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  • is social media really behind an epidemic of teenage mental illness?

    is social media really behind an epidemic of teenage mental illness?

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    A teenage girl lies on the bed in her room lightened with orange and teal neon lights and watches a movie on her mobile phone.

    Social-media platforms aren’t always social.Credit: Getty

    The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness Jonathan Haidt Allen Lane (2024)

    Two things need to be said after reading The Anxious Generation. First, this book is going to sell a lot of copies, because Jonathan Haidt is telling a scary story about children’s development that many parents are primed to believe. Second, the book’s repeated suggestion that digital technologies are rewiring our children’s brains and causing an epidemic of mental illness is not supported by science. Worse, the bold proposal that social media is to blame might distract us from effectively responding to the real causes of the current mental-health crisis in young people.

    Haidt asserts that the great rewiring of children’s brains has taken place by “designing a firehose of addictive content that entered through kids’ eyes and ears”. And that “by displacing physical play and in-person socializing, these companies have rewired childhood and changed human development on an almost unimaginable scale”. Such serious claims require serious evidence.

    Collection: Promoting youth mental health

    Haidt supplies graphs throughout the book showing that digital-technology use and adolescent mental-health problems are rising together. On the first day of the graduate statistics class I teach, I draw similar lines on a board that seem to connect two disparate phenomena, and ask the students what they think is happening. Within minutes, the students usually begin telling elaborate stories about how the two phenomena are related, even describing how one could cause the other. The plots presented throughout this book will be useful in teaching my students the fundamentals of causal inference, and how to avoid making up stories by simply looking at trend lines.

    Hundreds of researchers, myself included, have searched for the kind of large effects suggested by Haidt. Our efforts have produced a mix of no, small and mixed associations. Most data are correlative. When associations over time are found, they suggest not that social-media use predicts or causes depression, but that young people who already have mental-health problems use such platforms more often or in different ways from their healthy peers1.

    These are not just our data or my opinion. Several meta-analyses and systematic reviews converge on the same message2–5. An analysis done in 72 countries shows no consistent or measurable associations between well-being and the roll-out of social media globally6. Moreover, findings from the Adolescent Brain Cognitive Development study, the largest long-term study of adolescent brain development in the United States, has found no evidence of drastic changes associated with digital-technology use7. Haidt, a social psychologist at New York University, is a gifted storyteller, but his tale is currently one searching for evidence.

    Of course, our current understanding is incomplete, and more research is always needed. As a psychologist who has studied children’s and adolescents’ mental health for the past 20 years and tracked their well-being and digital-technology use, I appreciate the frustration and desire for simple answers. As a parent of adolescents, I would also like to identify a simple source for the sadness and pain that this generation is reporting.

    A complex problem

    There are, unfortunately, no simple answers. The onset and development of mental disorders, such as anxiety and depression, are driven by a complex set of genetic and environmental factors. Suicide rates among people in most age groups have been increasing steadily for the past 20 years in the United States. Researchers cite access to guns, exposure to violence, structural discrimination and racism, sexism and sexual abuse, the opioid epidemic, economic hardship and social isolation as leading contributors8.

    How social media affects teen mental health: a missing link

    The current generation of adolescents was raised in the aftermath of the great recession of 2008. Haidt suggests that the resulting deprivation cannot be a factor, because unemployment has gone down. But analyses of the differential impacts of economic shocks have shown that families in the bottom 20% of the income distribution continue to experience harm9. In the United States, close to one in six children live below the poverty line while also growing up at the time of an opioid crisis, school shootings and increasing unrest because of racial and sexual discrimination and violence.

    The good news is that more young people are talking openly about their symptoms and mental-health struggles than ever before. The bad news is that insufficient services are available to address their needs. In the United States, there is, on average, one school psychologist for every 1,119 students10.

    Haidt’s work on emotion, culture and morality has been influential; and, in fairness, he admits that he is no specialist in clinical psychology, child development or media studies. In previous books, he has used the analogy of an elephant and its rider to argue how our gut reactions (the elephant) can drag along our rational minds (the rider). Subsequent research has shown how easy it is to pick out evidence to support our initial gut reactions to an issue. That we should question assumptions that we think are true carefully is a lesson from Haidt’s own work. Everyone used to ‘know’ that the world was flat. The falsification of previous assumptions by testing them against data can prevent us from being the rider dragged along by the elephant.

    A generation in crisis

    Two things can be independently true about social media. First, that there is no evidence that using these platforms is rewiring children’s brains or driving an epidemic of mental illness. Second, that considerable reforms to these platforms are required, given how much time young people spend on them. Many of Haidt’s solutions for parents, adolescents, educators and big technology firms are reasonable, including stricter content-moderation policies and requiring companies to take user age into account when designing platforms and algorithms. Others, such as age-based restrictions and bans on mobile devices, are unlikely to be effective in practice — or worse, could backfire given what we know about adolescent behaviour.

    A third truth is that we have a generation in crisis and in desperate need of the best of what science and evidence-based solutions can offer. Unfortunately, our time is being spent telling stories that are unsupported by research and that do little to support young people who need, and deserve, more.

    Competing Interests

    The author declares no competing interests.

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  • California is expanding insurance access for teenagers seeking therapy on their own

    California is expanding insurance access for teenagers seeking therapy on their own

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    When she was in ninth grade, Fiona Lu fell into a depression. She had trouble adjusting to her new high school in Orange County, California, and felt so isolated and exhausted that she cried every morning.

    Lu wanted to get help, but her Medi-Cal plan wouldn’t cover therapy unless she had permission from a parent or guardian.

    Her mother — a single parent and an immigrant from China — worked long hours to provide for Fiona, her brother, and her grandmother. Finding time to explain to her mom what therapy was, and why she needed it, felt like too much of an obstacle.

    “I wouldn’t want her to have to sign all these forms and go to therapy with me,” said Lu, now 18 and a freshman at UCLA. “There’s a lot of rhetoric in immigrant cultures that having mental health concerns and getting treatment for that is a Western phenomenon.”

    By her senior year of high school, Lu turned that experience into activism. She campaigned to change state policy to allow children 12 and older living in low-income households to get mental health counseling without their parents’ consent.

    In October of last year, Gov. Gavin Newsom signed a new law expanding access to young patients covered by Medicaid, which is called Medi-Cal in California.

    Teenagers with commercial insurance have had this privilege in the state for more than a decade. Yet parents of children who already had the ability to access care on their own were among the most vocal in opposing the expansion of that coverage by Medi-Cal.

    Many parents seized on the bill to air grievances about how much control they believe the state has over their children, especially around gender identity and care.

    One mother appeared on Fox News last spring calling school therapists “indoctrinators” and saying the bill allowed them to fill children’s heads with ideas about “transgenderism” without their parents knowing.

    Those arguments were then repeated on social media and at protests held across California and in other parts of the country in late October.

    At the California Capitol, several Republican lawmakers voted against the bill, AB 665. One of them was Assembly member James Gallagher of Sutter County.

    “If my child is dealing with a mental health crisis, I want to know about it,” Gallagher said while discussing the bill on the Assembly floor last spring. “This misguided, and I think wrongful, trend in our policy now that is continuing to exclude parents from that equation and say they don’t need to be informed is wrong.”

    State lawmaker salaries are too high for them or their families to qualify for Medi-Cal. Instead, they are offered a choice of 15 commercial health insurance plans, meaning children like Gallagher’s already have the privileges that he objected to in his speech.

    To Lu, this was frustrating and hypocritical. She said she felt that the opponents lining up against AB 665 at legislative hearings were mostly middle-class parents trying to hijack the narrative.

    “It’s inauthentic that they were advocating against a policy that won’t directly affect them,” Lu said. “They don’t realize that this is a policy that will affect hundreds of thousands of other families.”

    Sponsors of AB 665 presented the bill as a commonsense update to an existing law. In 2010, California lawmakers had made it easier for young people to access outpatient mental health treatment and emergency shelters without their parents’ consent by removing a requirement that they be in immediate crisis.

    But at the last minute, lawmakers in 2010 removed the expansion of coverage for teenagers by Medi-Cal for cost reasons. More than a decade later, AB 665 is meant to close the disparity between public and private insurance and level the playing field.

    “This is about equity,” said Assembly member Wendy Carrillo, a Los Angeles Democrat and the bill’s author.

    The original law, which regulated private insurance plans, passed with bipartisan support and had little meaningful opposition in the legislature, she said. The law was signed by a Republican governor, Arnold Schwarzenegger.

    “Since then, the extremes on both sides have gotten so extreme that we have a hard time actually talking about the need for mental health,” she said.

    After Carrillo introduced the bill last year, her office faced death threats. She said the goal of the law is not to divide families but to encourage communication between parents and children through counseling.

    More than 20 other states allow young people to consent to outpatient mental health treatment without their parents’ permission, including Colorado, Ohio, Tennessee, and Alabama, according to a 2015 paper by researchers at Rowan University.

    To opponents of the new law, like Erin Friday, a San Francisco Bay Area attorney, AB 665 is part of a broader campaign to take parents’ rights away in California, something she opposes regardless of what kind of health insurance children have.

    Friday is a self-described lifelong Democrat. But then she discovered her teenager had come out as transgender at school and for months had been referred to by a different name and different pronouns by teachers, without Friday’s knowledge. She devoted herself to fighting bills that she saw as promoting “transgender ideology.” She said she plans to sue to try to overturn the new California law before it takes effect this summer.

    “We’re giving children autonomy they should never have,” Friday said.

    Under the new law, young people will be able to talk to a therapist about gender identity without their parents’ consent. But they cannot get residential treatment, medication, or gender-affirming surgery without their parents’ OK, as some opponents have suggested.

    Nor can minors run away from home or emancipate themselves under the law, as opponents have also suggested.

    “This law is not about inpatient psychiatric facilities. This law is not about changing child custody laws,” said Rachel Velcoff Hults, an attorney and the director of health of the National Center for Youth Law, which supported AB 665.

    “This law is about ensuring when a young person needs counseling or needs a temporary roof over their head to ensure their own safety and well-being, that we want to make sure they have a way to access it,” she said.

    Removing the parental consent requirement could also expand the number of mental health clinicians in California willing to treat young people on Medi-Cal. Without parental consent, under the old rules, clinicians could not be paid by Medi-Cal for the counseling they provided, either in a private practice or a school counselor’s office.

    Esther Lau struggled with mental health as a high school student in Fremont. Unlike Lu, she had her parents’ support, but she couldn’t find a therapist who accepted Medi-Cal. As the only native English speaker in her family, she had to navigate the health care bureaucracy on her own.

    For her, AB 665 will give clinicians incentive to accept more young people from low-income households into their practices.

    “For the opposition, it’s just about political tactics and furthering their agenda,” Lau said. “The bill was designed to expand access to Medi-Cal youth, period.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Urgent care needed for stroke survivors facing long-term depression

    Urgent care needed for stroke survivors facing long-term depression

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    Researchers say more needs to be done for depressed stroke survivors as new findings show 60% of stroke survivors would experience depression within 18 years, a much higher estimation than previous studies.

    This compares to 22% of the general population experiencing depression in the same time frame.

    The King’s College London study, published today in The Lancet Regional Health – Europe, also found 90% of cases of depression occurred within five years of surviving a stroke, indicating a key time for healthcare intervention.

    The findings, funded by the National Institute for Health and Care Research, looks at incidence of mild and severe depression in the South London Stroke Register, a cohort of 6600 survivors of stroke in the Lambeth and North Southwark boroughs.

    The population was 55.4% male with a median age of 68 years. 62.5% were from a white ethnic background and 29.7% from a Black ethnic background.

    While post-stroke depression is common after stroke and associated with poor functional ability and increased mortality, the study found that severe depression tended to occur earlier after stroke, had a longer duration and was quicker to recur than mild depression.

    Depression is common in stroke survivors but our research shows it persists for much longer than previously thought. We know that depression can limit a stroke survivor’s mobility including simple things as walking and holding objects and can also increase the risk of death. With an aging population in the UK and an increase in the proportion of older adults, it’s essential we plan for rising healthcare demands to tackle the anticipated surge in stroke cases.”


    Professor Yanzhong Wang, Professor of Statistics in Population Health at King’s College London

    Corresponding author Lu Liu, a PhD candidate with a clinical background at King’s College London, said: “Quality of life is important for stroke survivors as there is evidence depressed survivors have a reduced survival rate.

    “There are many reasons why this could be, including disruptions to the survivor’s social life, reduced physical ability and inflammatory disorders observed in depressed patients.

    “More clinical attention should be paid to patients with depression that is longer than one year because of the high risks of experiencing persistent depression.”

    Source:

    Journal reference:

    Liu, L., et al. (2024) Natural history of depression up to 18 years after stroke: a population-based South London Stroke Register study. The Lancet Regional Health – Europe. doi.org/10.1016/j.lanepe.2024.100882.

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  • Study reveals ADHD medication reduces psychiatric hospitalizations and work disability

    Study reveals ADHD medication reduces psychiatric hospitalizations and work disability

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    Attention-deficit/hyperactivity disorder (ADHD), which causes affected individuals to be impulsive, hyperactive, or inattentive, is typically treated with medications and psychosocial measures. Treatment is associated with numerous benefits, such as reduced suicidal ideation and depression, fewer accidents and inadvertent injuries, as well as better long-term employment statistics.

    Nevertheless, ADHD medication may have potential adverse outcomes like psychotic episodes. A new study in the JAMA Network Open explores the association between ADHD medication and the risk of hospitalization for psychiatric and non-psychiatric reasons.

    Study: Attention-deficit/hyperactivity disorder medications and work disability and mental health outcomes. Image Credit: Alena Kalincheva / Shutterstock.com

    ADHD and stimulants

    While ADHD medications include both stimulants and non-stimulants, stimulants used to treat ADHD have been reported to improve the level of functioning and quality of life. Short-term trial meta-analysis data indicates the first choice of ADHD stimulants in adults is amphetamine, whereas methylphenidate is often used for treating adolescents and children.

    More research is needed to determine the long-term safety of these therapeutics, particularly in regard to their ability to increase blood pressure and heart rate, cause seizures, and trigger psychosis or mania. Moreover, whether these agents continue to be effective over time remains unknown.

    To date, little research has elucidated the efficacy of these stimulants in reducing work disability. Work disability is defined as absence from work due to sickness, with or without a disability pension.

    About the study

    The current Swedish study obtained data from national registries of inpatients and outpatients and those who took medical leave or obtained disability pensions. Over 221,700 individuals between 16 and 65 years of age with a diagnosis of ADHD were included in the study, 55% of whom were male with a mean age of 25 years.

    Psychiatric and non-psychiatric hospitalization rates, suicides and attempts, and work disability were assessed, as well as measures of long-term outcomes in ADHD patients on medication.

    Study findings

    Among the most common medications for ADHD were methylphenidate, which was prescribed to about 70% of patients, followed by lisdexamphetamine, which was used by 35% of patients.

    The mean follow-up period was seven years. Over 25% of treated individuals were hospitalized for psychiatric illness during the follow-up period.

    The risk of hospitalization for psychiatric illness was reduced by 25% and 20% with amphetamine and lisdexamphetamine treatment, respectively. Amphetamine appeared to be more effective in adults, whereas dexamphetamine was more effective among adolescents and young adults.

    Other drugs with a favorable but smaller effect included combinations of ADHD drugs, with a 15% reduced risk, and dexamphetamine and methylphenidate, with a reduction of approximately 10% each. Methylphenidate was associated with increased effectiveness among the younger age groups; however, this medication was not associated with any discernible benefits in adults.

    The lower effectiveness of methylphenidate in adults could be due to the temporal reduction of efficacy with long-term use, as this drug is typically used as a first-line treatment.

    Drugs like modafinil, atomoxetine, clonidine, and guanfacine did not show any association with hospitalization risk. No drug was associated with a greater risk of hospitalization for reasons other than psychiatric.

    In contrast, some drugs or combinations, including amphetamine, lisdexamphetamine, polytherapy, dexamphetamine, methylphenidate, and atomoxetine, were associated with a lower risk of non-psychiatric hospitalization.

    Other favorable outcomes associated with dexamphetamine, lisdexamphetamine, and methylphenidate included a reduced risk of suicidal behavior by 30%, 25%, and about 10%, respectively. Suicidal behavior was 20% more common in individuals treated with atomoxetine, which is a non-stimulant drug that may be prescribed when stimulants are contraindicated or the patient is unwilling to use stimulants.

    ADHD individuals prescribed atomoxetine reported about 10% less disability than those not on this drug. This was particularly notable among patients 29 years of age and younger who had a 20% reduced risk of work disability. This effect was more significant among males at 15%, whereas its effects were insignificant among females. Methylphenidate produced similar but weaker effects at 10% in the same population.

    Atomoxetine may be prescribed for individuals with less severe ADHD, which explains the lower work disability in this group. Importantly, stimulant-associated adverse effects could also be present, which may negatively impact the work ability of those prescribed these medications. Alternatively, individuals with ADHD may have reached the point of work disability before the study began.

    What are the implications?

    The current study is the first to examine individual medications for their effectiveness in ADHD. Overall, a positive association was observed between medications like amphetamines and methylphenidate and psychiatric outcomes. The risk of cardiovascular disease or events, seizures, and unintentional injury appears to decrease on ADHD medication.

    ADHD medication use can reduce morbidity in adolescents and adults with ADHD.”

    Journal reference:

    • Taipale, H., Bergstrom, J., and Gemes, K. (2024). Attention-deficit/hyperactivity disorder medications and work disability and mental health outcomes. JAMA Network Open 7(3);e242859. doi:10.1001/jamanetworkopen.2024.2859

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  • Study suggests treating anxiety and depression significantly reduces ER visits and rehospitalizations among heart disease patients

    Study suggests treating anxiety and depression significantly reduces ER visits and rehospitalizations among heart disease patients

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    Ischemic heart disease (IHD) is a major cause of illness and death in developed countries. While advanced technology has boosted survival and rehabilitation odds, not much is known about the impact of anxiety or depression on the eventual outcomes. The prevalence of heart failure (HF) is predicted to increase by half in 2030. This will mean that eight million adults with HF, with almost $31 billion being required to treat them.

    Study: Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. Image Credit: sitthiphong/Shutterstock.com
    Study: Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. Image Credit: sitthiphong/Shutterstock.com

    A new study looks at this area in order to provide evidence for key recommendations in the treatment of such patients.

    Mental health and heart disease outcomes

    Several previous studies have reported that anxiety and depression are independent risk factors for IHD and HF. Anxiety increases the incidence of IHD and HF by 41% and 35%, respectively, while increasing IHD-related mortality by 41%. Since anxiety and depression may originate in common factors, further research on their cross-linkage with cardiovascular disease and its outcomes is necessary.

    Moreover, anxiety and depression both increase the odds of rehospitalizations and Emergency Department (ED) visits, pushing up healthcare costs. However, there is contradictory evidence for the benefits of treating anxiety or depression in IHD or HF, including recent trials like the SADHEART (Sertraline Antidepressant Heart Attack Randomized Trial).

    Yet these mental and physical conditions reduce the quality of life, acting synergistically with the others due to their shared pathways. For instance, “coexistence of depression results in perception of symptom severity that exceed measures of actual functional impairment.”

    About the study

    The aim of the current study, published online in the Journal of the American Heart Association, aimed to examine the effect of treatment for anxiety or depression on the odds of repeated hospital admissions, ED visits, or mortality.

    The researchers used a population-based cohort from the Ohio Medicaid database, exploring data retrospectively to assess the link between being treated for these conditions and future outcomes. All participants had ischemic heart disease (IHD) or heart failure, along with anxiety or depression.

    There were ~1,500 participants, over 80% being White, with a mean age of 50 years. The upper age limit was 64 since people older than this are not eligible for Medicaid.

    Treatment of anxiety and depression in the cohort

    Over 92% were diagnosed with anxiety and 56% with depression. About half were disabled, a similar number had a history of substance use, and almost 60% had lung disease.

    They were treated medically with antidepressant medication, or with psychotherapy, or both. About a quarter were on both courses of treatment, while ~30% were on antidepressants only and 15% on psychotherapy alone.

    Anxiety was diagnosed in 90% of those on both therapies and depression in 70%. In the antidepressant group, 93% were anxious, and 53% were depressed. The corresponding figures in the psychotherapy group were similar.

    The majority of those on treatment with antidepressants, alone or in combination with psychotherapy, were on benzodiazepines, antipsychotics, or mood stabilizers. Tricyclic antidepressants were used by a small proportion of patients.

    About half the patients were on beta-blockers for their heart conditions, 36% on angiotensin-converting enzyme inhibitors (ACEIs), and 26% on calcium channel blockers. 

    How did treatment affect outcomes?

    For all outcomes except mortality from IHD, “those who received some form of mental health treatment were significantly less likely to experience the outcome than those who received no mental health treatment.”

    Those who received both psychotherapy and antidepressant therapy showed the greatest benefit in all three outcomes compared to no treatment and also when compared to either therapeutic modality alone.

    The group treated with both modalities was 75% less likely to require another hospitalization or ED visit. After compensating for all known confounding factors, the risk of all-cause mortality dropped by 65% compared to those not treated for their mental ill-health.

    With psychotherapy alone, there was a 40% reduction in mortality from all causes. There was no significant difference in the antidepressant-only group. None of the treatments resulted in a difference in the risk of IHD mortality, perhaps because the study was underpowered to detect this effect.

    ED visits were reduced with all treatments. The combination therapy group showed a reduction of 74% compared to the no-treatment group. Psychotherapy alone, or antidepressants alone, was linked to a reduction in risk by 50%.

    Hospital readmissions were also lower with combined therapy, at ~75% below the no-treatment group. With psychotherapy alone or antidepressants alone, the risk was approximately 50% and 60% lower, respectively.

    Future implications

    “This article is the first to show that mental health treatment may be associated with reduced risk for relevant outcomes.”

    The unequivocal findings indicate the need to screen heart patients for anxiety and depression. If these conditions are diagnosed, providing appropriate treatment markedly improves the risk of rehospitalization and ED visits. Strategies must be optimized to diagnose and treat anxiety and depression in this group of patients to improve their quality of life.

    Sympathetic activation occurs with anxiety and depression, along with heart disease. This results in the release of pro-inflammatory cytokines, promoting the progression of all three conditions. This may explain in part why treatment of mental ill-health improves the incidence of cardiovascular events.

    This marks an advance from earlier studies that focused mostly on the safety of administering such medications to patients with IHD or HF and fills this research gap. Treating anxiety and depression in heart patients not only improves their health outcomes but may significantly reduce their healthcare costs, with a positive cost-benefit ratio.

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  • AI-based conversational agents show promise in young people’s mental health interventions

    AI-based conversational agents show promise in young people’s mental health interventions

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    In a recent review published in npj Digital Medicine, researchers examined the current state of research into fully automated conversational agents (CAs)-mediated interventions for the emotional component of mental health among young individuals.

    Study: Use of automated conversational agents in improving young population mental health: a scoping review. Image Credit: SewCreamStudio/Shutterstock.comStudy: Use of automated conversational agents in improving young population mental health: a scoping review. Image Credit: SewCreamStudio/Shutterstock.com

    Background

    Mental health issues are a significant concern for young people, leading to psychosocial difficulties in adulthood.

    Technology has emerged as an alternative to face-to-face approaches, with CAs being digital solutions that simulate human interaction using text, speech, gestures, facial expressions, or sensory expressions.

    However, fully automated CAs have limitations, such as relying primarily on adult populations and not distinguishing between young and older populations. Most reviews focus on a subcategory of conversational agents based on embodiment level.

    About the review

    In the present review, researchers explored the potential of automated conversational agents in enhancing the psychiatric well-being of the youth.

    The researchers searched PubMed, Web of Science, PsychInfo, Scopus, the Association for Computing Machinery (ACM) Digital Library, and IEEE Xplore in March 2023.

    They included primary research studies reporting on the development, usability/feasibility, or evaluation of fully autonomous conversational agents to enhance the psychiatric wellness of individuals aged ≤25 years. All studies belonged to peer-reviewed journals in the English language.

    The team excluded secondary research, dissertations, conference proceedings, and commentaries describing or reporting on the general characteristics of human-conversational agent interactions or intervention studies exclusively testing the general features of the human-technology interaction using CAs.

    They also excluded research on CA applications to improve cognitive, social, physical, or educational health and those emphasizing CA usage for only monitoring or assessment purposes. In addition, they excluded studies using semi- or non-automated CAs targeting individuals >25 years.

    Two independent researchers screened the records, and a third researcher resolved disagreements. Data extracted included general, technological, interventional, and peer-reviewed research characteristics.

    General aspects included publication year, country, and authors, whereas technological aspects included the conversational system type, name, communication modality, availability, and embodiment type.

    Interventional characteristics assessed included the targeted mental wellness outcome, scope, frequency, duration, theoretical framework, or standalone intervention).

    Research characteristics included participants’ information, study methodology and design, stage of research, and main results.

    Results

    Of the 9,905 initially identified records, 6,874 underwent title-abstract screening, and 152 underwent full-text screening. However, only 25 eligible records were analyzed, including 1,707 individuals.

    In total, 21 agents were identified, with most being disembodied chatbots, robots, and virtual representations, of which most studies used Paro, Nao, and Woebot.

    The dialog system used by the CAs was predominantly machine learning and natural language processing (n=12), with some using predetermined dialog systems and interactions matched and assembled to user input dynamically.

    Most CAs targeted anxiety (n=12), followed by depression, psychiatric well-being, general distress, and mood. Most records labeled the conversational agent applications as interventions, focusing on preventive measures for the general public and at-risk individuals.

    Nineteen studies reported the duration of interventions, most lasting two to four weeks (eight studies). Seventeen studies reported theoretical frameworks for the interventions, with Cognitive Behavioural Theory (CBT) applied to most interventions, and 14 automated CA applications mentioned positive psychology as their framework.

    Other theories included interpersonal theory, person-centered theory, the metacognitive intervention of narrative imagery, motivational interview, transtheoretical approach, dialectical behavioral theory, and emotion-focused theory.

    The sample sizes ranged from eight to 234 participants primarily recruited from educational, community, and healthcare settings, with a mean age of 17 years, and 58% were female.

    Fifteen studies reported feasibility outcomes, including engagement, retention/adherence rate, acceptability, user satisfaction, system usability, safety, and functionality.

    Two studies reported safety issues, with >50% of individuals reporting at least one adverse effect despite high feasibility. Fifteen studies reported anxiety outcomes, with five reporting a significant positive difference compared to controls.

    A randomized controlled trial found an improvement in medical procedure-related anxiety for participants undergoing more invasive procedures and with more frequent exposure to medical procedures.

    Nine studies reported depression, with five showing a significant difference compared to controls, favoring automated CAs.

    In uncontrolled trials, one showed a minimal change in depression scores, and two studies showed a significant improvement in psychological well-being but no significant effect on subjective happiness.

    Conclusion

    To conclude, based on the review findings, automated CAs can improve mental health outcomes, especially in anxiety and depression; however, further research could improve understanding of their effectiveness and potential limitations.

    The field is rapidly expanding, with advanced technical capabilities, especially in high-income countries.

    Future reviews should include safety research, address a broad range of clinical problems, include larger sample sizes, and conduct cost-effectiveness studies to inform affordability in low- and middle-income countries.

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  • Treatment for anxiety and depression associated with improved heart disease outcomes

    Treatment for anxiety and depression associated with improved heart disease outcomes

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    Treating anxiety and depression reduced emergency room visits and rehospitalizations among people with heart disease, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    For patients who had been hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, pharmacotherapy or a combination of the two was associated with as much as a 75% reduction in hospitalizations or emergency room visits. In some cases, there was a reduction in death.”


    Philip Binkley, M.D., M.P.H., lead study author, executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University in Columbus, Ohio

    Binkley noted that anxiety and depression are common in people with heart failure, and mental health can have a significant impact on an individual’s risk of other health conditions, disability and death.

    In this study, Binkley and colleagues examined the association of mental health treatment with antidepressant medication or psychotherapy, also known as talk therapy or a combination of the two in relation to, emergency room visits, hospitalizations and death in people with blocked arteries or heart failure and with a formal diagnosis of anxiety or depression before hospitalization.

    The analysis found using three different statistical models that adjusted for different variables and compared to patients not receiving treatment for anxiety or depression:

    • For people who received both medication and talk therapy for anxiety or depression the risk of hospitalization was reduced by 68% to 75% the risk of being seen in the emergency department was reduced by 67% to 74%, and the risk of death from any cause was reduced by 65% to 67%.

    • Psychotherapy treatment alone was associated with a 46% to 49% reduction of risk for hospital readmission and a 48% to 53% reduction in emergency room visits.

    • Medication treatment alone reduced hospital readmission by 47% to 58% and reduced ER visits by 41% to 49%.

    • Follow-up time was variable based on the needs of each patient.

    “Heart disease and anxiety/depression interact such that each promotes the other,” Binkley said. “There appear to be psychologic mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”

    Binkley considers the large number of people with heart disease and the marked reduction in hospitalizations and emergency room visits and the drop in death to be the strength of the study.

    “I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health. I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease,” he said.

    Study details and background:

    • 1,563 adults ages 22 to 64 over a three-year period were included, and all participants had a first hospital admission for blocked arteries or heart failure and had two or more health insurance claims for an anxiety disorder or depression.

    • Sixty-eight percent of participants were women, and 81% were noted as white race. All were enrolled in Ohio’s Medicaid program during the six months prior to the hospital admission. Health data was from two sources: Ohio Medicaid claims and Ohio death certificate files from July 1, 2009, to June 30, 2012.

    • Participants were followed through the end of 2014 or until death or the end of Medicaid enrollment.

    • About 23% of participants received both antidepressant medications and psychotherapy; nearly 15 percent received psychotherapy alone; 29% took antidepressants alone; and 33% received no mental health treatment.

    • About 92% of participants in the study were diagnosed with anxiety and 55.5% with depression prior to hospitalization.

    The study was limited to people enrolled in Medicaid, therefore, it may not be representative of people covered by commercial health insurance plans. In addition, the majority of participants were noted as white race, therefore, these finding are not applicable to people of other races, ethnicities or communities.

    Source:

    American Heart Association

    Journal reference:

    Carmin, C. N., et al. (2024) Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.031117.

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  • Study examines oral hygiene self-care behavior among patients with mental health disorders

    Study examines oral hygiene self-care behavior among patients with mental health disorders

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    A study aiming to examine oral hygiene self-care behavior among patients with self-reported mental health disorders was presented at the 102nd General Session of the IADR, which was held in conjunction with the 53rd Annual Meeting of the American Association for Dental, Oral, and Craniofacial Research and the 48th Annual Meeting of the Canadian Association for Dental Research, on March 13-16, 2024, in New Orleans, LA, USA.

    The abstract, “Oral Health Behaviors Associated with Mental Health Disorders” was presented during the “Oral Health and Systemic Conditions” Oral Session that took place on Thursday, March 14, 2024 at 2 p.m. Central Standard Time (UTC-6). 

    The study, by Gracie Groth of the Arizona School of Dentistry and Oral Health, Mesa, USA, reviewed electronic dental records for patients treated in an academic advanced care dental clinic between 2018 through 2021 to identify presence of self-reported anxiety, dental anxiety, depression, bipolar disorder, PTSD, and oral hygiene self-care behaviors (OHB). Specific OHB included self-reported frequency of daily toothbrushing (TB), interdental cleaning (ID), use of fluoride toothpaste (FTP) and mouthwash (MW), and recommended preventive recare interval and frequency of returning for recare visits within a 2-year period. 

    Descriptive statistics, Mann-Whitney U, and Wilcoxon rank-sum tests were used for data analysis. ATSU Mesa IRB #2023-136 Exempt. 854 charts were reviewed, with 250 records identified with self-reported MHD. Age of included patients ranged from 18 to 95 years, with mean age = 53.82 ±18.943. Most were females (n=145, 58.2%). Anxiety was the most common MHD (n=156, 62.4%), followed by depression (n=154, 61.6%), dental anxiety (n=64, 25.6%), bipolar disorder (n=37, 14.8%) and PTSD (n=22, 8.8%). 

    There were no significant differences in OHB, recare intervals or frequency of recare visits by MHDs. Most did not use ID (n=152, 60.8%) or MW (n=183, 73.2%). A Mann-Whitney U test showed there was a statistically significant difference between men and women for TB (W=11546.000, p=0.004) and FTP (W=11599.000, p=0.007), with women showing greater frequency of use. Mean recommended recare interval was 5 months, with <2 attended recare visits reported by sex and all types of MHD. Frequency of performing OHB, except for daily brushing with fluoride toothpaste, and returning for recare at recommended intervals was low for patients with self-reported MHD. 

    Source:

    International Association for Dental, Oral, and Craniofacial Research

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  • Unmet social needs negatively impact quality of life of dementia patients and caregivers

    Unmet social needs negatively impact quality of life of dementia patients and caregivers

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    People with dementia and those who care for them should be screened for loneliness, so providers can find ways to keep them socially connected, according to experts at UC San Francisco and Harvard, who made the recommendations after finding that both groups experienced declines in social well-being as the disease progressed.

    The patients, whose average age in the study was 80, had lost their social networks as their failing memories made conversation difficult, and their family and friends grew uncomfortable. Caregivers, whose average age was 67 and included spouses, adult children and others, became isolated as their responsibilities mounted. They also grieved the loss of their relationships with the patients when those relationships were good.

    Unmet social needs negatively impact quality of life, and that can lead to health outcomes like depression and cardiovascular disease, as well as high health-care use and early death.”

    Ashwin Kotwal, M.D., assistant professor of medicine in the UCSF Division of Geriatrics, and first author of the study

    “We know from previous research that older adults with higher levels of social isolation have more than double the odds of nursing home placement,” said Kotwal, who is also affiliated with the San Francisco VA Health Medical Center. 

    The study, which appears in The Gerontologist on March 18, 2024, included information from two dozen mainly male patients with dementia, and four dozen mainly female caregivers, some of whom were recently bereaved. 

    “Participating in support groups, in which patients and their caregivers can meet separately, may be low-stress places to socialize and get advice,” said Krista Harrison, Ph.D., of the UCSF Division of Geriatrics, Global Brain Health initiative and Philip R. Lee Institute for Health Policy Studies, the study’s senior author, noting that screenings take minutes and can be done by doctors, social workers or therapists. 

    “Clinicians should discuss options like community choirs that have been tailored for patients with dementia and their caregivers,” she said. “Prior research shows that meaningful activities can be enjoyed as the disease progresses. There may be simple ways of adapting activities, like switching attendance from a place of worship to participating in a service by Zoom with a small gathering at home.” 

    The interviews were conducted for two earlier studies: Dementia Palliative Care, led by Harrison, which examined patients with mild-to-moderate dementia and their caregivers; and Music and Dementia Caregiving, led by co-author Theresa Allison, M.D., Ph.D., which looked at patients with any stage of dementia and their live-in caregivers, including those who had the assistance of professional caregivers.

    Those in good relationships have the most to lose 

    A recent UCSF-led study of married couples, in which one partner had dementia, offered a fresh twist to the current study. The researchers found partners of people with dementia who were highly satisfied with their relationships experienced more loneliness than they had previously. But those in poor-quality relationships were not impacted by their partner’s dementia, despite having higher rates of depression and loneliness overall.

    “People who are really invested in their marriage or partnership have more to lose when one partner develops dementia,” said Kotwal, the study’s senior author. “But those with lower marital quality have already lost the emotional support from the marriage that can be protective against loneliness and depression.” 

    Source:

    University of California – San Francisco

    Journal reference:

    Kotwal, A., et al. (2024) “Relationships, very quickly, turn to nothing:” Loneliness, Social Isolation, and Adaptation to Changing Social Lives Among Persons Living with Dementia and Care Partners. The Gerontologist. doi.org/10.1093/geront/gnae014.

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  • Researchers create a method to determine psilocybin and psilocin potency in mushrooms

    Researchers create a method to determine psilocybin and psilocin potency in mushrooms

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    Since the 1970s, the federal government has listed the active ingredients in mushrooms-;psilocybin and psilocin-;as illegal and having no accepted medical use.

    However, in recent years, medical professionals have found that these substances are safe and effective for treating stubborn conditions such as treatment-resistant depression and post-traumatic stress disorder. Some jurisdictions now allow for the medical use of mushrooms, while others are considering permitting or at least decriminalizing their recreational use.

    Clinicians now find themselves needing to carefully measure the doses of mushrooms to ensure patients receive the proper amount during treatment. To solve this problem, University of Texas at Arlington researchers have created a method to determine the clinical potency of psilocybin and psilocin in the hallucinogenic mushroom species psilocybe cubensis.

    These legislative changes are expected to facilitate further research and potential clinical applications.” 


    Kevin Schug, the Shimadzu Distinguished Professor of Analytical Chemistry in the Department of Chemistry and Biochemistry

    Using liquid chromatography with tandem mass spectrometry, Schug and colleagues were able to extract and measure the strength of the mushrooms, according to findings published in the February issue of Analytica Chimica Acta. Co-authors included colleagues at Scottsdale Research Institute in Phoenix; Shimadzu Scientific Instruments in Maryland; and Millipore-Sigma in Round Rock, Texas. The results were then compared with two separate labs to ensure accuracy.

    “As medical professionals identify more safe and effective treatments using mushrooms, it will be important to ensure product safety, identify regulatory benchmarks and determine appropriate dosing,” Schug said. “Established and reliable analytical methods like the one we describe will be essential to these efforts to use mushrooms in clinical settings.”

    Source:

    University of Texas at Arlington

    Journal reference:

    Goff, R., et al. (2024). Determination of psilocybin and psilocin content in multiple Psilocybe cubensis mushroom strains using liquid chromatography – Tandem mass spectrometry. Analytica Chimica Acta. doi.org/10.1016/j.aca.2023.342161.

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