Patient’s BMI May Help MDs Choose Right Drug for Depression

New research suggests personalized and precision psychiatry can guide antidepressant choice and significantly help individuals with depression.

At present, selecting the best antidepressant that will be most effective for a specific person can be a trial and error process. The new study shows that body mass index (BMI), sex of the patient, and symptom profile can be used to determine a personalized pharmacological treatment.

“We are in the midst of a paradigm shift in the field of psychiatry, to find specific clinical and biological signals that help clinicians and patients decide what is the best treatment,” explained lead investigator Leanne Williams, Ph.D., VA Palo Alto Health Care System and the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.

“This is the shift to incorporate precision medicine approaches to improve outcomes for patients. Our study adds new knowledge to this effort, and does so for two commonly associated chronic conditions, clinical depression and obesity that need new treatment approaches.

“Our results have the potential for a significant impact on the majority of patients suffering from depression who are seen in primary care and community settings.”

In the study, researchers analyzed data from 659 adults (ages 18-65) with clinical depression who completed the International Study to Predict Optimized Treatment in Depression (iSPOT-D).

They were randomly assigned one of three antidepressants (venlafaxine-XR, sertraline, or escitalopram) and followed for eight weeks of treatment.

Height and weight were recorded and each participant completed the 17-item Hamilton Rating Scale (a self-reported depression inventory) before and after treatment to measure change in depression severity.

Patients who improved so substantially that they were no longer experiencing clinical symptoms were defined as “remitters.”

Researchers found that for both men and women, having a larger BMI than patients of “normal” weight, venlafaxine-XR predicted remission. Investigators believe this is associated with a reduction in physical symptoms, including sleep disturbance, somatic anxiety and appetite.

Females with higher BMI were likely to remit regardless of medication type and this effect was related to a change in cognitive symptoms, including thoughts of suicide and guilt.

Researchers believe the findings can be immediately applied in primary care and community settings in which most patients are treated. Primary care doctors have access to information regarding patient sex, BMI (weight relevant to height), along with symptoms of depression.

According to lead author Erin Green, Ph.D., “Although these findings require replication, they are ready for ‘prime time’ translation into clinical practice where there are currently no indicators and algorithms available for guiding treatment choice for patients with both depression and obesity.

“The future of psychiatry is in a precision, personalized medicine approach to refining diagnosis and tailoring treatments accordingly.”

According to Williams, the study demonstrates that currently available markers are poised to improve patient outcomes without introducing new costs. “Markers such as BMI are likely to complement others being developed out of neuroimaging and genomics,” she said.

Source: Elsevier Health Sciences/EurekAlert

 
Photo: Predicted probabilities of remission for each treatment at different levels of body mass index (BMI).Credit: Personalized Medicine in Psychiatry.

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Dad’s Age at Conception May Impact Child’s Social Development

** Note: Shallow depth of field

A father’s age at the time of conception may affect his child’s social development, according to a new study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). And this impact appears to be a result of genetic rather than environmental factors.

The findings show that children born to very young or older fathers — below 25 and over 51 years of age, respectively — showed more prosocial behaviors in early development. However, by the time they reached adolescence, they lagged behind their peers with middle-aged fathers.

These effects were specific to social development and were not observed in relation to maternal age.

For the study, researchers evaluated the social behaviors of twins from preschool to adolescence and found that those whose fathers were either very young or older at conception differed in how they acquired social skills. The findings also may offer insights into how paternal age influences children’s risk of autism and schizophrenia, which has been shown in earlier studies.

“Our study suggests that social skills are a key domain affected by paternal age. What was interesting is that the development of those skills was altered in the offspring of both older as well as very young fathers,” said Magdalena Janecka, Ph.D., a fellow at the Seaver Autism Center for Research and Treatment at Mount Sinai.

“In extreme cases, these effects may contribute to clinical disorders. Our study, however, suggests that they could also be much more subtle.”

Janecka and her co-authors used a UK-based sample of more than 15,000 twins who were followed between the ages of 4 and 16. To determine whether children’s social skills were affected by how old their father was when they were born, the researchers looked for differences in the developmental patterns of social skills, as well as other behaviors, including conduct and peer problems, hyperactivity, and emotionality.

Separately, they studied whether the impact of paternal age on development was more likely attributable to genetic or environmental factors.

The genetic analysis further revealed that development of social skills was influenced mainly by genetic rather than environmental factors, and that those genetic effects became even more prominent as fathers aged.

“Our results reveal several important aspects of how paternal age at conception may affect offspring,” said Janecka. “We observed those effects in the general population, which suggests children born to very young or older fathers may find social situations more challenging, even if they do not meet the diagnostic criteria for autism.”

“Further, increased importance of genetic factors observed in the offspring of older, but not very young fathers, suggests that there could be different mechanisms behind the effects at these two extremes of paternal age. Although the resulting behavioral profiles in their offspring were similar, the causes could be vastly different.”

The researchers hope to replicate these findings in future studies as well as determine their biological correlates.

“Those developmental differences, if confirmed, are likely traceable to alterations in brain maturation. Identifying neural structures that are affected by paternal age at conception, and seeing how their development differs from the typical patterns, will allow us to better understand the mechanisms behind those effects of paternal age, as well as, likely, autism and schizophrenia,” said Janecka.

Source: Elsevier

 

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People with Good Memories May Get Bored Quicker

Business colleagues getting bored in a meeting at office

New research from the University of Kansas finds that people with larger memory capacities remember things longer and, as a result, are harder to keep engaged because they believe they have been there and done that.

However, marketing and consumer behavior investigators believe this characteristic may be used to improve a person’s diet.

“People with larger working memory capacities actually encode information more deeply,” said Noelle Nelson, Ph.D., lead author of the research published in the Journal of Consumer Research.

“They remember more details about the things they’ve experienced, and that leads them to feel like they’ve had it more. That feeling then leads to the large-capacity people getting tired of experiences faster.”

The study could have implications for marketers seeking to maintain interest in their products and brands.

Consumers could also benefit from the research because it provides a window into how memory could be the key to becoming satiated, especially on products or habits they hope to quit, such as eating unhealthy foods.

“Our findings suggest that if they can enhance their memory for the other times they’ve eaten these foods, they may feel satiated and then not seek out those unhealthy things,” said Nelson.

Nelson co-authored the study with Dr. Joseph Redden, associate professor of marketing at the University of Minnesota.

They conducted four separate experiments with undergraduate student participants. The researchers measured people’s working memory capacities in different ways, such as how well they could remember a string of letters or how they performed on the Simon memory game where users must try to repeat a series of tones and lights.

Then participants then performed a task where they would eventually become tired of what they experienced, like viewing paintings or listening to music.

“We found that their capacity predicted how fast they got tired of the art or music,” Nelson said.

“People with larger memory capacities satiated on these things more quickly than people with smaller capacities.

“Essentially, large capacity people perceive that they’ve experienced things more times because they remember those experiences better.”

Past research has only speculated on the link between memory and the rate of satiation, but this study provides direct evidence, she said.

Marketers believe this type of research can be used to craft strategies on ways to keep people interested longer.

“For example, introducing new products or having distractions in ads might help break up the satiation process because they disrupt memory,” Nelson said.

The researchers didn’t specifically study overeating or unhealthy foods, but the findings should extend to those types of experiences, she said.

“Because a big part of overeating is psychological, a psychological solution such as memory processes, could help people control their eating,” Nelson said.

“Consumers might be able to satiate more quickly by simply recalling the last several times they ate.”

Source: University of Kansas

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Autism May Be Tied to Maternal Grandmother’s Smoking While Pregnant

Girls whose grandmothers smoked while their mothers were in utero are 67 percent more likely to display certain traits linked to autism, such as poor social communication skills and repetitive behaviors, according to a new study by researchers at the University of Bristol in the U.K.

In addition, boys and girls whose grandmothers smoked while their mothers were in utero are 53 percent more likely to be diagnosed with an autism spectrum disorder (ASD).

The findings overwhelmingly suggest that if a female is exposed to cigarette smoke while she is still in the womb, it could affect her developing eggs, resulting in changes that may eventually affect the development of her own children.

“We already know that protecting a baby from tobacco smoke is one of the best things a woman can do to give her child a healthy start in life. Now we’ve found that not smoking during pregnancy could also give their future grandchildren a better start too,” said the noted British epidemiologist and researcher Professor Jean Golding.

For the study, the researchers combed through the data of 14,500 participants enrolled in the Children of the 90s study, the birth cohort study developed by Golding that produced a detailed data set of children born in the area in 1991 and 1992.

Unlike the analysis of autistic traits, which was based on over 7,000 participants, the 177 diagnosed with ASD were too few to analyze grandsons and granddaughters separately.

By using detailed information collected over many years on multiple factors that may affect children’s health and development, the researchers were able to rule out other potential explanations for their results.

More research is needed to discover what the exact mechanisms are behind these molecular changes and to see whether the same associations are present in other groups of people.

Previous studies of maternal smoking during pregnancy and ASD in children have been inconclusive. Going back a generation has revealed an intergenerational effect, which surprisingly is most clear-cut when the mother herself did not smoke in pregnancy. The reasons for this are not entirely clear.

“In terms of mechanisms, there are two broad possibilities,”  said researcher Professor Marcus Pembrey. “There is DNA damage that is transmitted to the grandchildren or there is some adaptive response to the smoking that leaves the grandchild more vulnerable to ASD.

“We have no explanation for the sex difference, although we have previously found that grand-maternal smoking is associated with different growth patterns in grandsons and granddaughters,” he said.

“More specifically, we know smoking can damage the DNA of mitochondria, the numerous ‘power-packs’ contained in every cell, and mitochondria are only transmitted to the next generation via the mother’s egg. The initial mitochondrial DNA mutations often have no overt effect in the mother herself, but the impact can increase when transmitted to her own children.”

The prevalence of ASD has increased in recent years, and while some of this increase is probably due to improved diagnosis, changes in environment or lifestyle are also likely to play a role. The researchers also stress that many different factors, including genetic variation, are believed to affect an individual’s chances of developing ASD.

The findings are published in the journal Scientific Reports.

Source: University of Bristol

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Tips to Reduce Anxiety for Autistic Adults During Physician Visit

Primary care medical visits can pose complex and challenging experiences for adults with autism spectrum disorders, and a new study from the University of Southern California provides suggestions on ways in which both an individual and a provider can better prepare for the encounters.

Researchers offered the following example to describe what often happens:

  • During his first visit to the doctor’s office, Bobby fled from the waiting room, ran outside the building and hid in the parking lot.
  • During his second visit, the 22-year-old’s anxiety was just as palpable.
  • Bobby began jumping in place, repeating dialogue from his favorite TV show and complaining that the office’s bright, buzzing fluorescent lights hurt his eyes and ears.
  • Because he refused to allow any care providers to touch his body, his initial physical examination again had to be postponed.

“Adults with autism spectrum disorder face unique challenges to receiving optimal medical care due to a number of factors,” said Dr. Leah Stein Duker, assistant professor of research at the USC Chan Division of Occupational Science and Occupational Therapy.

These factors include difficulties with communication, challenges making health care decisions, overstimulation within the clinic environment and a lack of ASD-specific training for providers, she said.

Some physicians interviewed in a 2013 survey, for example, erroneously considered autism as only a childhood disorder.

“There is limited research detailing the specific needs of adults with ASD during primary care health encounters, and even fewer evidence-based strategies to facilitate these experiences,” Duker said.

“They are often fraught with serious difficulties for the patients, their caregivers and their practitioners — this means that the quality of their medical care is not what it could be or what it should be.”

Unfortunately, there are no professional standards or agreed-upon best practices for primary care encounters with autistic adults.

Researchers explain that this is a population that will only continue growing as the wave of children who were diagnosed with autism beginning in the early 1990s — and which grew exponentially throughout the ’90s and ’00s — comes of age.

Duker hopes to change that with a new research grant she recently received from the American Occupational Therapy Foundation.

The grant will fund a study in which she and her team will conduct interviews with adults with ASD, their caregivers and their providers to better understand the types of problems they face during primary care.

The interviews will form the basis for a preliminary intervention plan that will likely include target strategies such as physician education, caregiver training, tips for promoting patient–provider communication and decision-making strategies for patients and caregivers.

“My objective is to improve health care services for adults with ASD, which can ultimately enhance both short- and long-term outcomes for this vulnerable and underserved population,” Duker said.

At a presentation during last month’s annual conference of the American Occupational Therapy Association, Duker and her colleague Beth Pfeiffer, associate professor at Temple University’s College of Public Health, highlighted Bobby’s case to demonstrate how occupational therapy successfully helped Bobby’s primary care providers improve his overall care access and experience.

His occupational therapist and the medical office nursing staff developed a verbal and visual “picture schedule” for each phase of subsequent office visits in order to help Bobby know what to expect.

To reduce his anxiety, Bobby’s family reviewed the picture schedule and did role-playing with him during the week prior to each visit.

The occupational therapist worked with office staff to section off a “quiet area” of the waiting room with dimmed lighting, a sound machine to muffle office noises and walls painted a soothing light blue color.

In-service training was given to the physicians and staff about strategies to support successful visits, including the value of visual cues and alternative methods of communication.

The office also established a scheduling policy to ensure that patients with developmental and sensory needs like Bobby can book appointments when the clinic is not as busy, giving him extra time to complete exams and work with families and caregivers.

 

Source: USC

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Childhood Routines, Self-Regulation Reduce Weight Problems in Kids

New research finds that family structure including regular bedtimes, mealtimes and limited screen time appear to be linked to better emotional health in preschoolers. Moreover, strong emotional health is believed to lower the chances of obesity later in life.

Ohio State researchers say the study is the first to look at the connections between early childhood routines and self-regulation and their potential association with weight problems in the pre-teen years.

“This study provides more evidence that routines for preschool-aged children are associated with their healthy development and could reduce the likelihood that these children will be obese,” said lead author Sarah Anderson, Ph.D.

The study appears in the International Journal of Obesity.

Researchers evaluated three household routines when children were 3 years old: regular bedtime, regular mealtime and whether or not parents limited television and video watching to an hour or less daily. Then they compared those to parents’ reports of two aspects of children’s self-regulation at that same age.

Lastly, they investigated how the routines and self-regulation worked together to impact obesity at age 11, defined based on international criteria. (The U.S. criteria for childhood obesity is set lower and would have included more children.)

The research included 10,955 children who are part of the Millennium Cohort Study, a long-term study of a diverse population of children born in the United Kingdom from September of 2000 to January of 2002.

At age 3, 41 percent of children always had a regular bedtime, 47 percent always had a regular mealtime and 23 percent were limited to an hour or less daily of TV and videos. At age 11, about 6 percent were obese.

All three household routines were associated with better emotional self-regulation – a measure based on parents’ responses to questions such as how easily the child becomes frustrated or over-excited. Those children with greater emotional dysregulation were more likely to be obese later.

“We saw that children who had the most difficulties with emotion regulation at age 3 also were more likely to be obese at age 11,” said Anderson, an associate professor in Ohio State’s College of Public Health.

Anderson and her colleagues also found that the absence of a regular preschool bedtime was an independent predictor of obesity at 11. Obesity risk increased even when children “usually” had a regular bedtime, as opposed to “always.” The risk was greatest for those who had the least amount of consistency in their bedtimes.

How persistent and independent children were at age 3 – another aspect of self-regulation – was not related to obesity risk, nor were routines associated with these aspects of self-regulation.

The new findings build on previous research by Anderson and her colleagues showing an association between earlier preschool bedtimes and decreased odds of obesity later. The 2010 US national sample showed that obesity prevalence was lowest for children who got enough sleep, had limits on screen time and ate meals with their families.

“This research allows us to better understand how young children’s routines around sleep, meals, and screen time relate to their regulation of emotion and behavior,” Anderson said. “The large, population-based, UK Millennium Cohort Study afforded the opportunity to examine these aspects of children’s lives and how they impact future risk for obesity.”

This research should prompt future work looking at the role of emotional self-regulation in weight gain in children and how bedtime routines can support healthy development, Anderson said.

“Sleep is so important and it’s important for children in particular. Although there is much that remains unknown about how sleep impacts metabolism, research is increasingly finding connections between obesity and poor sleep,” she said.

While it’s impossible from this work to prove that routines will prevent obesity, “Recommending regular bedtime routines is unlikely to cause harm, and may help children in other ways, such as through emotion regulation,” Anderson said.

But competing family pressures including parents’ work schedules don’t always allow for consistency, Anderson pointed out.

“As a society, we should consider what we can do to make it easier for parents to interact with their children in ways that support their own and their children’s health.”

Source: Ohio State

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Overweight Type 2 Diabetics at Greater Risk for Brain Abnormalities

Overweight Type 2 Diabetics at Greater Risk for Brain Abnormalities

Overweight and obese individuals with early stage type II diabetes (T2D) tend to have more severe and progressive abnormalities in brain structure and cognition than do normal-weight people, according to new research published in the journal Diabetologia.

For the study, researchers in Korea and the US examined how being overweight or obese could impact the brain and the cognitive function of people with early stage type II diabetes

It is well-known that when T2D is chronic, patients are more susceptible to a wide range of health problems in multiple organs throughout the body. The disease may also lead to complications in the brain that accelerate cognitive dysfunction or increase the risk of dementia.

Although the exact mechanism underlying how T2D alters the brain is not fully understood, several metabolic side effects including insulin resistance, poor blood sugar control, and inflammation have been suggested as playing a role.

In addition, obesity is associated with a greater risk for T2D and can often precede its onset. Being overweight has also been linked to metabolic dysfunction, which is independently associated with brain alterations. Still, little is known about the impact on the brain of excess weight or obesity in the presence of T2D.

Researchers from the Ewha Brain Institute and the Ewha Womans University in South Korea and the Brain Institute at the University of Utah recruited 150 Koreans aged 30 to 60 to participate in the study. A total of 50 participants were overweight/obese with T2D, 50 were normal-weight with T2D, and 50 non-diabetic, normal-weight individuals acted as a control group.

Those with diabetes had been diagnosed within the previous five years and had not received stable insulin therapy. Individuals with chronic diabetic complications or major medical, neurological, or psychiatric disorders were excluded from the study.

Data about the structure of participants’ brains were acquired using magnetic resonance imaging (MRI), which allowed the mean thickness of the cerebral cortex to be measured across its entirety. Subjects also completed tests of memory, psychomotor speed, and executive function, as these are known to be affected in people with T2D.

The findings show that grey matter was significantly thinner in clusters in the temporal, prefrontoparietal, motor and occipital cortices of the brains of diabetic study participants when compared to the non-diabetic control group.

The researchers also found more extensive thinning of the temporal and motor cortices in the overweight/obese diabetic group, compared to normal-weight diabetics. There were also region-specific changes, suggesting that the temporal lobe has a particular vulnerability to the combined effects of having T2D and being overweight or obese.

Specifically, people of Asian ethnicity tend to be more vulnerable to slight increases in BMI and are at higher risk of T2D than other ethnicities. This vulnerability may be linked to differences at the cellular level as well as a tendency toward insulin resistance, even in lean individuals. The authors note that the potential for ethnic differences in brain vulnerability to T2D and/or obesity may need to be taken into account when interpreting their results.

“Our findings also highlight the need for early intervention aimed to reduce risk factors for overweight or obesity in type II diabetic individuals to preserve their brain structure and cognitive function,” said the authors. They stress that the importance of managing insulin resistance during early stage T2D may be greater than previously thought.

Source: Diabetologia

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Support from Online Friends Eases Students’ Test Anxiety

credit Photo by L. Brian Stauffer

Reading supportive comments, “likes” and private messages from social media friends before taking a test may help college students who have high levels of test anxiety significantly reduce their nervousness and improve their scores, according to a new study.

Researchers at the University of Illinois found that college students with high levels of test anxiety who sought social support from their online friends and read the messages before a simulated exam reduced their anxiety levels by 21 percent.

These students were able to perform as well on a set of computer programming exercises as students who had low levels of test anxiety, said lead author Robert Deloatch, a graduate student in computer science.

Up to 41 percent of students are estimated to suffer from test anxiety, which is a combination of physiological and emotional responses that occur while preparing for and taking tests, the researcher explained.

Test anxiety is associated with lower test scores and grade-point averages, as well as poorer performance on memory and problem-solving tasks. Test anxiety can be particularly acute when students face exams involving open-ended problems, such as those commonly used on computer science exams that require students to write and run code, according to the researchers.

When students’ test anxiety is reduced, their test scores, GPAs, and task performance improve accordingly, the study discovered.

Students with high test anxiety strongly fear negative evaluation, have lower self-esteem, and tend to experience increased numbers of distracting and irrelevant thoughts in testing situations, according to the study’s findings.

For the simulated exam, students had to solve two programming problems by writing and running code. Most of the participants were computer science majors or computer engineering students who passed a pretest that ensured they had basic programming knowledge.

The researchers measured the students’ levels of test anxiety using the Cognitive Test Anxiety scale, which assesses the cognitive problems associated with test-taking, such as task-irrelevant thinking and attention lapses.

The students also completed two other questionnaires that measured their levels of state anxiety — or “state-of-the-moment” unease — and their trait anxiety, which is anxiety that is considered to be a longstanding characteristic or personality trait, the researchers noted.

The day before the experiment, students in the social support group posted messages on their personal social media pages requesting encouragement — in the form of likes, comments, or private messages — about an upcoming computer programming challenge they planned to participate in.

For seven minutes immediately prior to taking the simulated test, students in the social support group read the responses associated with their online request.

Another group of students wrote about their thoughts and feelings, while a third group of students — the control group — crammed for the exam by reading information on computer programming data structures and answering questions about the text.

Prior to taking the exam, all the students completed a questionnaire to assess their levels of state anxiety. Students were then given 40 minutes to solve two programming problems that had many viable solutions.

“We found that only the students who received supportive messages from their Facebook network showed a significant decrease in anxiety and an increase in their performance on our simulated exam,” Deloatch said.

While prior researchers have found expressive writing to be helpful to some students with test anxiety, Deloatch said he and his team of researchers were surprised to find that the expressive-writing exercise instead increased the pretest jitters of low test-anxious students by 61 percent.

“We hypothesized that might have occurred because focusing on their anxiety as they wrote caused their apprehensiveness to increase rather than decrease,” Deloatch said.

Using social support to alleviate state-of-the-moment anxiety may have implications beyond education, such as helping job applicants quell their nervousness prior to interviews with potential employers, Deloatch said.

While the students who sought social support online felt that reading the supportive messages was helpful, “all of them were uncomfortable with soliciting support from their online friends, perceiving such posts as ‘attention seeking’ and ‘out of place,’” Deloatch said.

“As the majority of the participants in our study were computer science students, the competitive environment of the curriculum may have led to concerns about how others would perceive them. They may have felt that such statuses could harm their relations in group project settings.”

Source: University of Illinois

 
Photo: Supportive social media messages from online friends decreased the state anxiety of students with high test anxiety by 21 percent, University of Illinois computer science graduate student Robert Deloatch found in a new study. The paper, which is being published in the proceedings of the Conference on Human Factors in Computing Systems, was co-written by computer science professors Brian P. Bailey, Alex Kirlik and Craig Zilles. Credit: L. Brian Stauffer.

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ER Intervention Shown to Reduce New Suicide Attempts

ER Intervention Reduced New Suicide Attempts

A clinical trial involving nearly 1,400 suicidal patients in the emergency departments of eight hospitals found that a multifaceted intervention lowered the risk of new suicide attempts by 20 percent.

In a study published in JAMA Psychiatry, emergency department (ED) patients who received the intervention, which was composed of specialized screening, safety planning guidance, and periodic follow-up phone check-ins, made 30 percent fewer total suicide attempts compared to people who received standard ED care.

“We were happy that we were able to find these results,” said Brown University and Butler Hospital psychologist Dr. Ivan Miller, the study’s lead and corresponding author. “We would like to have had an even stronger effect, but the fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging.”

While suicide prevention efforts such as hotlines are well-known, published controlled trials of specific interventions have been much rarer, according to Miller.

The new report is one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller and Drs. Edwin Boudreaux of the University of Massachusetts, and Carlos Camargo of Massachusetts General Hospital and Harvard University.

According to Miller, the study focused on an especially high-risk group: patients who said they had engaged in suicidal ideation or had made an attempt within a week before their ED visit.

The trial took place in three phases to create three comparison groups.

In the first phase, August 2010 to December 2011, 497 patients received each ED’s usual treatment as a control group.

In the second phase, September 2011 to December 2012, 377 patients received additional suicide screening.

In the third phase, from July 2012 to November 2013, 502 patients received the experimental intervention. Those patients received additional suicide screening from ED physicians, suicide prevention information from nurses, and a personal safety plan that they could opt to fill out to be better prepared for times when they might begin to harbor suicidal thoughts again.

Over the next year they also received brief, periodic phone calls from trained providers at Butler Hospital who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving.

The intervention was designed to directly involve a designated loved one whenever feasible, as well, according to the researcher.

In all three phases, patients were briefly screened for suicidality at the ED and were also followed for a year with periodic assessment phone calls. Regardless of phase, patients who demonstrated a specific suicide risk during assessments were connected with the Boys Town suicide prevention hotline.

The number of suicide attempts and the proportion of people attempting suicide declined significantly in the intervention group compared to treatment as usual, according to the study’s findings. The middle group, which received only additional screening, did not show a significant drop compared to the treatment as usual group.

Suicide attempts were not the only measure the researchers employed to understand the potential impact of the intervention.

Fortunately, there were so few deaths by suicide among patients — only five total — that there could be no statistically valid conclusions drawn from that data point.

But the researchers also created a broader suicide composite score that included not only attempts and deaths, but also interrupted or aborted attempts, and acts to prepare an attempt.

Across the three groups, 46.3 percent of the patients reported one or more of these behaviors, but the relative risk declined significantly among people in the intervention compared to the usual care group (by 15 percent), but not among people who received screening alone.

While other interventions have also been found to reduce suicide risk, some of the most effective ones have involved providing patients with many hours of psychotherapy.

“This intervention was significantly less costly than most other interventions,” Miller said.

He added that the intervention was associated with significant declines in suicide attempts, even though not every patient engaged in the full intervention (e.g. only 37.4 percent reported receiving a safety plan and nearly 40 percent did not complete a follow-up phone call).

The intervention’s apparent efficacy also persisted despite the study’s ethical design, in which even people in the control phases received suicide prevention counseling that could have prevented an attempt if they presented an urgent need.

In further studies, the ED-SAFE team is looking at whether more intensive safety planning while patients are in the ED could help further. Miller and his colleagues are also conducting further tests of the phone follow-ups with patients from Butler Hospital and the Providence Veterans Affairs Medical Center.

Source: Brown University

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Depression Impacts Twice as Many Females as Males

Depression Impacts Twice as Many Females as Males

A new meta-analysis confirms that depression affects twice as many females as males, and this gap appears as early as age 12. The results, published in the journal Psychological Bulletin, are based on existing studies involving more than 3.5 million people in more than 90 countries.

“We found that twice as many women as men were affected,” says co-author Janet Hyde, a professor of psychology and gender and women’s studies at the University of Wisconsin (UW)-Madison.

“Although this has been known for a couple of decades, it was based on evidence far less compelling than what we used in this meta-analysis. We want to stress that although twice as many women are affected, we don’t want to stereotype this as a women’s disorder. One-third of those affected are men.”

The gender gap was evident in the earliest data studied by co-authors Hyde; Rachel Salk, now a postdoctoral fellow in psychiatry at the University of Pittsburgh School of Medicine; and Lyn Abramson, a professor of psychology at UW-Madison.

“The gap was already present at age 12, which is earlier than previous studies have found,” says Hyde. “We used to think that the gender difference emerged at 13 to 15 years but the better data we examined has pushed that down to age 12.”

The gender difference tapers off somewhat after adolescence, “which has never been identified, but the depression rate is still close to twice as high for women,” Hyde says.

For the meta-analysis, the researchers looked at both diagnoses of major depression and at symptoms of depression. “Symptoms are based on self-reported measures — for example, ‘I feel blue most of the time’ — that do not necessarily meet the standard for a diagnosis of major depression. To meet the criteria for major depression, the condition must be evaluated much more rigorously.”

The researchers also investigated the link between depression and gender equity in income. Surprisingly, nations with greater gender equity had larger gender differences — meaning women were disproportionately diagnosed with major depression.

“This was something of the opposite of what was expected,” says Hyde. “It may occur because, in more gender-equitable nations, women have more contact with men, and therefore compare themselves to men, who don’t express feelings of depression because it doesn’t fit with the masculine role.”

Puberty, which occurs around age 12 in girls, could explain the early onset.

“Hormonal changes may have something to do with it, but it’s also true that the social environment changes for girls at that age. As they develop in puberty, they face more sexual harassment, but we can’t tell which of these might be responsible,” says Hyde.

Although the data did not cover people younger than 12, “there are processes going on at 11 or 12 that are worth thinking about, and that matters in terms of intervening,” Hyde says.

“We need to start before age 12 if we want to prevent girls from sliding into depression. Depression is often quite treatable. People don’t have to suffer and face increased risk for the many related health problems.”

While the findings covered averages across the world, similar results emerged from the studies focusing on the United States alone, says Hyde.

Curiously, no relationship in either direction appeared for depression symptoms.

Despite the prevalence of and growing concern about depression, “this was the first meta-analysis on gender differences in depression,” Hyde says. “For a long while, I wondered why nobody had done this, but once I got into it, I realized it’s because there is too much data, and nobody had the courage to plow through it all. We did, and it took two years.”

Source: University of Wisconsin-Madison

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Posted by Patricia Adams in Default