations of PNE mice behavior?

    In a recent study published in Cells on 1 February 2024, researchers from the Department of Molecular and Cellular Physiology at the Shinshu University School of Medicine, including graduate student Mengyun Zhou, Assistant Professor Takuma Mori, and Professor Katsuhiko Tabuchi, developed and trained a deep learning-based system to automatically analyze footage from behavioral experiments on mice. They used this tool to explore the behavioral changes induced by PNE in mice without observer biases, seeking to shed light on the link between nicotine and neurodevelopmental disorders.

    The proposed AI-based framework relied on a combination of two well-established open-source toolkits, namely DeepLabCut and Simple Behavioral Analysis (SimBA). “AI tools can label the body parts of animals in a markerless video footage and precisely estimate their poses using supervised machine learning,” explains Prof. Tabuchi. “Since animal behaviors are defined as a specific arrangement of body parts over a short period of time, deep-learning toolkits like SimBA can use the pose estimations obtained with DeepLabCut to classify different types of animal behaviors.” 

    After reaching an optimal training protocol for their framework using manually labeled data, the researchers conducted several experiments using PNE and control mice, looking for indicators of ADHD- and ASD-like behaviors. First, they carried out cliff avoidance reaction tests, which are used to test impulsivity. In these tests, they placed the subject mouse on top of a slightly elevated platform and took note-;both manually and with the AI system-;of how long the mouse waited before jumping down the platform. The test results suggested that PNE mice are more impulsive, a behavioral feature of ADHD in humans.

    They also tested the working memory of mice using a Y-shaped maze and counted the number of times each mouse spontaneously switched from one arm of the maze to another. “We observed a decrease in the spontaneous alteration in PNE mice, suggesting that their working memory was altered, which is another behavioral feature of ADHD,” comments Mengyun Zhou. “These results suggest prenatal exposure to nicotine may cause ADHD in mice, which is consistent with clinical reports in humans.“

    Finally, the researchers conducted open-field and social-interaction experiments, which represented the main challenge for their AI-based system. In these experiments, the researchers observed either one or two mice behaving freely in a large enclosure and looked for indicators of anxiety and social behaviors, such as grooming and following. Interestingly, PNE mice exhibited social behavioral deficits and increased anxiety which are features of ASD. Subsequent histological analysis of hippocampal brain tissue confirmed decreased neurogenesis, a hallmark of ASD. Thus, it appears that smoking may not only increase the risk of ADHD, but also ASD.

    Worth noting, the results obtained using the AI-based system were highly reliable, as Prof. Tabuchi highlights: “We validated the accuracy of our behavioral analysis framework by drawing a careful comparison between the results generated by the model and behavior assessments made by multiple human annotators, which is considered the gold standard.” These analyses cement the potential of the proposed approach and showcase its capabilities for many types of behavioral studies.

    With any luck, further efforts will pave the way to a solid understanding of mechanisms behind neurodevelopmental disorders like ASD and ADHD, ultimately leading to better diagnostic tools and therapeutic methods.

    Source:

    Journal reference:

    Zhou, M., et al. (2024). Deep-Learning-Based Analysis Reveals a Social Behavior Deficit in Mice Exposed Prenatally to Nicotine. Cells. doi.org/10.3390/cells13030275.

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  • Study reveals impact of socioeconomic status on children’s anxiety in research settings

    Study reveals impact of socioeconomic status on children’s anxiety in research settings

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    When participating in research studies, moderately anxious or highly anxious children from minoritized groups are likely to be hypervigilant to threat, further compounding the effects of their general state of anxiety, a research study led by a University of California, Riverside, psychologist reports.

    The study, which involved the participation of 46 Inland Southern California preadolescent Latina girls (8–13 years), has implications also for children from families with low socioeconomic status. 

    “Psychological research is often conducted in white, educated, and affluent communities,” said Kalina Michalska, an associate professor of psychology, who led the research team. “People from minoritized groups or people with low income and/or limited access to education are often not exposed to scientific research, and have historically been exploited by science, which contributes to their discomfort or legitimate mistrust.”

    In the study, the girls first completed a laboratory testing session during which they and their caregivers reported on family demographics as well as the girls’ behavior, anxiety, and other mental health outcome measures. The girls then completed an emotion processing task while in an MRI scanner. They viewed images of fearful and happy faces projected into the scanner bore while the researchers measured their brain responses.

    “Trait anxiety” is a constant state of anxiety. “State anxiety” is defined as a momentary feeling of anxiety, the kind one might experience going to the doctor’s office to learn the results of tests or when giving a public lecture.

    The researchers found that among girls with average or high levels of trait anxiety, their state anxiety before being MRI-scanned was associated with greater brain responses -; specifically, an increased amygdala-hippocampal response -; to fearful faces (threat stimuli) versus happy faces. This means a generally anxious participant experienced high levels of momentary anxiety when situated in a distressing environment, such as the MRI scanner.

    Undergoing an MRI scan is anxiety-inducing not just for children but also, more generally, for people unfamiliar with the scanning environment.”


    Kalina Michalska, associate professor of psychology, UCR

    In the study, which appears in the open access journal BMC Psychiatry, girls who rated their families as having a lower community standing tended to have elevated pre-scan state anxiety, suggesting that factors such as social status can influence children’s reactions to the research environment.

    Michalska, an expert on pediatric anxiety disorders, urges neuroimaging researchers to control for state anxiety and help participants from all backgrounds feel as comfortable as possible during testing sessions. 

    “Without accounting for state anxiety, data from experiments such as ours could be misattributed to temperamental, environmental, or cultural factors rather than apprehension of the research environment,” she said.

    According to Michalska, when children who are at risk for anxiety disorder (trait anxiety) are anxious “in the moment” (state anxiety), the differences in brain activity are due to the momentary anxiety, not the anxiety disorder. 

    “When interpreting the data, it is important not to misattribute the findings to an anxiety disorder or to a whole community when it is only momentary and situational anxiety,” she said. “Brain responses in experiments like ours need to be attributed not necessarily to the fact that the participants are, say, Latina, but to their historical experiences with science. Our participants had high anxiety because they were entering a space that has historically been hostile to them.”

    Michalska is hopeful the team’s findings can lead to new conversations about mental health. 

    “Doctors can change the way they think about patients’ mental health and teachers can think differently about the mental health of their students,” she said. “Our data show that socioeconomic status can play a significant role in patients’ and students’ anxiety and suggest that the scanning environment may be particularly anxiety-inducing for participants who feel marginalized relative to other members of society.”

    Next, the researchers plan on measuring social experiences, such as parents’ experiences of ethnic racial discrimination and children’s experiences of the same. The researchers also plan to measure children’s vicarious experiences resulting from watching their parents’ encounters with ethnic racial discrimination. 

    Michalska was joined in the research by her former graduate student and first author of the paper Dana E. Díaz, now at Columbia University Irving Medical Center in New York, and Wan-Ling Tseng of Yale University in Connecticut.

    The research was funded by a grant from the Hellman Fellows Program and a National Institute of Health subaward from the UCR Center for Health Disparities Research.

    The title of the research paper is “Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls.”

    Source:

    University of California – Riverside

    Journal reference:

    Díaz, D.E., et al. (2024) Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls. BMC Psychiatry. doi.org/10.1186/s12888-023-05403-6.

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  • SLU study examines the relationship between adversity, psychiatric and cognitive decline

    SLU study examines the relationship between adversity, psychiatric and cognitive decline

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    Saint Louis University associate professor of health management and policy in the College for Public Health and Social Justice, SangNam Ahn, Ph.D., recently published a paper in Journal of Clinical Psychology that examines the relationship between childhood adversity, and psychiatric decline as well as adult adversity and psychiatric and cognitive decline. His team discovered that just one instance of adversity in childhood can increase cases of mental illness later in life, and adverse events in adults can lead to a greater chance of both mental illness and cognitive decline later in life. 

    Life is very complicated, very dynamic. I really wanted to highlight the importance of looking into the lasting health effect of adversity, not only childhood but also adulthood adversity on health outcomes, especially physical health and psychiatric and cognitive health. There have been other studies before, but this is one of the first that looks into these issues comprehensively.” 


    SangNam Ahn, Ph.D., associate professor of health management and policy, Saint Louis University

    Ahn, along with his team of researchers, examined data from more nearly 3500 individuals over the course of 24 years. The group took the longitudinal data and evaluated it using a list of lifetime potential traumatic events.

    The research team included childhood adversity events such as moving due to financial difficulties, family requiring financial help, a parent experiencing unemployment, trouble with law enforcement before the age of 18, repeating school, physical abuse and parental abuse of drugs or alcohol. Adulthood adversity events included the death of a child, the death of a spouse, experiencing a natural disaster after age 17, firing a weapon in combat, a partner abusing drugs or alcohol, being a victim of a physical attack after age 17, a spouse or child battling a serious illness, receiving Medicaid or food stamps and experiencing unemployment. 

    The study determined that nearly 40 percent of all individuals experienced a form of childhood adversity, while that number climbed to nearly 80 percent for adulthood adversity. Those who experienced childhood adversity were also 17 percent more likely to experience adulthood adversity. Only 13 percent of individuals sampled reported two or more forms of childhood adversity, while 52 percent of adults experienced two or more forms of adult adversity. 

    In cases of either childhood adversity or adulthood adversity, researchers found individuals who experienced adversity were also more likely to experience anxiety and depression later in life, and in the case of adulthood adversity, were also more likely to experience cognitive decline later in life. 

    Individuals with one childhood adversity experience saw a five percent higher chance of suffering from anxiety, and those with two or more childhood adversity experiences had 26 percent and 10 percent higher chances of depression and anxiety, respectively. Individuals who experienced two adulthood adversities had a 24 percent higher chance of depression, while also experiencing a three percent cognitive decline later in life. 

    While most of the results were expected or unsurprising, one area that stood out to Ahn was education. Those individuals studied who reported higher levels of education saw a reduction in the number of adversity experiences. Ahn hopes to study this avenue more to learn how education may be able to mitigate or prevent these declines. 

    “Before including education, there was a significant association between childhood adversity and cognitive impairment,” Ahn said. “But when including education as a covariate, that significant association disappeared. Interesting. So there were important implications here. Education and attending school, people could be better off even if they were exposed to childhood adversity. They’re likely to learn positive coping mechanisms, which may help avoid relying on unhealthy coping mechanisms, such as smoking or excessive drinking or drug use.

    “Education is quite important in terms of health outcomes,” Ahn added. “If I am educated, I’m likely to get a better job, have a higher income, and live in areas with less crime. I’m likely to buy gym membership or regularly exercise. I’m likely to shop at Whole Foods and get proper nutrition. All of which help combat these adversities we hinted at in the study. So the education and health outcomes are already closely related, and that is what we saw in our study.”

    Ahn also encourages clinicians and everyday people alike to discuss their stress. Clinicians can learn more about their patients and have a better approach when it comes to their physical and mental health, while others could potentially relate to shared experiences. But through awareness and recognition, these adverse experiences could potentially have less serious, lasting effects. 

    “Public health is very interested in stress,” Ahn said. “But we’re still examining how daily stress impacts our long term health outcomes. So to see the effects here in the study, I want people to pay attention to their stress and proactively address it. Clinicians should have deep discussions with their patients about their stress and mental state. And those topics can be approached in other areas too, like the classroom or the dining room table. The more we are aware of stress and discuss our stress, the better we can handle any adversities we find in life.”

    Source:

    Journal reference:

    Ahn, S., et al. (2024). Lifetime adversity predicts depression, anxiety, and cognitive impairment in a nationally representative sample of older adults in the United States. Journal of Clinical Psychology. doi.org/10.1002/jclp.23642.

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  • Research finds link between unhealthy eating and chronic pain severity, calls for comprehensive dietary support

    Research finds link between unhealthy eating and chronic pain severity, calls for comprehensive dietary support

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    In a recent study in Scientific Reports, researchers analyzed trends related to dietary and lifestyle habits among individuals living with chronic pain.

    Their results indicate that despite common suboptimal habits such as fast-food consumption and irregular mealtimes, many younger people, those with obesity, and individuals with extended pain expressed a desire to live healthier.

    These findings can help healthcare professionals address nutrition in pain management regimens.

    Study: Eating habits and the desire to eat healthier among patients with chronic pain: a registry-based study. Image Credit: fizkes/Shutterstock.comStudy: Eating habits and the desire to eat healthier among patients with chronic pain: a registry-based study. Image Credit: fizkes/Shutterstock.com

    Background

    Researchers believe that one in five adults worldwide lives with chronic pain, which should be treated using biopsychosocial strategies that address social, psychological, and biomedical factors and incorporate factors related to nutrition, stress reduction, sleep, exercise, and activity.

    Nutrition is closely related to chronic pain, with better nutrition correlating with better pain outcomes and vice versa. Diet can modulate inflammation, oxidative stress, gut health, and lipid and glucose metabolism while altering the central nervous system.

    Poor diet quality can also result from isolation and depression, which are commonly experienced by people living with chronic pain.

    Understanding dietary behaviors, particularly in terms of eating ultra-processed, nutrient-poor, and energy-rich foods, can help medical professionals treat chronic pain and encourage their patients to adopt more optimal dietary behaviors. However, large-scale surveys have not been used to investigate these factors.

    About the study

    Researchers recruited patients at a specialized pain and rehabilitation center in Sweden, many of whom had been diagnosed with neck pain, lower back pain, hypermobile Ehler-Danos syndrome, and fibromyalgia.

    To be included in the study, patients needed to fill up questionnaires, including self-reported height and weight, and to provide consent that their data could be utilized. Baseline information or data from before a consultation with a physician was used.

    Physical or functional impairments impacted the ability of several patients to work, and many also experienced psychosocial stresses like social isolation, depression, and anxiety.

    The researchers collected information about their pain, psychometric data, quality of life, physical disability, and socio-demographic backgrounds.

    The average pain intensity in the week preceding the survey was scored from 0 (meaning no pain) to 10 (meaning the worst possible pain level).

    Participants also provided information on when they had started feeling their current pain level and the locations of the body where they felt it, which was used to calculate a Pain Region Index (PRI).

    Depression and anxiety were each scored from 0 to 21, with a score over 10 indicating that the patient was depressed or anxious, respectively. Lifestyle factors included tobacco and alcohol consumption, adherence to regular mealtimes, and intake of fruit, vegetables, fast food, and confectionery.

    Participants were also asked to select their priorities from increasing exercise, eating healthier, ceasing smoking, reducing alcohol consumption, and reducing weight. They could also state that none of these were priorities.

    Statistical tests, correlation analysis, and regression modeling were used to analyze the data, and sensitivity analysis was used to evaluate bias due to missing data.

    Findings

    Of the 2,152 people included in the study, about 72% were women, 84% had been born in a Nordic country, 20% had been to university, and less than a third were satisfied with their socioeconomic status. On average, they were 46.1 years old, and more than half were obese or overweight.

    More than 50% said they had been in pain for five years or more, reported high pain intensity and spatial extent of pain, and had either depression or anxiety or both. One in three were categorized as clinically emotionally distressed.

    Based on statistical testing, people who said they desired to eat healthier (PD) were more likely to be young than those who did not (PND), had a higher BMI, reported a longer duration of pain, had greater spatial pain extent and emotional distress, and were less satisfied with their socioeconomic status.

    Slightly over 27% of participants reported having irregular mealtimes; these were twice as common among PD participants than among PND participants.

    The PD group also reported lower fruit and vegetable intake and higher confectionary and fast-food consumption. Notably, the PD group reported lower alcohol consumption frequency than the PND group and were slightly more likely to consume tobacco.

    Correlation analysis suggested that mealtime regularity was significantly associated with pain scores, duration, and PRI, but also varied with obesity and social and demographic factors. The pain score was significantly associated with all suboptimal eating habits.

    Even in the regression model, the desire to eat healthier was significantly associated with suboptimal dietary habits.

    Multivariate regression analysis also showed that the PD group was, on average, aged between 18 and 29, more likely to be obese, and more likely to have a higher PRI.

    Conclusions

    The effectiveness of lifestyle interventions, including dietary ones, depends on the motivations and desires of the intervention group.

    These findings show that many people with suboptimal eating habits want to adopt healthier behaviors, indicating an opportunity for healthcare professionals to intervene using behavior change and education strategies to help manage chronic pain.

    Journal reference:

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  • Exposure to neighborhood violence linked to unmet health needs and increased care utilization in children

    Exposure to neighborhood violence linked to unmet health needs and increased care utilization in children

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    A new collaborative study between Boston Medical Center, Brigham and Women’s Hospital, Boston Children’s Hospital, Hennepin Healthcare Research Institute, University of Pennsylvania, and Children’s Hospital of Philadelphia finds exposure to neighborhood violence among children was associated with unmet health needs and increased acute care utilization. Published in the American Journal of Preventive Medicine and based on nationally representative data on violence exposure and gold standard access to care measures from the National Health Interview Survey, this study shows that evidence-based interventions to improve access to care in communities impacted by violence are needed to mitigate long-term physical and mental health consequences for children.

    Millions of children in the U.S. are exposed to violence in their homes or communities. Research has shown that children exposed to violence have worse school performance in childhood, increased rates of substance use disorder in adolescence, increased rates of anxiety, depression, and post-traumatic stress disorder in adulthood, and increased risk of developing chronic medical conditions throughout their lives. Exposure to violence also deepens child health inequities, particularly in marginalized communities disproportionately exposed to violence due to systemic racism across generations.

    This study helps examine violence exposure at the population level as both a direct driver of health inequities and as a consequence of fundamental causes like racism, poverty, and other structural risk conditions. The researchers found that, even after controlling for the effects of other important factors like family income and insurance status, children exposed to neighborhood violence face unmet physical and mental health care needs, cost-related barriers, decreased access to prescription drugs, increased urgent care and emergency department utilization, and decreased access to preventive care, mental health care, and medications.

    The study also identified an association between exposure to neighborhood violence and mental health symptoms, including increased rates of depression and anxiety, which was consistent with multiple previous studies. Researchers also found that children exposed to violence have higher rates of delayed and forgone mental health care despite experiencing more mental health symptoms. Prior research shows how early access to care can mitigate the mental health consequences of violence exposure; improving access to high-quality, affordable mental health care services remains critical in communities impacted by neighborhood violence.

    Researchers call attention to built-in environment reforms like neighborhood greening and cleanup, poverty alleviation interventions like the expanded Child Tax Credit, insurance coverage protections like continuous Medicaid enrollment, and hospital-based violence prevention programs as opportunities to take action.

    Our findings highlight the profound impacts of limited access to care in communities affected by violence. We also identify specific opportunities for evidence-based clinician, health system, and policy actions that can reduce the incidence of neighborhood violence and mitigate its health consequences.”


    Rohan Khazanchi, MD, MPH, lead author, resident in the Harvard Internal Medicine-Pediatrics Residency Program at Brigham & Women’s Hospital, Boston Children’s Hospital, and Boston Medical Center

    “To improve health outcomes for the millions of children in the United States affected by neighborhood violence, we have to invest in their families and communities,” said senior author Aditi Vasan, MD, MSHP, a pediatrician at Children’s Hospital of Philadelphia and Assistant Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. “Our findings underscore the need for both upstream policy interventions, like the expanded Child Tax Credit, which would provide essential economic support for families in low-income communities impacted by violence, and downstream health system interventions focused on improving access to high-quality, trauma-informed care for these children and their families.”

    Source:

    Journal reference:

    Khazanchi, R., et al. (2024) Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. American Journal of Preventive Medicine. doi.org/10.1016/j.amepre.2024.01.009.

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  • How can food influence the severity of menopausal hot flashes?

    How can food influence the severity of menopausal hot flashes?

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    In a recent review published in Nutrients, researchers reviewed scientific literature from the previous five years, especially genome-wide association studies (GWAS), to identify mechanisms and nutrients related to menopause hot flashes.

    Study: Menopause Hot Flashes and Molecular Mechanisms Modulated by Food-Derived Nutrients. Image Credit: fizkes/Shutterstock.comStudy: Menopause Hot Flashes and Molecular Mechanisms Modulated by Food-Derived Nutrients. Image Credit: fizkes/Shutterstock.com

    Background

    The etiology of vasomotor symptoms (VMS), such as hot flashes, is unknown; however, they may be molecular and polygenic.

    Food provides bioactive compounds and nutrients to the human body, digested via several enzymatic biological pathways. The compounds can stimulate molecular signaling pathways, which activate effector protein molecules controlling hot flashes experienced by menopausal women.

    About the review

    In the present review, researchers explored the biological mechanisms underlying menopause hot flashes and related food-derived nutrients.

    Introduction

    Menopause refers to a physiological process that affects women at 50 years of age, characterized by a year of amenorrhea with no additional pathological or physiological factors.

    The menopausal transitional phase, occurring between irregular menstrual periods and menopause, precedes this one year.

    Menopausal transition symptoms include monthly irregularities, hot flashes, sleeplessness, sweating, vertigo, palpitation, tinnitus, headache, memory issues, mood changes, lack of focus, skin changes, genitourinary atrophy, and body weight changes.

    Hot flashes, a common menopausal transitional feature, may present with palpitations, night sweats, irritability, and anxiety and lasts two to four minutes.

    Hot flashes might occur infrequently or at least once per hour and are frequently associated with worse life quality, decreased productivity, reduced mood, embarrassment, exhaustion, anxiety, sleep disruption, social isolation, and impaired memory performance.

    Hormone therapies are highly effective in treating hot flashes but are not always feasible. Future studies on pathways underlying menopause hot flashes could aid in developing targeted therapies, as foods might alter the processes of menopause hot flashes and regulate their effects.

    Nutritional compounds and pathways involved in menopause hot flashes

    Several biochemical pathways and compounds cause hot flashes, a frequent symptom of menopause. These pathways differ from individual to individual and involve thermoregulatory processes controlled by the parasympathetic and sympathetic nervous systems.

    Thermoregulatory processes, such as the upregulation of neuropeptides like kisspeptin and neurokinin B, help to dissipate heat during menopause.

    Nutritional compounds that modulate signaling pathways, such as nutrients that modulate the kisspeptin-gonadotropin-releasing hormone (GnRH) pathway; nutrients that modulate the aryl hydrocarbon receptor (AHR) signaling; catechol estrogens and estrogen sulfotransferase; and nutrients that modulate the inflammatory-oxidative stress biomarker, may cause hot flashes.

    Compounds linked to hot flashes include genistein, docosahexaenoic acid (DHA), polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), β-carotene, curcumin, folic acid (Pteroyl-L-glutamic acid), vitamin B12, high-fat diet components, tryptophan metabolites, apigenin, chrysin, epicatechin, quercetin, resveratrol, and vitamin E.

    Genistein boosts GnRH production via regulating kisspeptin receptors, sirtuin 1 (SIRT1), protein kinase c γ (PKCγ), and makorin ring finger protein 3 (MKRN3). DHA, PUFA, and SFA promote GnRH mRNA expression.

    Palmitate disrupts hypothalamic function in GnRH neurons by regulating spexin (SPX) and its receptors, galanin receptor 2 (GALR2) and galanin receptor 3 (GALR3), through pathways involving protein kinase C (PKC), mitogen-activated protein kinases (MAPKs), and Toll-like receptor 4 (TLR4).

    β-carotene, curcumin, tryptophan metabolites, and high-fructose diet (HFD) components such as cholesterol, fructose, and palmitic acid activate aryl hydrocarbon receptors (AHR) and folic acid and vitamin B12 inhibit their transcriptional activity.

    Vitamin E lowers hot flashes over the week and enhances antioxidant status by boosting total antioxidant capacity (TAC). Higher ghrelin levels are associated with an increased risk of hot flashes in women in the early and late stages of menopause.

    Hot flashes are associated with insulin resistance in postmenopausal women, and the relationship between the two depends on the leptin-adiponectin interaction.

    Low estrogen activation of glucose transporter 1 (GLUT) may cause hot flashes, a frequent central nervous system symptom. Studies have demonstrated significant connections between SNPs in numerous genes, including aryl hydrocarbon receptor (AHR), aryl hydrocarbon receptor repressor (AHRR), aryl hydrocarbon receptor nuclear translocator (ARNT), catechol-O-methyltransferase (COMT), and cytochrome P450 (CYP) enzymes such as CYP1 A2, CYP3A4, and CYP19 A1.

    These symptoms are most prevalent among African American women, Asian women, and white women of Hispanic and non-Hispanic heritage in the United States.

    Conclusion

    To conclude, based on the review findings, several variables, including food-derived nutrients and molecular pathways, impact hot flashes, a frequent symptom of menopause.

    These symptoms are a primary concern for women, and understanding the underlying causes is critical. Modifying these processes may help relieve hot flash symptoms.

    Hot flashes may be associated with lower estrogen levels, hypothalamic processes, adipocyte-derived hormones, the kisspeptin-GnRH pathway, aryl hydrocarbon receptor signaling, glucose availability, inflammatory-oxidative stress, catechol estrogens, and estrogen sulfotransferase.

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  • Forest bathing boosts youth mental health in urban environments

    Forest bathing boosts youth mental health in urban environments

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    Youth mental health in urban environments is significantly better when more nature is incorporated into city design. 

    A new study from University of Waterloo researchers suggests that forest bathing, the simple method of being calm and quiet amongst the trees, observing nature around you while breathing deeply, can help youth de-stress and boost health and well-being.

    The study was the first ever to collect on-site, real-time survey data from adolescents about their emotional responses to various urban environments like a transit hub, residential streets, trails, parks, and waterways. Natural urban spaces were consistently related to significantly higher scores in positive outcomes.

    While the findings may not be surprising to most people, what’s significant is that for the first time, we’re able to specifically say this is how much anxiety is reduced when kids are by a park as opposed to by a city center.”

    Leia Minaker, associate professor in the School of Planning and director of the Future Cities Initiative

    The Future Cities Initiative is the latest in the University of Waterloo’s efforts to address the need to create healthy and prosperous urban futures for all.

    After standing and looking at an urban lake for just two or three minutes, youth scores on a validated anxiousness scale decreased by nine per cent. On the other hand, their anxiousness scores were 13 per cent higher when standing in a busy downtown location for the same length of time. This is after adjusting for several other factors, including age, gender, ethnicity, mental health diagnosis, and social status. 

    With urbanization accelerating rapidly, it’s vital to understand urban environments’ impact on youth better. Especially given that depression and anxiety are among the leading causes of illness among adolescents.

    The study found that nature motifs or patterns on buildings, natural sights in urban environments, such as lakes and public activity parks, and landscape elements, like gardens and trees, enhance positive emotional experiences for youth. While these urban characteristics are unique to adolescents, they might be interpreted differently from adults who pursue other activities. For example, adults might be more likely to walk or run in green spaces, whereas youth are more likely to skateboard or hang out. 

    In designing cities with health and sustainability for all age groups in mind, these findings provide clear evidence that planners, city builders, and healthcare providers can use to advocate for specific natural urban design features. 

    “Teens are frequently excluded from any kind of decision about the cities they live in,” Minaker said. “It’s important to get their opinions and quantify their experiences because childhood experiences influence many long-term health and disease outcomes.”

    The researchers’ next step will be to find a link in the mental health data to the long-term economic and social impacts. Future research will assess the mental and physical health of kids living in high-rise apartment buildings, another area of research that is poorly understood in North America. 

    Source:

    Journal reference:

    Buttazzoni, A., & Minaker, L. M. (2023). Associations between real-time, self-reported adolescent mental health and urban and architectural design concepts. Cities & Health. doi.org/10.1080/23748834.2023.2286741.

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  • Cognitive behavioral therapy helps prevent postpartum mental health challenges in low-resource settings

    Cognitive behavioral therapy helps prevent postpartum mental health challenges in low-resource settings

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    Results from a large clinical trial funded by the National Institutes of Health show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth. The unique intervention was administered by non-specialized providers who had the equivalent of a bachelor’s degree in psychology-;but no clinical experience. The results suggest this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.

    In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists. This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”


    Joshua A. Gordon, M.D., Ph.D., Director of the National Institute of Mental Health, part of NIH

    Led by Pamela J. Surkan, Ph.D., Sc.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab Province of Pakistan between April 2019 and January 2022. Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive behavioral therapy (CBT)-based intervention called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.

    The researchers found that 9% of women in the intervention group developed moderate-to-severe anxiety compared with 27% of women in the routine care group. Additionally, 12% percent of women in the intervention group developed depression compared with 41% of women in the routine care group.

    “Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr. Surkan. “The link between maternal and child health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”

    The Happy Mother-Healthy Baby intervention was created using input from pregnant women in a hospital in Rawalpindi, Pakistan. Pregnant women took part in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and to practice replacing them with helpful thoughts and behaviors. The first five sessions were conducted in early to mid-pregnancy, and the sixth session occurred in the third trimester.

    Prior research suggests that up to 30% of women in the Global South, which includes South America, Africa, and most of southern Asia, report experiencing anxiety during pregnancy. Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention. However, it can be challenging for women living in low-resource settings to access trained clinical care. The findings from this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialist clinical care may be hard to access.

    “In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr. Surkan.

    Source:

    NIH/National Institute of Mental Health

    Journal reference:

    Surkan, P. J., et al. (2024). Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: a randomized, phase 3 trial. Nature Medicine. doi.org/10.1038/s41591-024-02809-x.

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  • Study finds sharp increase in antidepressant dispensing among adolescents and young adults during COVID-19 pandemic

    Study finds sharp increase in antidepressant dispensing among adolescents and young adults during COVID-19 pandemic

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    Antidepressant dispensing to adolescents and young adults increased sharply after the COVID-19 pandemic began – particularly among females – a new study finds.

    While a growing number of young people ages 12 to 25 were receiving antidepressants before the pandemic, the antidepressant dispensing rate rose nearly 64% faster after March 2020, according to Michigan Medicine led findings in Pediatrics.

    Antidepressant dispensing to adolescents and young adults was already high and rising before March 2020. Our findings suggest these trends accelerated during the pandemic.”


    Kao Ping Chua, M.D., Ph.D., lead author, pediatrician and researcher at University of Michigan Health C.S. Mott Children’s Hospital and the Susan B. Meister Child Health Evaluation and Research Center

    Researchers analyzed data from a national database reporting 92% of prescriptions dispensed in U.S. pharmacies. They found that the increase in the antidepressant dispensing rate during the pandemic was driven by females. 

    After March 2020, this rate increased 130% faster among female adolescents ages 12-17 years and 60% faster among female young adults ages 18-25 years. 

    “Multiple studies suggest that rates of anxiety and depression among female adolescents increased during the pandemic,” Chua said. “These studies, coupled with our findings, suggest the pandemic exacerbated a pre-existing mental health crisis in this group.”

    In contrast to females, the antidepressant dispensing rate changed little among male young adults after March 2020 and declined among male adolescents, which Chua found surprising.

    “It’s hard to believe this decline reflects improved mental health,” he said.

    He believes a more likely explanation is that male adolescents may have skipped physicals and other health care visits during the pandemic, decreasing opportunities to diagnose and treat anxiety and depression.

    The transition away from in-person learning, he notes, may have also decreased opportunities for teachers and other school staff to detect mental health problems in male adolescents. 

    Chua said the overall rise in antidepressant dispensing to adolescents and young adults may not only be related to worsened mental health. Long waitlists for psychotherapy, for example, may have also played a role.

    “In my primary care clinic, I often heard from patients and families that they were facing 6-9 month wait lists for therapy during the pandemic. In those situations, it didn’t make sense to withhold antidepressants and recommend a therapy-only approach,” he said.

    Further studies, Chua says, should identify which interventions can best promote the mental health of adolescents and young adults. 

    Source:

    Michigan Medicine – University of Michigan

    Journal reference:

    Chua, K-P., et al. (2024) Antidepressant Dispensing to US Adolescents and Young Adults: 2016–2022. Pediatrics. doi.org/10.1542/peds.2023-064245.

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