Category: Mental Health

A new study reveals that cognitive therapy over the phone is just as effective as meeting face-to-face. The research was published September 28, in the journal PLoS ONE.

Researchers at the University of Cambridge together with the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care (NIHR CLAHRC) and NHS Midlands & East also found that providing talking therapy over the phone increases access to psychological therapies for people with common mental disorders and potentially saves the NHS money.

For the study, data from 39,000 patients in seven established Improving Access to Psychological Therapies (IAPT) services (an initiative which aims to expand the availability of psychological therapies) in the East of England were used to compare Cognitive Behavioural Therapy (CBT) delivered face-to-face versus over the phone. For all but an infrequent, identifiable clinical group with more severe illness, therapy over the phone was as effective as face to face, and the cost per session was 36.2% lower.

Patients may be unable to access health services due to transport problems, work commitments and physical disability, among many reasons. So increasing availability of talking therapies over the phone will make mental health services more accessible to patients.

On the back of the study results, NHS Midlands & East has instigated a regional training programme to standardise service delivery and ensure therapists are competent at phone contacts. The training programme has recently been extended into a partnership with a third party organisation.

Professor Peter Jones, Principal Investigator of the study from the University of Cambridge, said: "Providing therapy over the phone will not only help individuals gain much-needed access to mental health treatment, it will provide a more cost effective way of providing these services at a time when everyone is concerned about cutting costs."

Mental health illnesses affect one in four adults in Britain every year. Additionally, the NHS spends more on mental health than it does on cancer, heart disease, stroke and asthma put together (a total of £9.95 billion in 2010-2011), with general practitioners spending more than a third of their time on mental health issues.

NewsPsychology (Oct. 3, 2012) — Mental health workers are more likely to be depressed or anxious when they experience discrimination from their managers than when it comes from patients, a study has found.

Discrimination from the patients’ visitors also causes more distress than discrimination from the patients.

A research team led by Professor Stephen Wood at the University of Leicester’s School of Management looked at the effects of prejudice, including sex, racial and age discrimination, from different groups of people on mental health workers.

The study, funded by the Department of Health’s National Institute for Health and Clinical Excellence, draws on the experience of 1,733 mental health workers in the UK, including doctors, nurses, psychiatrists and support staff. The researchers distributed questionnaires to every worker in 100 wards and 36 outpatient teams, measuring four states of mind: anxiety, depression, emotional exhaustion and job satisfaction. It also looked at whether they had experienced discrimination in the past year, alongside more general questions such as how fair they perceived their organisation to be.

They then used advanced statistical analysis to assess whether workers who suffered discrimination at the hands of four different groups of people — patients, visitors, managers and co-workers — were more or less likely than other workers to have negative feelings.

From the four different discrimination sources, discrimination from managers had the largest impact on the anxiety, depression, emotional exhaustion and job dissatisfaction of the mental health worker. In addition, and perhaps surprisingly, discrimination from patients’ visitors had a larger impact on depression and emotional exhaustion than discrimination from the patients themselves. Discrimination from one’s fellow workers had less effect on any form of distress than that from managers or visitors.

Stephen Wood, Professor of Management at the Leicester School of Management, said: “The finding that managers can distress workers the most can be explained by managers’ large power over staff’s working lives, including their chances of keeping a job and winning promotion. Moreover, workers feel distressed if they feel the organisation employing them is not treating them fairly — and the behaviour of managers is key to this sense of fairness.

“Aggression from relatives and other visitors is, like aggression from managers, viewed as reflecting badly on the procedures and fairness of the organisation. However, aggression from patients is not readily attributed to failings in the organisation.”

The researchers suggest in a paper on the findings that a tightening of policy towards visitors may be desirable, arguing: “The option of permanently excluding them from the premises or involving the police might increase the sense that the organisation is concerned about their staff’s welfare and treats them fairly.”

Professor Wood’s co-authors are Johan Braeken, Professor of Methodology and Statistics at Tilburg University in the Netherlands, and Karen Niven of Manchester Business School.

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The above story is reprinted from materials provided by University of Leicester.

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NewsPsychology (Oct. 3, 2012) — A new Indiana University study is the first of its kind to show it may be possible to improve memory and thought process speed among breast cancer survivors.

Diane M. Von Ah, Ph.D., R.N., assistant professor at the IU School of Nursing and a researcher at the Indiana University Melvin and Bren Simon Cancer Center, and colleagues studied two different treatment options for breast cancer survivors because they often report problems with memory or feelings of mental slowness, which can lead to depression, anxiety, fatigue and an overall poorer quality of life. These symptoms can be severe and may persist after cancer treatment ends.

To date, there have been very few treatment options available for patients to deal with these problems. The IU researchers compared no treatment to two different training programs.

The results, recently published in the journal Breast Cancer Research and Treatment, showed that a memory training program improved memory performance, while a program called Insight, developed by Posit Science, improved both memory performance and the ability and speed in which the survivors processed information.

Memory training, for example, involved teaching participants strategies for remembering word lists, sequences and text material.

Insight is a computer program in which study participants followed a series of progressively more difficult information tasks.

“These results are encouraging in that both training programs led to positive improvements for breast cancer survivors. The results suggest that the Insight program may have a greater impact on these women,” Dr. Von Ah said. “Even though this was the largest cognitive training study in breast cancer survivors, we need to confirm our findings in a larger study.”

The study included 82 breast cancer survivors who reported concerns about their cognitive function, such as poor memory and mental slowness. All of the women had undergone chemotherapy. Each woman completed cognitive assessments prior to, immediately after, and two months after training.

The study was supported by the Robert Wood Johnson Foundation Nurse Faculty Scholar Program, an American Cancer Society Institutional Research Grant, the IU School of Nursing Center for Enhancing Quality of Life in Chronic Illness, and the Mary Margaret Walther Program of the Walther Cancer Institute.

Co-authors included the following IU Simon Cancer Center researchers: Janet S. Carpenter, Ph.D., R.N., and Michael Weaver, Ph.D., R.N., both of the IU School of Nursing; Andrew Saykin, Psy.D., Patrick Monahan, Ph.D., Bryan Schneider, M.D., Fred Unverzagt, Ph.D., and Jingwei Wu, M.S., of the IU School of Medicine; Menggang Yu, Ph.D., of the University of Wisconsin; George Rebok, Ph.D., of Johns Hopkins University; and Karlene Ball, Ph.D., of the University of Alabama at Birmingham.

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The above story is reprinted from materials provided by Indiana University School of Medicine.

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A study of children in the New Bedford, Mass., area suggests that low-level prenatal mercury exposure may be associated with a greater risk of attention-deficit/hyperactivity disorder (ADHD)-related behaviors and that fish consumption during pregnancy may be associated with a lower risk of these behaviors, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

ADHD is one of the most common neurodevelopmental disorders of childhood and affects 8 percent to 12 percent of children worldwide, although its cause is not well understood. The developmental neurotoxicity of mercury is known, but the findings from epidemiological studies are inconsistent with some studies showing associations between mercury exposure and ADHD-related behaviors and others reporting null associations, according to the study background.

Nonoccupational methylmercury exposure comes primarily from eating fish, and the U.S. Environmental Protection Agency and the U.S. Food and Drug Administration have recommended pregnant women limit their total fish intake to no more than two, six-ounce servings per week. However, fish is also a source of nutrients, such as omega-3 fatty acids, which have been shown to benefit brain development, potentially confounding mercury-related risk estimates, the study background also indicates.

Sharon K. Sagiv, Ph.D., M.P.H., of the Boston University School of Public Health, and colleagues analyzed data from the New Bedford birth cohort, a group of infants born between 1993 and 1998, to investigate the association of peripartum maternal hair mercury levels (n=421) and prenatal fish intake (n=515) with ADHD-related behaviors at age 8 years.

"In this population-based prospective cohort study, hair mercury levels were consistently associated with ADHD-related behaviors, including inattention and hyperactivity/impulsivity. We also found that higher prenatal fish consumption was protective for these behaviors," the authors comment.

Statistical analysis indicates mercury exposure appeared to be associated with inattention and impulsivity/hyperactivity and some outcomes had an apparent threshold with associations at 1 μg/g (microgram/per gram) or greater of mercury. For example, at 1 μg/g or greater, the adjusted risk ratios for mild/markedly atypical inattentive and impulsive/hyperactive behaviors were 1.4 and 1.7 respectively, according to the study results.

There also appeared to be a "protective" (lower risk) association for fish consumption of greater than two servings per week with ADHD-related behaviors, particularly impulsive/hyperactive behaviors (relative risk = 0.4), the study results show.

"In summary, these results suggest that prenatal mercury exposure is associated with a higher risk of ADHD-related behaviors, and fish consumption during pregnancy is associated with a lower risk of these behaviors," the authors conclude. "Although a single estimate combining these beneficial vs. detrimental effects vis-à-vis fish intake is not possible with these data, these findings are consistent with a growing literature showing risk of mercury exposure and benefits of maternal consumption of fish on fetal brain development and are important for informing dietary recommendations for pregnant women."

Editorial: Attention-Deficit/Hyperactivity Disorder a Preventable Epidemic?

In an editorial, Bruce P. Lanphear, M.D., M.P.H., of Simon Fraser University, Vancouver, British Columbia, Canada, writes: "The study by Sagiv et al, which tested whether prenatal exposure to methyl mercury was associated with the development of ADHD-related behaviors, is an important and rigorously conducted prospective birth cohort study."

"What are the implications of the Sagiv et al study and other research on environmental contaminants and ADHD? First, we can take some comfort in recent legislation to reduce mercury contamination, at least from domestic sources. Second, these studies should spur our efforts to enhance the collection of data needed to calculate national estimates and trends in ADHD," Lanphear continues.

"Third, it is time to convene a national scientific advisory panel to evaluate environmental influences of ADHD and make recommendations about what can be done to prevent it. Fourth, this study and a flurry of new evidence linking environmental contaminants with ADHD reinforce the urgency of revising the regulatory framework for environmental contaminants and toxicants," Lanphear concludes.

Published today in the Proceedings of the National Academy of Sciences, the study finds that treatment of maternal depression with serotonin reuptake inhibitors (SRIs) can accelerate babies' ability to attune to the sounds and sights of their native language, while maternal depression untreated by SRIs may prolong the period of tuning.

"This study is among the first to show how maternal depression and its treatment can change the timing of language development in babies," says Prof. Janet Werker of UBC's Dept. of Psychology, the study's senior author. "At this point, we do not know if accelerating or delaying these milestones in development has lasting consequences on later language acquisition, or if alternate developmental pathways exist. We aim to explore these and other important questions in future studies."

The study followed three groups of mothers — one being treated for depression with SRIs, one with depression not taking antidepressants and one with no symptoms of depression. By measuring changes in heart rate and eye movement to sounds and video images of native and non-native languages, the researchers calculated the language development of babies at three intervals, including six and 10 months of age. Researchers also studied how the heart rates of unborn babies responded to languages at the age of 36 weeks in the uterus.

"The findings highlight the importance of environmental factors on infant development and put us in a better position to support not only optimal language development in children but also maternal well-being," says Werker, who adds that treatment of maternal depression is crucial. "We also hope to explore more classes of antidepressants to determine if they have similar or different impacts on early childhood development."

High resolution photos of Werker (reading to children) and co-author Tim Oberlander are available upon request.

Background

"These findings once again remind us that poor mental health during pregnancy is a major public health issue for mothers and their infants," says co-author Dr. Tim Oberlander, a professor of developmental pediatrics at UBC and CFRI. "Non-treatment is never an option. While some infants might be at risk, others may benefit from mother's treatment with an antidepressant during their pregnancy. At this stage we are just not sure why some but not all infants are affected in the same way. It is really important that pregnant women discuss all treatment options with their physicians or midwives."

Previous research by Werker has found that during the first months of life, babies rapidly attune to the language sounds they hear and the sights they see (movements in the face that accompany talking) of their native languages. After this foundational period of language recognition, babies begin focusing on acquiring their native tongues and effectively ignore other languages.

The current study suggests that this key developmental period — which typically ends between the ages of eight and nine months — can be accelerated or delayed, in some cases by several months. In another recent study, Werker has found that this development period lasts longer for babies in bilingual households than in monolingual babies, particularly for the face recognition aspects of speech.

The maternal depression and language acquisition study was co-authored by UBC post-doctoral fellow Whitney Weikum at CFRI, Tim Oberlander of CFRI, UBC's Dept. of Pediatrics and BC Children's Hospital, and Takao Hensch, a professor of neurology at Harvard University.

This program of research was funded by agencies including the Human Frontiers Research Program (HFSP), the Canadian Institutes for Advanced Research (CIFAR), the Michael Smith Foundation, and the 

Journal Reference:

1. Whitney M. Weikum, Tim F. Oberlander, Takao K. Hensch, and Janet F. Werker. Biological Embedding of Early Social Adversity: From Fruit Flies to Kindergartners Sackler Colloquium: Prenatal exposure to antidepressants and depressed maternal mood alter trajectory of infant speech perception. Proceedings of the National Academy of Sciences, 2012; DOI: 10.1073/pnas.1121263109

 The combination of shortened telomeres, a biological marker of aging associated with cancer development, and elevated depression significantly impacted bladder cancer mortality, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held in Anaheim, Calif. Oct. 16-19, 2012.

"We found that patients with bladder cancer with shorter telomeres and high levels of depression symptoms have a threefold increased risk for mortality," said Meng Chen, Ph.D., an epidemiologist at The University of Texas MD Anderson Cancer Center in Houston.

As part of an ongoing, large-scale epidemiologic study of bladder cancer, Chen and colleagues collected clinical and mental health information on 464 patients with bladder cancer. They assessed patients' depression levels with the Center for Epidemiologic Studies Depression Scale (CES-D).

Depression symptoms alone affected mortality: Patients with CES-D scores of 16 or greater had a median survival time of 58 months, while those with scores below 16 had a median survival time longer than 200 months. In addition, patients with CES-D scores of 16 or greater had a 1.89-fold increased risk for all-cause mortality compared with patients with CES-D scores less than 16.

Telomere length was measured from patient blood samples. Univariate analysis revealed that long telomeres were associated with improved survival, but this finding was not significant in a multivariate analysis.

When evaluating the combination of depression and telomere length, the researchers found that compared with patients without depression symptoms (i.e., CES-D scores less than 16) and long telomeres, patients with depression symptoms (i.e., CES-D scores of 16 or greater) and short telomeres demonstrated more than a threefold increased risk for mortality and significantly shorter disease-free survival (31.3 months versus 199.8 months).

Although the mechanisms behind these findings need to be furthered studied, "these results suggest the potential important role of psychological factors to improve survival in cancer patients," Chen said.

In addition, the researchers pointed to evidence that smoking cessation, weight loss and increased physical activity can slow telomere shortening and potentially improve survival.

"In terms of building a prediction model for bladder cancer mortality, current models only focus on clinical variables, such as treatment and tumor stage and grade," Chen said. "Our study suggests that psychological factors and perhaps lifestyle changes could be included in this prediction model."

 Men have borne the brunt of worsening mental health across the population of England since the start of the economic downturn in 2008, reveals research published in the online journal BMJ Open.

But unemployment and a falling household income don't seem to be the culprits, prompting the authors to suggest that it is the threat of losing their jobs that has affected men's mental health.

They base their findings on data taken from the national representative annual Health Survey for England for adults aged 25 to 64, between 1991 and 2010.

Response rates during this period varied from 85 per cent in 1991 to 64 per cent in 2008, and included just short of 107,000 people.

Respondents were asked about their employment status and educational attainment, and those scoring 4 or more on the General Health Questionnaire-12, which is used to gauge levels of anxiety and depression, were deemed to have a high likelihood of poor mental health.

The analysis showed that rates of poor mental health were highest between 1991 and 1993, when the UK was in recession, after which they fell steadily until 2004, when they started a gradual rise until 2008, at which point they rose sharply.

In 2008, when the global economic downturn began, the prevalence of mental ill health was 13.7 per cent, rising to 16.4 per cent in 2009, falling back to 15.5 per cent in 2010.

Over most of the period under study, more women than men reported poor mental health. But during periods of recession the sharpest rises in the prevalence of mental ill health occurred among men.

In the early 1990s, the prevalence of mental ill health among men rose from 12.3 per cent in 1991 to 14.5 per cent in 1992.

A similar trend occurred in the 2008 economic downturn when the prevalence among men rose from 11.3 to 16.6 per cent among men in 2009; among women this rose from 16 to 16.2 per cent.

Factoring in age, indicated that the prevalence of poor mental health among men increased by 5.1 per cent in 2009 and by 3 per cent in 2010. There were no such significant increases among women.

But the study only examined changes in mental health up to 2010, and women may have been affected more severely after this time, particularly given subsequent changes in public sector employment, say the authors.

The prevalence of mental ill health, however, was not confined to those out of work; and taking account of employment status and educational attainment made no difference to the figures.

"The finding that mental health across the general population has deteriorated following the recession's onset, and that this association does not appear to be limited to those out of employment nor those whose household income has declined, has important implications," say the authors.

They suggest that the reason for the gender differences in the impact of recession could be that men's mental health is more vulnerable to the fear of job loss.

"One potential explanation for our results would be that job insecurity during the current recession is responsible for the deterioration in mental health, with men's psychological health remaining more affected by economic fluctuations despite greater female labour market participation," they conclude.

Low depressive symptoms and a longer telomere length are compelling factors that contribute to a prolonged life for bladder cancer patients, according to researchers at The University of Texas MD Anderson Cancer Center.

In an observational study, a team of MD Anderson researchers analyzed clinical and behavioral data collected from 464 bladder cancer patients, according to research presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research.

"This is the first study of its kind that analyzes bladder cancer outcomes," said Meng Chen, Ph.D., an instructor in MD Anderson's Department of Epidemiology. "Psychological factors are not usually included in epidemiologic studies"

The patients observed were enrolled in an ongoing study of bladder cancer that provides extensive genetic, epidemiologic and psychological data. The collaboration of MD Anderson epidemiologists and psychologists is led by the study's principal investigator, Xifeng Wu, M.D., Ph.D., professor and chair of the epidemiology department.

Patients' information was analyzed according to four different groups. The first group involved patients with long telomeres and no depressive symptoms; the second identified patients who had long telomeres with depressive symptoms; the third had shortened telomeres and no depressive symptoms, while the fourth group had shortened telomeres and depressive symptoms.

Bladder cancer is the fourth most common cancer of men and is usually diagnosed in people over the age of 60. The American Cancer Society estimates 56,000 men and 18,000 women will have a bladder cancer diagnosis in 2012.

Research has identified shortened telomere length as an aging-associated biomarker in several diseases, including cancer. As people grow older, telomeres on the tips of chromosomes, which protect chromosomes from unraveling as cells replicate, shorten and eventually fail, leading to cell death. MD Anderson researchers analyzed blood samples to measure telomere length.

Depressive symptoms were analyzed using the Center for Epidemiologic Studies Depression Scale (CES-D). The self-report scale — one of the most common screening tests used for finding levels of depression — revealed patients who scored at high levels of depressive symptoms have a 1.89-fold risk of dying compared to those with lower levels of depression, who will live a little over three times longer — 200 months vs. 58 months.

The study also revealed the combination of factors, longer telomeres and low levels of depressive symptoms, increased survival for bladder cancer patients by more than six-fold — 31.3 months vs 199.8 months. Those with short telomeres and high levels of depression had a three-fold risk of mortality.

A certain level of stress, which has also been associated with shortened telomere length, is a dominating factor with many cancer patients. "People are not treating the depression directly, but mainly focused on coping with cancer,"said Chen. "This leads to additional stress that increases mortality."

Enhanced stress management should be an integral part of cancer treatment, "Lifestyle behaviors including a healthy diet, regular exercise and smoking-cessation are factors for reducing stress and ultimately depression in cancer patients." " said co-author Jie Lin, Ph.D., assistant professor in the Department of Epidemiology.

Lin also said the new risk factors such as psychological risk factors identified by the team could be included in future risk prediction models. The team is optimistic that this study will encourage clinicians to incorporate behavioral factors into risk models so interventions can be developed to prolong survival for bladder cancer patients.

Contributing authors to the work include Jan Blalock, Ph.D., Paul Cinciripini, Ph.D. from the Department of Behavioral Science, and Lorenzo Cohen, Ph.D., from the Department of General Oncology.