When participating in research studies, moderately anxious or highly anxious children from minoritized groups are likely to be hypervigilant to threat, further compounding the effects of their general state of anxiety, a research study led by a University of California, Riverside, psychologist reports.
The study, which involved the participation of 46 Inland Southern California preadolescent Latina girls (8–13 years), has implications also for children from families with low socioeconomic status.
“Psychological research is often conducted in white, educated, and affluent communities,” said Kalina Michalska, an associate professor of psychology, who led the research team. “People from minoritized groups or people with low income and/or limited access to education are often not exposed to scientific research, and have historically been exploited by science, which contributes to their discomfort or legitimate mistrust.”
In the study, the girls first completed a laboratory testing session during which they and their caregivers reported on family demographics as well as the girls’ behavior, anxiety, and other mental health outcome measures. The girls then completed an emotion processing task while in an MRI scanner. They viewed images of fearful and happy faces projected into the scanner bore while the researchers measured their brain responses.
“Trait anxiety” is a constant state of anxiety. “State anxiety” is defined as a momentary feeling of anxiety, the kind one might experience going to the doctor’s office to learn the results of tests or when giving a public lecture.
The researchers found that among girls with average or high levels of trait anxiety, their state anxiety before being MRI-scanned was associated with greater brain responses -; specifically, an increased amygdala-hippocampal response -; to fearful faces (threat stimuli) versus happy faces. This means a generally anxious participant experienced high levels of momentary anxiety when situated in a distressing environment, such as the MRI scanner.
Undergoing an MRI scan is anxiety-inducing not just for children but also, more generally, for people unfamiliar with the scanning environment.”
Kalina Michalska, associate professor of psychology, UCR
In the study, which appears in the open access journal BMC Psychiatry, girls who rated their families as having a lower community standing tended to have elevated pre-scan state anxiety, suggesting that factors such as social status can influence children’s reactions to the research environment.
Michalska, an expert on pediatric anxiety disorders, urges neuroimaging researchers to control for state anxiety and help participants from all backgrounds feel as comfortable as possible during testing sessions.
“Without accounting for state anxiety, data from experiments such as ours could be misattributed to temperamental, environmental, or cultural factors rather than apprehension of the research environment,” she said.
According to Michalska, when children who are at risk for anxiety disorder (trait anxiety) are anxious “in the moment” (state anxiety), the differences in brain activity are due to the momentary anxiety, not the anxiety disorder.
“When interpreting the data, it is important not to misattribute the findings to an anxiety disorder or to a whole community when it is only momentary and situational anxiety,” she said. “Brain responses in experiments like ours need to be attributed not necessarily to the fact that the participants are, say, Latina, but to their historical experiences with science. Our participants had high anxiety because they were entering a space that has historically been hostile to them.”
Michalska is hopeful the team’s findings can lead to new conversations about mental health.
“Doctors can change the way they think about patients’ mental health and teachers can think differently about the mental health of their students,” she said. “Our data show that socioeconomic status can play a significant role in patients’ and students’ anxiety and suggest that the scanning environment may be particularly anxiety-inducing for participants who feel marginalized relative to other members of society.”
Next, the researchers plan on measuring social experiences, such as parents’ experiences of ethnic racial discrimination and children’s experiences of the same. The researchers also plan to measure children’s vicarious experiences resulting from watching their parents’ encounters with ethnic racial discrimination.
Michalska was joined in the research by her former graduate student and first author of the paper Dana E. Díaz, now at Columbia University Irving Medical Center in New York, and Wan-Ling Tseng of Yale University in Connecticut.
The research was funded by a grant from the Hellman Fellows Program and a National Institute of Health subaward from the UCR Center for Health Disparities Research.
The title of the research paper is “Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls.”
Díaz, D.E., et al. (2024) Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls. BMC Psychiatry. doi.org/10.1186/s12888-023-05403-6.
A new collaborative study between Boston Medical Center, Brigham and Women’s Hospital, Boston Children’s Hospital, Hennepin Healthcare Research Institute, University of Pennsylvania, and Children’s Hospital of Philadelphia finds exposure to neighborhood violence among children was associated with unmet health needs and increased acute care utilization. Published in the American Journal of Preventive Medicine and based on nationally representative data on violence exposure and gold standard access to care measures from the National Health Interview Survey, this study shows that evidence-based interventions to improve access to care in communities impacted by violence are needed to mitigate long-term physical and mental health consequences for children.
Millions of children in the U.S. are exposed to violence in their homes or communities. Research has shown that children exposed to violence have worse school performance in childhood, increased rates of substance use disorder in adolescence, increased rates of anxiety, depression, and post-traumatic stress disorder in adulthood, and increased risk of developing chronic medical conditions throughout their lives. Exposure to violence also deepens child health inequities, particularly in marginalized communities disproportionately exposed to violence due to systemic racism across generations.
This study helps examine violence exposure at the population level as both a direct driver of health inequities and as a consequence of fundamental causes like racism, poverty, and other structural risk conditions. The researchers found that, even after controlling for the effects of other important factors like family income and insurance status, children exposed to neighborhood violence face unmet physical and mental health care needs, cost-related barriers, decreased access to prescription drugs, increased urgent care and emergency department utilization, and decreased access to preventive care, mental health care, and medications.
The study also identified an association between exposure to neighborhood violence and mental health symptoms, including increased rates of depression and anxiety, which was consistent with multiple previous studies. Researchers also found that children exposed to violence have higher rates of delayed and forgone mental health care despite experiencing more mental health symptoms. Prior research shows how early access to care can mitigate the mental health consequences of violence exposure; improving access to high-quality, affordable mental health care services remains critical in communities impacted by neighborhood violence.
Researchers call attention to built-in environment reforms like neighborhood greening and cleanup, poverty alleviation interventions like the expanded Child Tax Credit, insurance coverage protections like continuous Medicaid enrollment, and hospital-based violence prevention programs as opportunities to take action.
Our findings highlight the profound impacts of limited access to care in communities affected by violence. We also identify specific opportunities for evidence-based clinician, health system, and policy actions that can reduce the incidence of neighborhood violence and mitigate its health consequences.”
Rohan Khazanchi, MD, MPH, lead author, resident in the Harvard Internal Medicine-Pediatrics Residency Program at Brigham & Women’s Hospital, Boston Children’s Hospital, and Boston Medical Center
“To improve health outcomes for the millions of children in the United States affected by neighborhood violence, we have to invest in their families and communities,” said senior author Aditi Vasan, MD, MSHP, a pediatrician at Children’s Hospital of Philadelphia and Assistant Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. “Our findings underscore the need for both upstream policy interventions, like the expanded Child Tax Credit, which would provide essential economic support for families in low-income communities impacted by violence, and downstream health system interventions focused on improving access to high-quality, trauma-informed care for these children and their families.”
Source:
Journal reference:
Khazanchi, R., et al. (2024) Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. American Journal of Preventive Medicine.doi.org/10.1016/j.amepre.2024.01.009.
MUCH has been written about rising rates of mental health problems in children and teenagers, particularly in the US, with many possible explanations proposed. In Bad Therapy: Why the kids aren’t growing up, US journalist Abigail Shrier offers a bold hypothesis: this crisis is being perpetuated by the very measures supposed to counter it – used by families, schools and, especially, professionals.
For Shrier, the problems start with the many ways modern child-rearing…
Youth mental health in urban environments is significantly better when more nature is incorporated into city design.
A new study from University of Waterloo researchers suggests that forest bathing, the simple method of being calm and quiet amongst the trees, observing nature around you while breathing deeply, can help youth de-stress and boost health and well-being.
The study was the first ever to collect on-site, real-time survey data from adolescents about their emotional responses to various urban environments like a transit hub, residential streets, trails, parks, and waterways. Natural urban spaces were consistently related to significantly higher scores in positive outcomes.
While the findings may not be surprising to most people, what’s significant is that for the first time, we’re able to specifically say this is how much anxiety is reduced when kids are by a park as opposed to by a city center.”
Leia Minaker, associate professor in the School of Planning and director of the Future Cities Initiative
The Future Cities Initiative is the latest in the University of Waterloo’s efforts to address the need to create healthy and prosperous urban futures for all.
After standing and looking at an urban lake for just two or three minutes, youth scores on a validated anxiousness scale decreased by nine per cent. On the other hand, their anxiousness scores were 13 per cent higher when standing in a busy downtown location for the same length of time. This is after adjusting for several other factors, including age, gender, ethnicity, mental health diagnosis, and social status.
With urbanization accelerating rapidly, it’s vital to understand urban environments’ impact on youth better. Especially given that depression and anxiety are among the leading causes of illness among adolescents.
The study found that nature motifs or patterns on buildings, natural sights in urban environments, such as lakes and public activity parks, and landscape elements, like gardens and trees, enhance positive emotional experiences for youth. While these urban characteristics are unique to adolescents, they might be interpreted differently from adults who pursue other activities. For example, adults might be more likely to walk or run in green spaces, whereas youth are more likely to skateboard or hang out.
In designing cities with health and sustainability for all age groups in mind, these findings provide clear evidence that planners, city builders, and healthcare providers can use to advocate for specific natural urban design features.
“Teens are frequently excluded from any kind of decision about the cities they live in,” Minaker said. “It’s important to get their opinions and quantify their experiences because childhood experiences influence many long-term health and disease outcomes.”
The researchers’ next step will be to find a link in the mental health data to the long-term economic and social impacts. Future research will assess the mental and physical health of kids living in high-rise apartment buildings, another area of research that is poorly understood in North America.
Source:
Journal reference:
Buttazzoni, A., & Minaker, L. M. (2023). Associations between real-time, self-reported adolescent mental health and urban and architectural design concepts. Cities & Health. doi.org/10.1080/23748834.2023.2286741.
Results from a large clinical trial funded by the National Institutes of Health show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth. The unique intervention was administered by non-specialized providers who had the equivalent of a bachelor’s degree in psychology-;but no clinical experience. The results suggest this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.
In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists. This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”
Joshua A. Gordon, M.D., Ph.D., Director of the National Institute of Mental Health, part of NIH
Led by Pamela J. Surkan, Ph.D., Sc.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab Province of Pakistan between April 2019 and January 2022. Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive behavioral therapy (CBT)-based intervention called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.
The researchers found that 9% of women in the intervention group developed moderate-to-severe anxiety compared with 27% of women in the routine care group. Additionally, 12% percent of women in the intervention group developed depression compared with 41% of women in the routine care group.
“Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr. Surkan. “The link between maternal and child health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”
The Happy Mother-Healthy Baby intervention was created using input from pregnant women in a hospital in Rawalpindi, Pakistan. Pregnant women took part in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and to practice replacing them with helpful thoughts and behaviors. The first five sessions were conducted in early to mid-pregnancy, and the sixth session occurred in the third trimester.
Prior research suggests that up to 30% of women in the Global South, which includes South America, Africa, and most of southern Asia, report experiencing anxiety during pregnancy. Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention. However, it can be challenging for women living in low-resource settings to access trained clinical care. The findings from this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialist clinical care may be hard to access.
“In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr. Surkan.
Surkan, P. J., et al. (2024). Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: a randomized, phase 3 trial. Nature Medicine. doi.org/10.1038/s41591-024-02809-x.
Antidepressant dispensing to adolescents and young adults increased sharply after the COVID-19 pandemic began – particularly among females – a new study finds.
While a growing number of young people ages 12 to 25 were receiving antidepressants before the pandemic, the antidepressant dispensing rate rose nearly 64% faster after March 2020, according to Michigan Medicine led findings in Pediatrics.
Antidepressant dispensing to adolescents and young adults was already high and rising before March 2020. Our findings suggest these trends accelerated during the pandemic.”
Kao Ping Chua, M.D., Ph.D., lead author, pediatrician and researcher at University of Michigan Health C.S. Mott Children’s Hospital and the Susan B. Meister Child Health Evaluation and Research Center
Researchers analyzed data from a national database reporting 92% of prescriptions dispensed in U.S. pharmacies. They found that the increase in the antidepressant dispensing rate during the pandemic was driven by females.
After March 2020, this rate increased 130% faster among female adolescents ages 12-17 years and 60% faster among female young adults ages 18-25 years.
“Multiple studies suggest that rates of anxiety and depression among female adolescents increased during the pandemic,” Chua said. “These studies, coupled with our findings, suggest the pandemic exacerbated a pre-existing mental health crisis in this group.”
In contrast to females, the antidepressant dispensing rate changed little among male young adults after March 2020 and declined among male adolescents, which Chua found surprising.
“It’s hard to believe this decline reflects improved mental health,” he said.
He believes a more likely explanation is that male adolescents may have skipped physicals and other health care visits during the pandemic, decreasing opportunities to diagnose and treat anxiety and depression.
The transition away from in-person learning, he notes, may have also decreased opportunities for teachers and other school staff to detect mental health problems in male adolescents.
Chua said the overall rise in antidepressant dispensing to adolescents and young adults may not only be related to worsened mental health. Long waitlists for psychotherapy, for example, may have also played a role.
“In my primary care clinic, I often heard from patients and families that they were facing 6-9 month wait lists for therapy during the pandemic. In those situations, it didn’t make sense to withhold antidepressants and recommend a therapy-only approach,” he said.
Further studies, Chua says, should identify which interventions can best promote the mental health of adolescents and young adults.
California voters will decide March 5 whether to pump billions more dollars into combating the nation’s worst homelessness crisis, an investment Democratic Gov. Gavin Newsom argues will finally provide the housing and treatment so badly needed by tens of thousands of homeless people.
Newsom is spearheading Proposition 1, a $6.4 billion bond he says would fund 11,150 new beds and housing units for people living on the streets with untreated mental illness or addiction, and ongoing capacity for 26,700 additional outpatient appointments. It would also alter how $3 billion to $4 billion in existing annual tax funding for mental health services is spent, funneling a hefty portion of it into housing.
Many authorities on mental health and homelessness agree California desperately needs thousands more housing units and treatment beds to successfully attack the growing public health crisis. Health and law enforcement groups have lined up behind the initiative, as have the mayors of the state’s major cities.
Homelessness statistics in California have risen a staggering 20% since Newsom took office in 2019, to more than 180,000 people — 68% of them on the streets and not in shelters. The numbers are growing despite Newsom’s unprecedented investment of more than $20 billion in homelessness programs, plus billions more for health and social services.
Yet many of the front-line workers implementing Newsom’s initiatives fear that Proposition 1 would simply pour more money into a broken homelessness response system that is largely failing to house those in need.
Rather than focus on getting homeless people into mental health and addiction programs — and ultimately into housing — many caseworkers say they waste precious time and taxpayer dollars searching for their homeless clients after encampments have been cleared by state and local officials, a policy Newsom has encouraged, not only for the safety of homeless people but for those in surrounding neighborhoods.
Once they locate their clients, advocates must help them — often repeatedly — obtain food, clothing, and medication refills, and replace official government documents like birth certificates and IDs. “You can’t get housing without that stuff,” said Afton Francik, an outreach worker with the Sacramento-based nonprofit Hope Cooperative, which is implementing several of Newsom’s homelessness and mental health initiatives.
Perhaps the biggest challenge they face, outreach workers and case managers say, is rebuilding the trust that took time to establish — and which they say is essential to getting people into treatment and housing.
“It makes it so much harder to even find people or help them get into housing because you have to go back and repeat that work you already did,” Francik said.
Newsom says California has placed at least 71,000 people indoors — either in permanent or temporary housing — since he took office in 2019. State money flows to cities and counties, which have opened at least 15,000 housing units and 2,485 residential treatment beds, plus additional outpatient capacity, during his tenure.
Newsom has also revamped health programs to get people off the streets, including a massive $12 billion transformation of the state Medicaid health insurance program that provides some patients with housing and one-on-one case management services.
As he promotes Proposition 1, Newsom is calling for stricter enforcement, saying he feels a deep responsibility to keep California’s streets clean and safe, and to respond to growing neighborhood concerns about trash, mental illness, crime, and drugs. He has acknowledged that sweeps can traumatize homeless people but argues that local officials who receive state money to clear encampments are supposed to find shelter or treatment for those displaced.
Sacramento County Sheriff Jim Cooper, who supports Proposition 1, said sweeps are sometimes necessary for public health and safety.
“This is a huge drain on public resources and emergency services,” Cooper said. “Drugs are everywhere. There is so much mental illness. We’ve got to get these folks the help and treatment they need.”
But critics of the sweeps argue that it’s inhumane to forcibly move people without providing shelter or housing. “We’re seeing a ton of enforcement, but there’s literally nowhere to put people,” said Crystal Sanchez, president of the Sacramento Homeless Union.
Newsom acknowledged the state doesn’t have enough housing for everyone who needs it, and that Proposition 1 is part of the solution. The measure would expand his existing housing and treatment programs, which do not trigger the land use and environmental reviews that often delay or kill new projects.
“We are in a unique position to take what we have been promoting — these promises — and make them real,” Newsom said in January.
Like all of Newsom’s homeless housing initiatives, Proposition 1 would rely on outreach teams and caseworkers to help homeless people obtain services and housing.
But in boots-on-the-ground interviews from rural Northern California to San Diego, such workers said it would be difficult to get more people into housing if they must continue picking up the pieces after encampment clearings — a policy the U.S. Supreme Court will scrutinize in April.
The question the court will consider is whether to allow criminal or civil penalties against homeless people living outdoors if no shelter or housing is available. Newsom said in an amicus brief that cities and counties should be allowed to clear encampments, signaling he has no plans to retreat from the policy.
“When encampments are being cleared by law enforcement, it totally upends people’s lives and violates that trust in a way that they’re going to be more resistant to help,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, whose California chapter supports the ballot initiative. “If someone has a mental illness and is unhoused, trust is the most important thing in trying to engage them in treatment and actually getting them into housing.”
Take Samuel Buckles, a longtime Sacramento resident who said he struggles with mental health and is addicted to fentanyl. Buckles, 53, lost his home in a fire and then his job early in the covid-19 pandemic. Since then, he has worked odd jobs as a handyman and purchased a recreational vehicle that he parked around Sacramento and called home.
When law enforcement officials cleared his camp in early February, they confiscated his RV because he had allowed the registration to lapse. He lost his birth certificate and Social Security card, all his medications for diabetes and high blood pressure, his extra clothing, and a fridge packed with groceries he’d recently purchased with his food stamp benefits.
“That was my home and everything I had in the world,” Buckles said on a cold February morning from his new form of shelter: a tent donated by outreach workers.
It was the first time in years he said he had truly felt homeless.
In mid-February, law enforcement cleared the encampment he had relocated to, forcing him to move again. Feeling despondent, he said he had given up on the promise of housing. “Please make this pain stop. I don’t know how much more I can take,” he said.
Buckles was able to grab a few possessions from his RV after it was confiscated, but replacing the documents he needs for housing may take months and repeat visits by outreach workers, said Greg Stupplebeen, an outreach manager with Hope Cooperative.
Even if Buckles had his paperwork in order, “there’s nowhere to put anybody right now,” Stupplebeen told him.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
This 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.
Since 2000, the number of full-time healthcare workers has almost doubled. Women account for a significant proportion of this growth and remain integral to the successful provision of healthcare services. Therefore, it is imperative to understand what contributes to the well-being of women in the workplace.
Due to the wide range of different roles that women play in society, they can be subject to immense pressure to be successful both at home and in the workplace. This can lead to adverse consequences, such as occupational burnout, psychological distress, anxiety, depression, or even suicidal thoughts.
In the healthcare sector, these adverse effects can lead to loss of patient trust, lack of adherence to treatment protocols, and lower quality care. Thus, it is critical that female healthcare workers, in particular, receive appropriate support.
About the study
In the current study, a total of 71 studies published in 26 countries between 1979-2022 were reviewed. Adult female healthcare professionals between 18 and 74 years of age were enrolled in these studies and included mental healthcare providers, clinical social workers, nurses, and physicians.
Several well-being-related factors were investigated, including resilience, wellness, burnout, stress, and quality of life (QOL). For the current study, individuals who identified as women were included, irrespective of the sex assigned at birth.
Study findings
This extensive review examined different study designs related to the well-being of female professionals in the healthcare sector across different countries and social contexts. Previous research defined well-being as being disease-free or not having work dissatisfaction; however, this definition is inadequate, as well-being should also encompass promoting happiness, security, and comfort.
Several studies have reported a negative association between poor work-life balance and a sense of well-being. To this end, women have often been encouraged to prioritize the household’s and children’s needs rather than their professional development.
About 25% of the reviewed studies suggested that limited professional autonomy and poor working conditions made women experience burnout at a faster rate than their male colleagues. However, the burnout rate was lower when women worked in a supportive environment and had flexible schedules.
Moreover, 20% of the studies highlighted the importance of personal relationships, in which familial relationships, romance, and friendship positively influenced a sense of well-being among women employed in the healthcare sector. The impact of environmental influence and the individual’s lived experience were vital to well-being.
About 16% of the studies revealed that implicit gender bias was a key source of mental distress among female healthcare workers. This was manifested in various ways, including unequal pay, fewer opportunities to progress, and not addressing female colleagues by their professional titles.
Several studies discussed the positive association between intentional mindfulness, exercise, sleep, nutrition, and well-being. The findings from these studies highlight that lifestyle interventions could reduce stress levels, compassion fatigue, and burnout.
Opportunities to pursue mentoring and professional development had a positive impact in 11% of the reviewed articles. These activities foster a deeper connection with colleagues and lead to a greater sense of belonging, which subsequently provides fulfillment in professional opportunities and higher job satisfaction.
Conclusions
The current review explored the well-being of female professionals in the healthcare sector and further analyzed the correlation between well-being and work-related stressors. Several factors were found to lead to emotional turmoil and job dissatisfaction, which can have severe consequences for the affected individual and the quality of patient care.
The study findings should motivate future research evaluating different levels of gender-sensitive interventions. More prophylactic methods, such as educational workshops, mindfulness practices, and institutional policy, should be implemented to study the effects of more holistic well-being practices for women.
Furthermore, the definition of well-being could be made more inclusive by combining physical and mental health. Well-being should also incorporate a sense of meaning or purpose, life satisfaction, and the ability to manage stress.
Journal reference:
Karakcheyeva, V., Willis-Johnson, H., Corr, P. G., & Frame, L. A. (2024) The Well-Being of Women in Healthcare Professions: A Comprehensive Review. Global Advances in Integrative Medicine and Health13. doi:10.1177/27536130241232929
The Mediterranean diet (MD) is a popular and medically accepted diet for weight management and health promotion; however, the potential mental health benefits associated with this diet remain unclear. A new study in the British Journal of Nutrition discusses the association between MD and depressive symptoms in a cohort of older men and women.
Current estimates indicate that about 5% of the global population suffers from depression, with depression among the leading causes of disability throughout the world. Importantly, the prevalence of depression increases with age, with one-third of older people affected.
Women are at greater risk for depressive symptoms from adulthood onwards, with this risk further increasing after the age of 60 years. In Italy, 10% of people over 65 years of age report depressive symptoms, with up to 14% of women 85 years and older experiencing depression.
Biological, psychological, social, and environmental factors contribute to the development of depression; therefore, diet can be considered a modifiable risk factor for this condition. Previous research has shown that following the MD is related to a lower risk of depressive symptoms overall.
The current study examined the association between MD, due to its ideal nutritional and antioxidant profile, and depressive symptoms. More specifically, the researchers were interested in clarifying the existence of this association, and especially sex-related differences, in older people, with the added contribution of separating these associations by dietary components.
Data were obtained from a food frequency questionnaire intended to semi-quantitatively assess adherence to the MD in the form of the Mediterranean diet score (MDS) and a depression measurement scale. Study participants were part of the population-based community-dwelling Nutrition, Gut Microbiota, and Brain Aging (NutBrain) cohort, and the study was conducted from October 2019 to January 2023.
What did the study show?
A total of 325 men and 473 women were included in the study, 60% of whom were between 65 and 74 years of age. The mean age was 73 years, with about 66% of study participants married and living with others, whereas 50% were considered underprivileged.
About 20% of the study cohort suffered from depressive symptoms, with 8% of men and 28% of women reporting depressive symptoms. Men with and without depression differed only in the significantly greater number of medications used in those with depression.
Among women, unmarried women, those living alone, those prescribed more drugs, and those who considered themselves to be sicker were more likely to experience symptoms of depression, as were those who ate less fish, vegetables, and healthy fats relative to saturated fat. About 33% of men reported adherence to the MD compared to 25% of women.
Study participants with the top third of MDS scores were 55% less likely to report depressive symptoms. When stratified by sex, women with the top third of MDS scores were at a 60% reduced risk of depression.
High fish consumption was associated with a 44% reduced risk of depressive symptoms in men and women. When stratified by sex, women with high fish consumption were 56% less likely to experience depressive symptoms. With each additional gram of fish consumption, the likelihood of depression declined by 2% overall and in women but not men.
The type of fish associated with a reduced risk of depression when three or more servings were consumed each week included shellfish, sole, trout, sea bream, cod, hake, and sea bass. This reduction was 62% overall for fish and 4% for shellfish.
When stratified by sex, women were associated with a reduced risk of depression by 43% with two to three servings of these fish each week; however, this risk further declined by 70% with three or more servings each week as compared to those consuming two or fewer servings of fish. This association was not observed in men.
Women with a high ratio of monounsaturated fatty acids to saturated fatty acids (MUFA/SFA) in their diet were 42% less likely to report depressive symptoms. For both men and women, nut and fruit consumption was associated with a reduced risk of depressive symptoms by 82% and 42%, respectively.
With each one-point increase in MDS, the risk of depressive symptoms decreased by 16% overall and by 18% in women. When only men were considered, this reduction was not significant.
What are the implications?
Adherence to the highest tertile of the MD is inversely associated with depressive symptoms and, in particular, this is only evident in women.”
The negative association of the MD, particularly fresh fish and higher MUFA/SFA, with depression corroborates earlier research.
The association of fresh fish with a reduced risk of depressive symptoms could be due to reduced inflammation, regulation of hypothalamic and pituitary hormones, which regulates other endocrine functions, reduced oxidative stress, gut microbiota profile, as well as other metabolic and intracellular pathways related to mental health.
The differential effects in women may be due to a higher prevalence of vitamin D deficiency in women, which is associated with poor mental health, including depression and psychosis, as well as changes in brain cell membranes caused by the supply of omega-3 fatty acids abundant in the MD. However, further research is needed to confirm these hypotheses.
While these findings cannot be experimentally confirmed, and the inclusion of study subjects may show multiple biases, the study cohort was representative of the older community in each locality. Despite these limitations, the study findings emphasize the key role of a healthy diet in promoting mental health in older people. Thus, public health efforts towards this goal will likely be productive, even as further studies are conducted to understand the biological processes responsible for these benefits.
Standing in front of the concrete steps of her home in Midway, Texas, Collier, initially barefoot and wearing a baggy gray T-shirt, told officers she planned to see a doctor in the morning because she had been bleeding.
Police body camera footage obtained by KFF Health News through an open records request shows that the officers then told Collier — who was 29 at the time and enrolled in online classes to study psychology — to turn around.
Instead of taking her to get medical care, they handcuffed and arrested her because she had outstanding warrants in a neighboring county for failing to appear in court to face misdemeanor drug charges three weeks earlier. She had missed that court date, medical records show, because she was at a hospital receiving treatment for pregnancy complications.
Despite her symptoms and being about 13 weeks pregnant, Collier spent the next day and a half in the Walker County Jail, about 80 miles north of Houston. She said her bleeding worsened there and she begged repeatedly for medical attention that she didn’t receive, according to a formal complaint she filed with the Texas Commission on Jail Standards.
“There wasn’t anything I could do,” she said, but “just lay there and be scared and not know what was going to happen.”
Welfare Check Turns Into Arrest for Pregnant Texan
Collier’s experience highlights the limited oversight and absence of federal standards for reproductive care for pregnant women in the criminal justice system. Incarcerated people have a constitutional right to health care, yet only a half-dozen states have passed laws guaranteeing access to prenatal or postpartum medical care for people in custody, according to a review of reproductive health care legislation for incarcerated people by a research group at Johns Hopkins School of Medicine. And now abortion restrictions might be putting care further out of reach.
Collier’s arrest was “shocking and disturbing” because officers “blithely” took her to jail despite her miscarriage concerns, said Wanda Bertram, a spokesperson for the Prison Policy Initiative, a nonprofit organization that studies incarceration. Bertram reviewed the body cam footage and Collier’s complaint.
“Police arrest people who are in medical emergencies all the time,” she said. “And they do that regardless of the fact that the jail is often not equipped to care for those people in the way an emergency room might be.”
After a decline during the first year of the pandemic, the number of women in U.S. jails is once again rising, hitting nearly 93,000 in June 2022, a 33% increase over 2020, according to the Department of Justice. Tens of thousands of pregnant women enter U.S. jails each year, according to estimates by Carolyn Sufrin, an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine, who researches pregnancy care in jails and prisons.
The health care needs of incarcerated women have “always been an afterthought,” said Dana Sussman, deputy executive director at Pregnancy Justice, an organization that defends women who have been charged with crimes related to their pregnancy, such as substance use. For example, about half of states don’t provide free menstrual products in jails and prisons. “And then the needs of pregnant women are an afterthought beyond that,” Sussman said.
Researchers and advocates worry that confusion over recent abortion restrictions may further complicate the situation. A nurse cited Texas’ abortion laws as one reason Collier didn’t need care, according to her statement to the standards commission.
Texas law allows treatment of miscarriage and ectopic pregnancies, a life-threatening condition in which a fertilized egg implants outside the uterus. However, different interpretations of the law can create confusion.
A nurse told Collier that “hospitals no longer did dilation and curettage,” Collier told the commission. “Since I wasn’t hemorrhaging to the point of completely soaking my pants, there wasn’t anything that could be done for me,” she said.
Collier testified that she saw a nurse only once during her stay in jail, even after she repeatedly asked jail staffers for help. The nurse checked her temperature and blood pressure and told her to put in a formal request for Tylenol. Collier said she completed her miscarriage shortly after being released.
Collier’s case is a “canary in a coal mine” for what is happening in jails; abortion restrictions are “going to have a huge ripple effect on a system already unequipped to handle obstetric emergencies,” Sufrin said.
‘There are no consequences’
Jail and prison health policies vary widely around the country and often fall far short of the American College of Obstetricians and Gynecologists’ guidelines for reproductive health care for incarcerated people. ACOG and other groups recommend that incarcerated women have access to unscheduled or emergency obstetric visits on a 24-hour basis and that on-site health care providers should be better trained to recognize pregnancy problems.
In Alabama, where women have been jailed for substance use during pregnancy, the state offers pregnancy tests in jail. But it doesn’t guarantee a minimum standard of prenatal care, such as access to extra food and medical visits, according to Johns Hopkins’ review.
Policies for pregnant women at federal facilities also don’t align with national standards for nutrition, safe housing, and access to medical care, according to a 2021 report from the Government Accountability Office.
Even when laws exist to ensure that incarcerated pregnant women have access to care, the language is often vague, leaving discretion to jail personnel.
Since 2020, Tennessee law has required that jails and prisons provide pregnant women “regular prenatal and postpartum care, as necessary.” But last August a woman gave birth in a jail cell after seeking medical attention for more than an hour, according to the Montgomery County Sheriff’s Office.
Pregnancy complications can quickly escalate into life-threatening situations, requiring more timely and specialized care than jails can often provide, said Sufrin. And when jails fail to comply with laws on the books, little oversight or enforcement may exist.
In Louisiana, many jails didn’t consistently follow laws that aimed to improve access to reproductive health care, such as providing free menstrual items, according to a May 2023 report commissioned by state lawmakers. The report also said jails weren’t transparent about whether they followed other laws, such as prohibiting the use of solitary confinement for pregnant women.
Krishnaveni Gundu, as co-founder of the Texas Jail Project, which advocates for people held in county jails, has lobbied for more than a decade to strengthen state protections for pregnant incarcerated people.
In 2019, Texas became one of the few states to require that jails’ health policies include obstetrical and gynecological care. The law requires jails to promptly transport a pregnant person in labor to a hospital, and additional regulations mandate access to medical and mental health care for miscarriages and other pregnancy complications.
But Gundu said lack of oversight and meaningful enforcement mechanisms, along with “apathy” among jail employees, have undermined regulatory protections.
“All those reforms feel futile,” said Gundu, who helped Collier prepare for her testimony. “There are no consequences.”
Before her arrest, Collier had been to the hospital twice that month experiencing pregnancy complications, including a bladder infection, her medical records show. Yet the commission found that Walker County Jail didn’t violate minimum standards. The commission did not consider the police body cam footage or Collier’s personal medical records, which support her assertions of pregnancy complications, according to investigation documents obtained by KFF Health News via an open records request.
In making its determination, the commission relied mainly on the jail’s medical records, which note that Collier asked for medical attention for a miscarriage once, in the morning on the day she was released, and refused Tylenol.
“Your complaint of no medical care is unfounded,” the commission concluded, “and no further action will be taken.”
Collier’s miscarriage had ended before she entered the jail, argued Lt. Keith DeHart, jail lieutenant for the Walker County Sheriff’s Office. “I believe there was some misunderstanding,” he said.
Brandon Wood, executive director of the commission, wouldn’t comment on Collier’s case but defends the group’s investigation as thorough. Jails “have a duty to ensure that those records are accurate and truthful,” he said. And most Texas jails are complying with heightened standards, he said.
Bertram disagrees, saying the fact that care was denied to someone who was begging for it speaks volumes. “That should tell you something about what these standards are worth,” she said.
Last year, Chiree Harley spent six weeks in a Comal County, Texas, jail shortly after discovering she was pregnant and before she could get prenatal care, she said.
I was “thinking that I was going to be well taken care of,” said Harley, 37, who also struggled with substance use.
Jail officials put her in the infirmary, Harley said, but she saw only a jail doctor and never visited an OB-GYN, even though she had previous pregnancy complications including losing multiple pregnancies at around 21 weeks. This time she had no idea how far along she was.
She said that she started leaking amniotic fluid and having contractions on Nov. 1, but that jail officials waited nearly two days to take her to a hospital. Harley said officers forced her to sign papers releasing her from jail custody while she was having contractions in the hospital. Harley delivered at 23 weeks; the baby boy died less than a day later in her arms.
The whole experience was “very scary,” Harley said. “Afterwards we were all very, very devastated.”
Comal County declined to send Harley’s medical and other records in response to an open records request. Michael Shaunessy, a partner at McGinnis Lochridge who represents Comal County, said in a statement that, “at all times, the Comal County Jail provided Chiree Harley with all appropriate and necessary medical treatment for her and her unborn child.” He did not respond to questions about whether Harley was provided specialized obstetric care.
‘I trusted those people’
In states like Idaho, Mississippi, and Louisiana that installed near-total abortion bans after the Supreme Court eliminated the constitutional right to abortion in 2022, some patients might have to wait until no fetal cardiac activity is detected before they can get care, said Kari White, the executive and scientific director of Resound Research for Reproductive Health.
White co-authored a recent study that documented 50 cases in which pregnancy care deviated from the standard because of abortion restrictions even outside of jails and prisons. Health care providers who worry about running afoul of strict laws might tell patients to go home and wait until their situations worsen.
“Obviously, it’s much trickier for people who are in jail or in prison, because they are not going to necessarily be able to leave again,” she said.
Advocates argue that boosting oversight and standards is a start, but that states need to find other ways to manage pregnant women who get caught in the justice system.
For many pregnant people, even a short stay in jail can cause lasting trauma and interrupt crucial prenatal care.
Collier remembers being in “disbelief” when she was first arrested but said she was not “distraught.”
“I figured I would be taken care of, that nothing bad was gonna happen to me,” she said. As it became clear that she wouldn’t get care, she grew distressed.
After her miscarriage, Collier saw a mental health specialist and started medication to treat depression. She hasn’t returned to her studies, she said.
“I trusted those people,” Collier said about the jail staff. “The whole experience really messed my head up.”
This 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.
