Tag: mental health

WHO and OHCHR launch guidance to reform legislation for ending coercive practices in mental health care

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Ahead of World Mental Health Day, the World Health Organization (WHO) and the Office of the High Commissioner on Human Rights (OHCHR) are jointly launching new guidance, entitled “Mental health, human rights and legislation: guidance and practice”, to support countries to reform legislation in order to end human rights abuses and increase access to quality mental health care.

Human rights abuses and coercive practices in mental health care, supported by existing legislation and policies, are still far too common. Involuntary hospitalization and treatment, unsanitary living conditions and physical, psychological, and emotional abuse characterize many mental health services across the world.

While many countries have sought to reform their laws, policies and services since the adoption of the United Nations Convention on the Rights of Persons with Disabilities in 2006, too few have adopted or amended the relevant laws and policies on the scale needed to end abuses and promote human rights in mental health care.

Mental health is an integral and essential component of the right to health. This new guidance will support countries to make the changes needed to provide quality mental health care that assists a person’s recovery and respects their dignity, empowering people with mental health conditions and psychosocial disabilities to lead full and healthy lives in their communities.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General

“Our ambition must be to transform mental health services, not just in their reach, but in their underlying values, so that they are truly responsive to the needs and dignity of the individual. This publication offers guidance on how a rights-based approach can support the transformation needed in mental health systems” said Volker Türk, UN High Commissioner for Human Rights.

Promoting more effective community-based mental health care

The majority of reported government expenditure on mental health is allocated to psychiatric hospitals (43% in high-income countries). However, evidence shows that community-based care services are more accessible, cost-efficient and effective in contrast to institutional models of mental health care.

The guidance sets out what needs to be done to accelerate deinstitutionalization and embed a rights-based community approach to mental health care. This includes adopting legislation to gradually replace psychiatric institutions with inclusive community support systems and mainstream services, such as income support, housing assistance and peer support networks.

Ending coercive practices

Ending coercive practices in mental health – such as involuntary detention, forced treatment, seclusion and restraints – is essential in order to respect the right to make decisions about one’s own health care and treatment choices.

Moreover, a growing body of evidence sets out how coercive practices negatively impact physical and mental health, often compounding a person’s existing condition while alienating them from their support systems.

The guidance proposes legislative provisions to end coercion in mental health services and enshrine free and informed consent as the basis of all mental health-related interventions. It also provides guidance on how more complex and challenging cases can be handled in legislation and policies without recourse to coercive practices.

Using the guidance to adopt a right-based approach to mental health

Recognizing that mental health is not the sole responsibility of the health care sector alone, the new guidance is aimed at all legislators and policy-makers involved in drafting, amending and implementing legislation impacting mental health, such as laws addressing poverty, inequality and discrimination.

The new guidance also provides a checklist to be used by countries to assess and evaluate whether mental health-related legislation is compliant with international human rights obligations. In addition, the guidance also sets out the importance of consulting persons with lived experience and their representative organizations as a critical part of this process, as well as the importance of public education and awareness on rights-based issues.

While the guidance proposes a set of principles and provisions that can be mirrored in national legislation, countries may also adapt and tailor these to their specific circumstances (national context, languages, cultural sensitivities, legal systems, etc.), without compromising human rights standards.

On 10 October, WHO will join global communities in marking World Mental Health Day 2023, the theme of which is “Mental health is a universal human right”.

Source:

World Health Organization

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March 28, 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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March 28, 2024

How mastering the art of being alone can boost your mental health

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RECENTLY, I was walking alone on a quiet, winding trail. The path was hard to follow and slick with snow. The sun felt warm on my face. As I trudged uphill, I missed my partner, but felt grateful to be visiting my sister who I don’t see often.

I was on my own for a couple of hours that day. During that time, I felt wide-ranging emotions, including curiosity, anxiety and joy. It was a welcome period of solitude and I returned to civilisation feeling calmer and more clear-headed than when I had set out.

Think about the last time you were alone. Maybe you were commuting to work or had woken up before the rest of your household. Perhaps you live alone. Did you revel in that period of solitude, long to connect with another person or let it pass by without much thought?

Solitude is inevitable. Adults in the UK and US spend around one-third of their waking lives alone and that increases as we get older. In many places, we live alone in greater proportions than ever before. A recent survey of 75 countries shows that 17 of them have more than 25 per cent solo households.

As social creatures, research has historically pointed us away from time alone. But recently, more people are spending time away from the crowd, and even seem to crave it. Now, we have evidence as to why alone time can feel so good and may in fact be vital to your health and well-being. Moreover, we have…

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March 27, 2024
Deciding when to keep a child home from school

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Many parents struggle deciding whether their middle or high school-aged child should stay home from school if they don’t feel well, a new national poll suggests.

Among top factors: how their adolescent or teen is behaving due to symptoms and if they can get through a school day, the risk that they’re contagious and whether the student will miss a test, presentation or after school activity.

One in five parents also consider if their child needs a mental health day, according to the University of Michigan Health C.S. Mott Children’s Hospital National Poll on Children’s Health.

In some cases, the decision to keep kids home from school is clear, such as if the child is vomiting or has a high fever. But parents often have to guess at whether their child’s report of ‘not feeling well’ represents a good reason to miss school.”

Sarah Clark, M.P.H, Mott Poll co-director

The nationally representative report is based on 1,300 responses from parents of children ages 11 to 18 surveyed in February 2024.

Sick day decisions go beyond physical illness

More than half of parents say they’re more likely to keep kids home just to be safe in situations where it’s unclear how sick their child is. Another quarter of parents would send their child to school and hope for the best while less than a fifth would let their child decide.

As grades become more important to adolescents and teens in junior and senior high school, many parents also include academic considerations in their sick day decision. Nearly two thirds of parents say their child worries about an absence’s negative impact on grades or missing friends or school activities.

Clark recommends parents ask more questions to learn about their child’s request to stay home. If it’s on the day of a test, she says, it may reflect their lack of preparation or anxiety about performing well.

Mental health day considerations

Many parents recognize increasing mental health concerns among children, reflected by the 19% who say they’re open to allowing a child to take a mental health day.

Clark notes that in some instances, face to face interactions may trigger or exacerbate mental health issues, such as a breakup with a romantic partner, a falling out with friends, or an embarrassing incident shared on social media.

“It’s understandable that students may fear facing peers in uncomfortable social situations, but they can’t miss school every time they expect an unpleasant interaction,” she said.

“Facing discomfort is a natural part of life, and parents play an important role in helping kids to learn how to navigate these challenges in order to build resilience and develop healthy strategies for handling social stressors.”

In balancing their decisions about allowing their child a mental health day, parents may think about the purpose of the day away from school, she says. It may be an opportunity to help their child plan how to handle interactions, practice strategies to stay calm and ease anxiety, and identify specific peers, teachers or staff who could be sources of support.

For children who have been diagnosed with depression or anxiety, missing school may be necessary to sustain the child’s well-being, Clark adds. Parents should consult with their child’s mental health provider for guidance.

Complying with school attendance policies

Nearly all parents polled say their school has an attendance policy, which they felt was necessary to ensure children go to school consistently. The majority of parents also think the amount and timeframe for making up missed schoolwork is reasonable.

However, many also acknowledge that compliance with school attendance policies can be particularly challenging for children with chronic medical conditions who often miss school due to medical visits or to avoid exacerbations of their condition.

“Parents agreed that attendance policies are important to preventing truancy or excessive absenteeism linked to poor school performance,” Clark said.

“However, parents of children with health issues that require traveling to regular appointments and even hospitalizations may need to have conversations with school administrators and teachers about the likelihood of health related absences. These families may need to enlist the child’s healthcare providers for support in requesting school flexibility in completing assignments at home or with additional time.”

Source:

Michigan Medicine – University of Michigan

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March 25, 2024
My Boyfriend Won’t Stop Meditating!

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My boyfriend says he must meditate for one hour every day. Why does this annoy me so much? He works in tech, if that’s relevant. —Seeking Enlightenment

Dear Seeking,

I think it’s pretty obvious. On the one hand, meditation is the most self-centered, antisocial habit there is—or one of them, at least. (I can think of another intensely solitary act that some people insist they “must” do daily to maintain a clear head.) Its motives are usually brazenly egotistical: personal productivity, sleep hacking, enhanced creativity. On the other hand, it is also a spiritual discipline whose highest aim, traditionally, is ego death, self-transcendence, and the eventual enlightenment of the entire world. The contradictions pile up. No wonder meditation is so popular in tech, an industry in which the persistent effort to increase market share often sails under utopian language about connecting the world, obliterating human limitations, and making life for all beings unimaginably great.

I’m not saying that you should tell him this, of course. If your boyfriend is far enough along his path to enlightenment (God help him), he will likely point out that such “contradictions” are actually paradoxes, koans, the highest form of spiritual truth. The dualistic mind is clouded by either/or thinking, you see, a kind of binary logic that cannot yet glimpse that loftier plane where all 0s are simultaneously 1s and apparent hypocrisies synthesize into unified Truth. I’m sure you’ve gotten this lecture before, and as tiresome as it is, he’s not entirely wrong. We waste so much of our lives trying to fix the frictions and logical oppositions that make our world meaningful in the first place. The thorn is necessary to the beauty of the rose. The bug is actually a feature. The flaws in our loved ones are inseparable, in the end, from their strengths.

All of which is to say: Be grateful that your boyfriend is not yet so evolved that he eludes all inconsistencies. The only thing more annoying than human contradictions is the person who has successfully transcended them.

Why is it that when a friend asks to take a photo of me it’s fine, but when my beloved mom does it I want to scream? —Brat

This question might actually be above my pay grade, Brat. A certain kind of psychotherapist would tell you that any photo is an act of acquisition—the photographer is trying to possess, to capture, to make static—and that the shutter-happy mom embodies the archetype of the Oedipal Mother, who is trying to devour her own children. Maybe your hostility stems from your conflation of the camera with the maternal gaze, the ever-present eye that threatens to obliterate your own point of view. Or maybe the violent language of photography (to shoot, to capture) evokes, on some unconscious level, the sublimated aggression of the mother-child relationship that must be repressed to maintain a viable family life.

You probably don’t find these explanations very convincing. I don’t either. The truth is that I could probably list dozens of activities—asking about your day, checking in about your health, buying unsolicited gifts—that operate according to the same double standard: fine when it’s a friend, annoying as hell when it’s a parent. The problem has nothing to do with photos and everything to do with proximity. It’s easy to resent your mom precisely because she is your mom, an all-purpose dispenser of love and support whose sole purpose is to be obsessively attentive to your needs and sensitive to what irks you. It’s easy to forget that she is also an autonomous being who is probably entering the second half of her life and simply trying to document, in some small way, the fleeting moments of happiness that seem to be passing more quickly every year.

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March 25, 2024
Study reveals ADHD medication reduces psychiatric hospitalizations and work disability
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Attention-deficit/hyperactivity disorder (ADHD), which causes affected individuals to be impulsive, hyperactive, or inattentive, is typically treated with medications and psychosocial measures. Treatment is associated with numerous benefits, such as reduced suicidal ideation and depression, fewer accidents and inadvertent injuries, as well as better long-term employment statistics.

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

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

ADHD and stimulants

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

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

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

About the study

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

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

Study findings

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

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

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

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

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

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

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

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

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

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

What are the implications?

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

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

Taipale, H., Bergstrom, J., and Gemes, K. (2024). Attention-deficit/hyperactivity disorder medications and work disability and mental health outcomes. JAMA Network Open 7(3);e242859. doi:10.1001/jamanetworkopen.2024.2859
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March 24, 2024
Reciprocated care in Alzheimer’s couples enhances mutual well-being

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In cases of Alzheimer’s disease, it’s common for a spouse to take on the role of caregiver. Research led by the University of California, Davis, suggests that patients can also support their caretakers, and that reciprocated care has mutual benefits.

A new paper published in the journal Aging and Mental Health highlights that couples coping with dementia can navigate the challenges with greater resilience and well-being by working together and supporting each other.

We know that dementia is degenerative, there’s no way back, and spousal caregivers typically face substantial burden. But having a mutually beneficial relationship in early stages may help reduce caregiver burden and even slow the progression of dementia symptoms.”

Meng Huo, assistant professor with the Department of Human Ecology and lead author of the study

Nearly 7 million people aged 65 and older in the United States have Alzheimer’s disease. In this study, researchers surveyed 72 couples from Northern California and Nevada in which one person was living with early-stage Alzheimer’s disease and their spouse was the primary caregiver. They assessed the support that spouses provided to each other and found that people with dementia assisted their spousal caregivers often.

“Debunking the myth that dementia patients are only recipients of care is crucial,” Huo said. “Recognizing their potential to help will encourage them to be able to maintain their personal dignity. Dementia patients know they’re declining, but it’s important for them to also know that they can still do a lot of things.”

Practical and emotional support

Huo said the positive effects of empathy and support on emotional well-being, stress levels, communication and illness management can contribute to better overall health outcomes for individuals with dementia and their caregivers.

Researchers found that the support given by patients occurred in various ways, like practical help such as folding the laundry, dishwashing and cooking. Huo said the most common type of support was emotional, including showing appreciation and care.

“In one example, the caregiver had surgery and the dementia patient talked about how she brought flowers and food when she went to the hospital to see the caregiver, and she encouraged the caregiver to stay socially connected to make sure there’s companionship,” Huo said.

Caregiver, patient empathy

Researchers hope the findings can improve existing interventions that mostly target caregivers by including the dementia patients too.

“Dementia caregivers need support,” Huo said. “Support can occur within this ongoing relationship between dementia patients and caregivers. By maintaining the support reciprocity, we may be able promote effective illness management in the long run.”

This study was funded by the National Institute on Aging and the UC Davis Alzheimer’s Disease Research Center. Other listed authors on this paper are from Seoul National University in South Korea, the University of Texas at Austin and Pennsylvania State University.

Source:

University of California – Davis

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March 23, 2024
Link found between neighborhood poverty, food access, and birth outcomes

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Living in neighborhoods where residents have lower incomes and limited food access during pregnancy was associated with an increased risk of babies born small for gestational age or with lower birthweight, according to a new study from the NIH Environmental Influences on Child Health Outcomes (ECHO) Program.

Previous studies have shown that maternal diet during pregnancy can impact the physical and mental health of a mother. However, less is known about how food insecurity affects health outcomes for newborns. In a new research article, ECHO researchers analyzed data to understand what connections might exist between where a pregnant person lives, their access to food, and birth outcomes.

This ECHO analysis, recently published in the American Journal of Clinical Nutrition, indicates a possible connection.

Given the long-term effects of adverse birth outcomes on later cardiovascular disease risk and other conditions, more research is needed to evaluate whether interventions and policies that improve food access during pregnancy would be effective in improving birth outcomes and promoting child health.”

Izzuddin M. Aris, PhD, Harvard Pilgrim Health Care Institute

Using nationwide data from more than 22,000 ECHO Cohort participants, a team of ECHO researchers found that, during pregnancy, 24% of those participants lived in a low-income neighborhood where a third or more residents lived over one mile from a grocery store (or more than 10 miles in rural areas). They also found that about 14% of the participants lived in neighborhoods with high poverty rates and where more than 100 households had no access to a vehicle and lived more than half a mile from the nearest grocery store.

Residence in low-income, low-food-access and low-income, low-vehicle-access neighborhoods was associated with lower birth weight, higher odds of babies born small for gestational age, and lower odds of babies born large for gestational age. However, researchers did not find any associations of individual food insecurity with birth outcomes.

To conduct this study, researchers matched pregnant individuals’ home addresses with information about nearby food availability from the U.S. Food Access Research Atlas, which provided data on household income, the availability of a household vehicle, and where people can access food in different neighborhoods.

“In future studies, we want to look at health habits and chemical exposures to understand what else could be affecting birth outcomes,” said Dr. Aris.

Dr. Aris led a team of ECHO Cohort researchers from across the country who collaborated on the data analysis and writing for this research article.

Source:

Environmental influences on Child Health Outcomes

Journal reference:

Aris, I. M., et al. (2024). Birth outcomes in relation to neighborhood food access and individual food insecurity during pregnancy in the Environmental Influences on Child Health Outcomes (ECHO)-wide cohort study. The American Journal of Clinical Nutrition. doi.org/10.1016/j.ajcnut.2024.02.022.

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March 23, 2024
Study suggests treating anxiety and depression significantly reduces ER visits and rehospitalizations among heart disease patients

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

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

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

Mental health and heart disease outcomes

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

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

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

About the study

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

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

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

Treatment of anxiety and depression in the cohort

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

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

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

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

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

How did treatment affect outcomes?

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

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

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

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

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

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

Future implications

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

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

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

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

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March 22, 2024
AI-based conversational agents show promise in young people’s mental health interventions

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

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

Background

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

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

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

About the review

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

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

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

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

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

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

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

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

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

Results

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

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

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March 22, 2024