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  • New psychological treatment for epileptic children lowers mental health problems

    New psychological treatment for epileptic children lowers mental health problems

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    A new psychological treatment for children with epilepsy, developed by a UCL-led team of scientists, has been shown to reduce mental health difficulties compared to standard care, a new study finds.

    Mental health problems such as worries, low mood and behaviour problems are more common in children and young people with brain conditions such as epilepsy, than in the general population – with up to 60% of those with epilepsy having associated mental health disorders and many having more than one mental health condition.

    These conditions can have a big impact on patients’ quality of life and overall health.

    Currently, mental health problems in children and young people with epilepsy are often not identified because centres that treat epilepsy are usually separated from those that treat mental health difficulties. When mental health difficulties are identified, standard treatment for children who also have epilepsy is usually carried out by specialists, such as child and adolescent mental health services (CAMHS) or hospital-based paediatric psychology services. The treatment given usually involves treating each mental health condition (ie. anxiety, depression, behavioural issues) individually.

    The new treatment, named the Mental Health Intervention for Children with Epilepsy (MICE), is based on the treatments that the National Institute for Health and Care Excellence (NICE) recommends for the treatment of common mental health difficulties, like cognitive behavioural therapy for anxiety and depression. However, it uses a modular approach, that enables multiple mental health conditions to be treated at once, instead of having different treatments for different mental health difficulties.

    It was also modified specifically for children and young people with epilepsy, for example including sessions that explain about the relationship between epilepsy and mental health.

    Additionally, the treatment can be delivered over the phone or via video call so that people did not have to travel to the hospital and miss time from school or work. And rather than being outsourced to services such as CAMHS, it was integrated into epilepsy services – meaning that it could be delivered by non-mental health specialists.

    Lead author Dr Sophie Bennett, who carried out the research while working at UCL Great Ormond Street Institute of Child Health, said: “This treatment breakthrough means that we have a new way to help children and young people with epilepsy who also have mental health difficulties.

    “The treatment can be delivered from within epilepsy services to join up care. It doesn’t need to be delivered by specialist mental health clinicians like psychologists.

    “Integrating the care can help children with epilepsy and their families more effectively and efficiently. We were particularly pleased that benefits were sustained when treatment ended.”

    The new treatment, outlined in The Lancet, was created together with young people and their families and the professionals who care for them, including doctors, nurses and psychologists.

    Patients were given an initial assessment followed by weekly calls with the clinician – although face-to-face therapy was available if preferred. The sessions were delivered to either the young person directly, or via their caregiver, based on their individual circumstances.

    Researchers trialled the treatment with 334 children and young people aged three to 18. Of these, 166 received the new MICE treatment and 168 received the usual treatment for mental health problems in children with epilepsy.

    They assessed adolescents’ mental health and overall well-being from a parent-reported Strengths and Difficulties Questionnaire (SDQ) – covering areas such as emotional problems, conduct, hyperactivity and peer problems.

    The results showed that the children who had the MICE treatment had fewer mental difficulties than those who had the usual treatment, and the change is equivalent to a decrease of 40% in the likelihood of having a psychiatric disorder.

    These groundbreaking findings not only promise brighter futures for children with epilepsy but also pave the way for a revolutionary shift in mental healthcare practices.


    The collaborative efforts of scientists, patients, and healthcare professionals have brought forth a new era of treatment of mental health challenges associated with epilepsy, offering a beacon of hope for families in the face of mental health challenges associated with epilepsy.”


    Professor Roz Shafran, Co-Chief Investigator, UCL Great Ormond Street Institute of Child Health and GOSH

    Co-Chief Investigator, Professor Helen Cross (UCL Great Ormond Street Institute of Child Health and GOSH), said: “This study shows real progress for clinicians considering the high rate of mental health problems in children with epilepsy, as we demonstrate the benefit of a therapy that can be implemented within existing epilepsy services.”

    Co-author, Professor Isobel Heyman (UCL Great Ormond Street Institute of Child Health and Clinical Co-Lead for mental health at Cambridge Children’s Hospital), said: “These promising results show that staff working in paediatric settings can be trained to deliver effective mental health treatment to children with a physical health condition (epilepsy).

    “It clearly demonstrates that children’s healthcare needs can be met in a holistic way to treat the ‘whole child’, in the same place at the same time.”

    The work was conducted in collaboration with experts at Great Ormond Street Children’s Hospital (GOSH), King’s College London and UCLA, and with funding from the National Institute for Health and Care Research (NIHR).

    Source:

    University College London

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  • Kobe University study identifies FAM81A as key player for synaptic function

    Kobe University study identifies FAM81A as key player for synaptic function

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    A protein that appears in postsynaptic protein agglomerations has been found to be crucial to their formation. The Kobe University discovery identifies a new key player for synaptic function and sheds first light on its hitherto uncharacterized cellular role and evolution.

    What happens at the synapse, the connection between two neurons, is a key factor in brain function. The transmission of the signal from the presynaptic to the postsynaptic neuron is mediated by proteins and their imbalance can lead to neuropsychiatric conditions such as severe depression, autism, or alcohol dependence. However, due to the vast diversity of proteins present at this junction, many have not yet been studied and often it is not even clear whether those previously found actually belong there or whether they are just impurities resulting from the analysis process. A particularly conspicuous structure directly underneath the postsynaptic membrane is the so-called “postsynaptic density,” an agglomeration of possibly thousands of different proteins.

    To shed some light on the postsynaptic density, Kobe University neurophysiologist Takumi Toru and his group first compared 35 datasets of previous studies on the phenomenon to find out which uncharacterized proteins appear consistently.

    We established an analytical pipeline to unify and align protein structures in different datasets. This resulted in the identification of a poorly characterized synaptic protein that has been detected in more than 20 of these datasets.”

    Kaizuka Takeshi, first author of the paper

    This suggested that the protein, which goes by the label FAM81A, is probably relevant to the function of the whole structure, so the team analyzed its interactions with other proteins, its distribution in and around neurons and its effect on neuron shape and function, the mechanism of its function, and its evolution. In short, they gave this protein a full first characterization.

    Takumi summarizes their results, now published in the journal PLoS Biology, “The important finding is that FAM81A interacts with at least three major postsynaptic proteins and modulates their condensation. This suggests that FAM81A is a major regulatory factor in the postsynaptic density.” The group could confirm that FAM81A facilitates the condensation of key proteins into a membrane-less organelle through liquid-liquid phase separation, a process in which strongly interacting molecules exclude elements of the surrounding medium, and that the absence of the protein leads to a significant decrease of activity in cultured neurons.

    Humans have two related copies of the gene, FAM81A and FAM81B. However, while FAM81A is expressed in the brain, FAM81B is expressed only in the testes. Furthermore, birds and reptiles also have two copies of the gene, but amphibians, fish and invertebrates have only one, and its expression is not localized to one tissue. “Interestingly, it seems that the evolutionary conservation of FAM81A function in the synapse is limited compared to other synaptic molecules, as the FAM81A homolog in fish is not detected in the synapse. This suggests that FAM81A could be a key protein in understanding the cognitive functions of higher vertebrate brains,” says Kaizuka.

    But their work was only the first step. To really understand the role of the protein, it is necessary to study its function in the complex environment of the brain. The Kobe University research team thus wants to create mouse models that lack the gene for FAM81A and study what this means both for the function of the synapses and the behavior of the organism.

    Source:

    Journal reference:

    Kaizuka, T., et al. (2024) FAM81A is a postsynaptic protein that regulates the condensation of postsynaptic proteins via liquid–liquid phase separation. PLOS Biology. doi.org/10.1371/journal.pbio.3002006.

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  • Research on fishing as PTSD treatment gets a $1.3 million funding boost

    Research on fishing as PTSD treatment gets a $1.3 million funding boost

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    A “game-changing” $1.3m cash injection has been awarded to researchers exploring if doctors can prescribe fishing to treat PTSD. 

    The vital funding will allow the University of Essex’s Dr Nick Cooper and collaborator Dr Mark Wheeler to expand their influential work which has helped hundreds of military veterans. 

    Now the Department of Psychology’s Dr Cooper will explore if casting a rod from the bankside can aid police officers, paramedics, firefighters, and the coast guard deal with trauma. 

    Taking place over the course of three and a half years the National Institute for Health and Care Research-funded project (NIHR) is one of only three being explored across the UK. 

    It is hoped Casting Away Trauma will develop innovative nature-based treatments for mental health conditions on the NHS. 

    Watch a YouTube documentary on the project’s life-changing work here.

    This is a game-changing funding for our research, which will help us show definitively if fishing can make a real difference to the people who have given so much to keep us all safe. 


    We are incredibly proud to receive NIHR funding to expand our project, which we have proved has a real impact on servicemen and women. 


    We have shown that a weekend of angling has demonstrable and real impact on vulnerable veterans and can help them back into society. 


    We are incredibly excited and honoured to receive the funding to expand our research.” 


    Dr Nick Cooper, Department of Psychology, University of Essex

    PTSD -Post Traumatic Stress Disorder – sees sufferers relive traumatic and can lead to debilitating depression, anxiety and even suicide. 

    The Casting Away Trauma project has found a way to break barriers stopping veterans and other sufferers from engaging with traditional therapy. 

    By emphasising learning a new recreational skill rather than traditional therapy they use peer support and sessions led by a qualified recreation coach to ease the symptoms. 

    Dr Wheeler added: “This is a tremendous piece of news for all concerned. 

    “As joint CEO of iCARP CIC, alongside Dr Cooper, I can state that, as an organisation, we are immensely proud to have played our part in this ground-breaking research project. 

    “From our first research design and trip, 10 years ago now, we have worked tirelessly to reach this point and could not be more pleased for all our supporters, collaborators and volunteers who have all played an integral part in the programme. 

    “We look forward to the next part of the journey with excitement and anticipation. 

    Dr Cooper and Dr Wheeler will conduct the research through their community interest company iCARP CIC, which runs picturesque lakes nestled near Harwich, Essex.” 

    Their previous research took servicemen with PTSD, who had an average of 12 years military experience on a weekend fishing retreat – focussing on relaxation, socialisation and learning new skills. 

    The innovative intervention sparked significant clinical change in 60% of participants that also reduced depression and anxiety for a month after the trip – with wellbeing scores soaring. 

    It also confirmed the 30-hour, 2-day peer-support intervention can now be expanded to deliver a large-scale trial using the same methods. 

    The project has been praised by the Ministry of Defence (receiving a gold award in 2022), recognised by The Angling Trust and recently received a contract to deliver community mental health treatment for the NHS Essex Partnership University Trust via local volunteering bodies. 

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  • Housing affordability for new mothers may help stave off postpartum depression

    Housing affordability for new mothers may help stave off postpartum depression

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    Becoming a parent comes with lots of bills. For new mothers, being able to afford the rent may help stave off postpartum depression.

    “Housing unaffordability has serious implications for mental health,” said Katherine Marcal, an assistant professor at the Rutgers School of Social Work and author of a study published in the journal Psychiatry Research. “For mothers who rent their homes, the ability to make monthly payments appears to have a correlation to well-being.”

    Housing hardship – missing rent or mortgage payments, moving in with others, being evicted or experiencing homelessness – has been associated with increased risk for depression. Yet little is understood about unique manifestations of housing hardship among postpartum mothers in renter households, said Marcal.

    To address this gap, Marcal used data from the Future of Families and Child Wellbeing Study, a multiyear study of nearly 5,000 children born in the United States between 1998 and 2000. As part of the research, mothers were interviewed in hospitals shortly after giving birth, and five times over the next 15 years.

    Marcal drew on data for 2,329 mothers who reported being renters at year one of the survey. Participants were asked a series of questions related to housing hardship. For instance, had they ever missed a rent or utility payment, moved in with friends or family or spent at least one night homeless during the postpartum year?

    Using latent class analysis, a modeling approach that allows clustering of data and statistical inference, Marcal used Future of Families and Child Wellbeing Study responses to investigate manifestations of housing hardship.

    Four groups emerged from the data: a “stable” group with very little housing hardship; “rent-assisted” mothers with government housing assistance; “cost-burdened” mothers who skip periodic rent and utility payments but manage to avoid most severe housing outcomes; and a “housing insecure” group or mothers who experience elevated rates of displacement.

    Finally, these clustered data were analyzed with responses from year three of the Future of Families and Child Wellbeing Study, when participants were asked if they had experienced major depressive and anxiety disorders.

    What emerged was a clear connection between housing hardship and depression. Mothers in the housing insecure group were far more likely to be depressed than those in the stable group. For anxiety risk, the best determinant was whether rent was paid each month. In total, the prevalence of maternal depression was 21 percent, while the prevalence of anxiety was 5 percent.

    Marcal also identified a racial component to the findings: Black renters were less likely than whites to be cost-burdened.

    The reason is counterintuitive, Marcal said.

    Black families are more likely to receive rental assistance, but Blacks are also more likely to be evicted faster than whites.”


    Katherine Marcal, Assistant Professor, Rutgers School of Social Work 

    In other words, Black tenants don’t remain cost-burdened for long. “They’re either making their rent payments or they’re getting evicted or moving out,” Marcal said.

    Taken together, the findings highlight the importance of government housing support for low-income families.

    “Rental assistance is very effective in keeping people housed and in reducing risk for depression and anxiety,” Marcal said. “But what this research shows is that we need to do a much better job at promoting equity in assistance programs.”

    Source:

    Journal reference:

    Marçal, K. (2024). Housing hardship and maternal mental health among renter households with young children. Psychiatry Research. doi.org/10.1016/j.psychres.2023.115677.

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  • 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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  • Study reveals mechanisms behind antidepressant effects of diabetes drug

    Study reveals mechanisms behind antidepressant effects of diabetes drug

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    Research in animals has shown that the diabetes drug dulaglutide, which is a glucagon-like peptide-1 (GLP-1) receptor agonist may reduce symptoms of depression. A new study published in Brain and Behavior reveals the mechanisms that are likely involved.

    By conducting a range of tests in mice treated with and without dulaglutide, investigators confirmed the effects of dulaglutide on depressive-like behaviors, and they identified 64 different metabolites and four major pathways in the brain associated with these effects.

    Markers of depression and the antidepressant effects of dulaglutide were linked to lipid metabolism, amino acid metabolism, energy metabolism, and tryptophan metabolism.

    “These primary data provide a new perspective for understanding the antidepressant-like effects of dulaglutide and may facilitate the use of dulaglutide as a potential therapeutic strategy for depression,” the authors wrote.

    Source:

    Journal reference:

    Jin, M., et al. (2024) Dulaglutide treatment reverses depression-like behavior and hippocampal metabolomic homeostasis in mice exposed to chronic mild stress. Brain and Behavior. doi.org/10.1002/brb3.3448.

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  • New approach needed to better prepare and support women during menopause transition, experts say

    New approach needed to better prepare and support women during menopause transition, experts say

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    A new approach to menopause that better prepares and supports women during midlife is needed – going beyond medical treatments, to empower women using high-quality information on symptoms and treatments, empathic clinical care and workplace adjustments as required, says a new four paper Series published in The Lancet.

    The misconception of menopause as always being a medical issue which consistently heralds a decline in physical and mental health should be challenged across the whole of society. Many women live rewarding lives during and after menopause, contributing to work, family life and the wider society. Changing the narrative to view menopause as part of healthy aging may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it.”


    Martha Hickey, Series Co-Author, Professor, University of Melbourne and Royal Women’s Hospital, Melbourne

    She continues, “The experience of menopause differs for every person. Our Series calls for an individualized approach where women are empowered with accurate, consistent and impartial information to make informed decisions which are right for them over the menopause transition. This may include taking menopause hormone therapy (aka HRT) for symptoms such as hot flushes and night sweats, which can range from mild to extremely debilitating, after a discussion with their doctor about the risks and benefits. Whilst some women may also choose psychological therapies such as cognitive behavioral therapy to reduce the psychological impact of hot flushes and night sweats and improve sleep.”

    Menopause as a part of healthy aging

    In many societies the topic of menopause has long been a taboo subject. Now, countries such as the UK, the USA and Australia are experiencing a ‘menopause moment’, with more open discussion across politics, workplaces and the media.

    Whilst welcoming the increase in awareness of menopause, the Series’ authors raise concern about the media’s tendency to focus on extreme negative experiences of menopause, depicting it as an unfortunate and distressing experience heralding a critical downturn in women’s health which can only be solved by hormone replacement.

    “Whilst it’s certainly the case that some women have extremely negative experiences of menopause and benefit from hormone therapies, that isn’t the whole picture. The reality is much more complex and varied, with some women reporting neutral experiences and others highlighting good aspects, such as freedom from menstruation and menstrual pain. Menopause is having a cultural moment, and this is an opportunity for it to be recognised as a natural part of healthy ageing for women which, with the right preparation and support, is not something to fear,” says Dr Lydia Brown, University of Melbourne. 

    There is a widely held belief that menopause is associated with poor mental health, however a review of 12 studies, published as part of the Series, which investigates the association between the menopause transition and depression does not confirm this. Two of the 12 studies report increased depressive symptoms over menopause, but three found no such increase and the remaining seven studies report mixed results. After reviewing these studies and others, the Series’ experts conclude there is no robust evidence that risk of anxiety, bipolar disorder, psychosis or suicide increases for all women over the menopause transition. 

    Empowered women with support across society 

    The Series calls for healthcare professionals, researchers, workplaces, and wider society to support the empowerment of women during menopause, ensuring they have the knowledge and self determination to make informed decisions and can seek effective help if needed. 

    Healthcare workers can support their patients by validating their experiences and providing balanced and consistent information about symptoms and treatment options if required, encouraging women to discuss their individual preferences to reach shared decisions. 

    A review of evidence on menopause symptoms highlights that hot flushes and/or night sweats affect up to 80% of women, with over a third (38%) describing these symptoms as moderate to severe at age 50 years. 

    The most effective treatment for hot flushes and night sweats is hormone therapy – often referred to as Menopausal Hormone Therapy (MHT) or Hormone Replacement Therapy (HRT). Treating hot flushes may also improve sleep and mood and MHT prevents fractures in weak bones. However, evidence on the benefit of menopause hormone therapy on other symptoms associated with menopause and ageing in women is lacking.

    “There are several medications for menopause symptoms available as prescriptions that can be crucial tools in helping some women manage hot flushes and night sweats, possibly also leading to improved sleep and quality of life. These include menopause hormone therapy and non-hormonal alternatives, including newer agents targeting the neurokinin receptor such as fezolinetant. Information about these treatments, their benefits, risks, and comparative effectiveness should be made readily available to women seeking medication with the support of healthcare professionals. MHT is the best-known medication and data suggests it’s slightly more effective than alternative medications for treating hot flushes and night sweats. However, no medication can reliably resolve all negative experiences during menopause and commercial interests have influenced how MHT is presented – overshadowing evidence-based alternative options,” says Dr Andrea La Croix, University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science. 

    “As well as menopausal hormone therapy, clinicians should discuss additional ways to manage some menopausal symptoms, such as cognitive behavior therapy for hot flushes and night sweats. CBT may also reduce stress and improve sleep and mood. Lifestyle changes addressing diet, smoking and exercise may additionally benefit sleep and mood and improve long-term health. Some don’t wish to take menopause hormone treatment unless their symptoms are severe and prefer to use other approaches. Our Series is all about increasing awareness of evidence-based options for women, so they can choose how they wish to navigate menopause, free from judgment and stigma,” adds Professor Myra Hunter, King’s College London. 

    Unfortunately, commercial interests, such as organizations who are marketing menopause products to consumers including pharmaceutical companies and private providers, have strongly influenced media messaging about menopause and MHT. In this messaging, across both news media and social media, the small but serious risks of MHT are often downplayed or ignored. This Series argues that women should have access to accurate and evidence-based information about menopause in a form they can understand, created without undue commercial influence, such as the NIH funded My Meno Plan website in the USA.

    The authors also call for more research into aspects of menopause that are a priority for women. For example, a global Menopause Priority Setting Partnership is underway across more than 40 countries to develop a new, patient-focused research agenda.

    Workplaces, by the creation of open, inclusive and supportive cultures, have a role to play in supporting women during menopause. According to the UK Health and Safety Executive, women aged 45-54 report more work-related stress than men or women of any other age group, associated with high job demands, lack of control and lack of support. A qualitative study of 137 women reported that women want their managers to be informed and empathetic about menopause and understand how the work environment might exacerbate their symptoms.

    The authors highlight how, through resources such Menopause at Work, employers can implement evidence-based and practical policies to support their employees including via education, conversations and flexible working hours. 

    In addition to clinicians, researchers and workplaces, the authors highlight the need for a substantial societal shift in the views of midlife and older women, with a greater appreciation of their considerable contribution to society, their skills in the paid and unpaid workforce and how they often care for families across generations, 

    “There is a lot we can learn about attitudes to menopause and growing older in general from communities, such as many Asian cultures, where ageing in women confers respect and status, rather than stigma. Everyone can play a part in shifting society’s view of older women by engaging in conversation – such as those organized by the Menopause Cafe where people of all genders and ages gather to discuss menopause and share tips, questions and experiences,” says Rachel Weiss (not an author), founder of Menopause Cafe charity.

    She continues, “The pendulum has swung from ‘put up and shut up’ about menopause to sensationalizing it. It’s good that we are talking more about menopause, now we need to swing the pendulum to the middle and normalize menopause, so that anyone who wants to talk about it can, so that people are not scared of it and so that a diverse experience of menopause is depicted in the media, not just celebrity horror stories.” 

    Some women need specific care 

    Globally, around 10% of women experience menopause prematurely (under age 40) or early (between the ages of 40 and 44). There are often delays in diagnosis and some women experience feelings of distress and isolation. There is also evidence to suggest women who enter premature or early menopause may have an increased risk of conditions such as cardiovascular disease, and osteoporosis (fragile bones). Use of MHT may reduce these risks. 

    People with cancer are more likely to experience early menopause or menopause symptoms due to treatment. For example, endocrine therapy for breast cancer can cause hot flushes and/or night sweats that may be more severe and prolonged than natural menopause. Women with cancer often report a lack of centralised care and access to safe and effective treatments for their menopause symptoms. 

    Menopause does not usually cause mental health problems, but those with severe hot flushes/night sweats, previous clinical depression or recent stressful life events are at an increased risk of depression. There should be greater awareness and support for this group. Whilst MHT helps with hot flushes and night sweats, it is not a treatment for depression and clinicians should offer evidence-based treatments depending on severity and patient preference. 

    Greater awareness, better understanding of mechanisms, new treatments and additional support for people who experience early menopause, menopause after cancer treatment and/or who are at a higher risk of depression over the menopause transition, is urgently needed.

    The Series concludes all women should have access to realistic and balanced information about menopause and possible experiences, effective treatment as needed and shared decision-making to better equip them to navigate this life stage. 

    Source:

    Journal reference:

    The Lancet 2024 Series on menopause. https://www.thelancet.com/series/menopause-2024

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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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  • Loneliness negatively affects the physical health of older adults

    Loneliness negatively affects the physical health of older adults

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    The loneliness often experienced by older people in our society has a negative effect on their physical health, according to researchers from Amsterdam UMC and the University of Glasgow. Emiel Hoogendijk, epidemiologist at Amsterdam Public Health, analyzed research results from more than 130 studies and found that loneliness led to an increase in physical frailty, which in turn increases the risk of adverse health outcomes such as depression, falls and cognitive decline. These results are published today in The Lancet Healthy Longevity. 

    Recently, and especially during the COVID-19 pandemic, there is more attention for the potential harmful effects of loneliness and social isolation on the health of older people. We wanted to see how far these effects went and saw that all kinds of reduced social functioning, such as loneliness, social isolation and lack of social support, were associated with physical decline in older adults.”


    Emiel Hoogendijk, epidemiologist at Amsterdam Public Health

    Led by Peter Hanlon, clinical research fellow at the University of Glasgow, along with researchers from Amsterdam UMC, Canada, Australia and Sweden, researchers analysed the relationship between social functioning and physical frailty in older adults. “Frailty refers to a lot of different forms of physical deterioration, such as weight loss, reduced walking speed and decrease in muscle strength. These can all then have an effect on, for example, how likely you are to fall,” says Hanlon. 

    Previous research has already indicated that frailty can lead to a decrease in social contact, “In some cases, physical vulnerability can also cause people to lose social contacts or become lonelier, for example because they become less mobile,” says Hoogendijk. This research shows that this relationship can also be reversed, with a decrease in social contact leading to frailty.

    Impaired social functioning can have harmful effects on health, with the US Surgeon General claiming last year that loneliness is just as harmful as smoking 15 cigarettes per day. “We know that people with feelings of loneliness or with a lack of social contacts have a higher risk of, amongst others, depression and various chronic diseases. For example, a lack of social contact can have a direct effect on the immune system, but it can also have an indirect effect on health, for example through an unhealthier lifestyle. We want to do more research into this in the coming period,” says Hoogendijk. 

    Impaired social and physical functioning often occur at the same time. “Older people who are physically vulnerable often also have to deal with a decline in both social and mental functioning. As we are caring for older adults, we need to pay attention to all of these aspects,” says Hanlon. He concludes: “Loneliness, for example, is not an easy problem to solve. However, there is more and more knowledge available about possible effective interventions, including activities that support older people to increase their social connections.” 

    Source:

    Amsterdam University Medical Center

    Journal reference:

    Hanlon, P., et al. (2024) The relationship between frailty and social vulnerability: a systematic review. The Lancet Healthy Longevity. doi.org/10.1016/S2666-7568(23)00263-5.

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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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