Category: Mental Health

Only about half of American children and teenagers who have certain mental disorders receive professional services, according to a nationally representative survey funded in part by the National Institute of Mental Health (NIMH). The survey also provides a comprehensive look at the prevalence of common mental disorders.

The results are part of the National Health and Nutrition Examination Survey (NHANES), a collaboration between NIMH and the National Center for Health Statistics of the Centers for Disease Control and Prevention. The survey conducted from 2001 to 2004 had 3,042 participants. These most recent results include data from children and adolescents ages 8 to 15, and were published online ahead of print December 14, 2009, in the journal Pediatrics.

"Data on the prevalence of mental disorders among U.S. youth have been varied, making it difficult to truly understand how many children and teens are affected," said NIMH Director Thomas R. Insel, M.D. "These data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children."

In the study, the young people were interviewed directly. Parents or caregivers also provided information about their children's mental health. The researchers tracked six mental disorders — generalized anxiety disorder (GAD), panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) and conduct disorder. The participants were also asked about what treatment, if any, they were receiving.

Overall, 13 percent of respondents met criteria for having at least one of the six mental disorders within the last year. About 1.8 percent of the respondents had more than one disorder, usually a combination of ADHD and conduct disorder. Among the specific disorders,

• 8.6 percent had ADHD, with males more likely than females to have the disorder;
• 3.7 percent had depression, with females more likely than males to have the disorder;
• 2.1 percent had conduct disorder;
• 0.7 percent had an anxiety disorder (GAD or panic disorder);
• 0.1 percent had an eating disorder (anorexia or bulimia).

"With the exception of ADHD, the prevalence rates reported here are generally lower than those reported in other published findings of mental disorders in children, but they are comparable to other studies that employed similar methods and criteria," said lead author Kathleen Merikangas, Ph.D., of NIMH.

Those of a lower socioeconomic status were more likely to report any disorder, particularly ADHD, while those of a higher socioeconomic status were more likely to report having an anxiety disorder. Mexican-Americans had significantly higher rates of mood disorders than whites or African-Americans, but overall, few ethnic differences in rates of disorders emerged.

Merikangas and colleagues also found that overall, 55 percent of those with a disorder had consulted with a mental health professional, confirming the trend of an increase in service use for childhood mental disorders, especially ADHD. However, only 32 percent of youth with an anxiety disorder sought treatment, a finding consistent with other studies. Moreover, African-Americans and Mexican-Americans were significantly less likely to seek treatment than whites, reiterating the need to identify and remove barriers to treatment for minority youth, noted the researchers.

"Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth," said Dr. Merikangas. "When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth," she concluded.

The holidays can be challenging for even the most diligent dieters. But are weekends just as detrimental? Researchers at the University of Pittsburgh and Quinnipiac University in Hamden, Conn., found that weekend eating patterns change significantly.

J. Jeffrey Inman, a University of Pittsburgh professor of marketing and associate dean for research in the Joseph M. Katz Graduate School of Business, and his coauthor, Adwait Khare, Quinnipiac University professor of marketing, studied two years' worth of data on consumers' eating behavior and found that the quantity and quality of foods eaten during a meal and over the course of the day differs considerably on weekends and holidays.

Just as important as the daily caloric increase on weekends and holidays is the nutritional value of the food consumed, according to the research, which was published in the Fall 2009 issue of the Journal of Public Policy & Marketing. Labor Day barbeques and Thanksgiving Day feasts focus on family and friends bonding over tables laden with high-calorie foods. Because the quantity and quality of food consumed changes during these times, Inman suggests that the U.S. Department of Agriculture incorporate recommendations for holiday and weekend eating into its food pyramid guidelines.

Understanding eating patterns and knowing that a weekend can be just as dangerous to the diet as a holiday dinner arms consumers, doctors, and nutritionists with more knowledge to fight obesity, says Inman.

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Journal Reference:

1. Daily, Week-Part, and Holiday Patterns in Consumers' Caloric Intake Adwait Khare and J. Jeffrey Inman. Daily, Week-Part, and Holiday Patterns in Consumers' Caloric Intake. Journal of Public Policy & Marketing, 2009; 28 (2): 234 DOI: 10.1509/jppm.28.2.234

According to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), eating a meal quickly, as compared to slowly, curtails the release of hormones in the gut that induce feelings of being full. The decreased release of these hormones, can often lead to overeating.

"Most of us have heard that eating fast can lead to food overconsumption and obesity, and in fact some observational studies have supported this notion," said Alexander Kokkinos, MD, PhD, of Laiko General Hospital in Athens Greece and lead author of the study. "Our study provides a possible explanation for the relationship between speed eating and overeating by showing that the rate at which someone eats may impact the release of gut hormones that signal the brain to stop eating."

In the last few years, research regarding gut hormones, such as peptide YY (PYY) and glucagon-like peptide (GLP-1), has shown that their release after a meal acts on the brain and induces satiety and meal termination. Until now, concentrations of appetite-regulating hormones have not been examined in the context of different rates of eating.

In this study, subjects consumed the same test meal, 300ml of ice-cream, at different rates. Researchers took blood samples for the measurement of glucose, insulin, plasma lipids and gut hormones before the meal and at 30 minute intervals after the beginning of eating, until the end of the session, 210 minutes later. Researchers found that subjects who took the full 30 minutes to finish the ice cream had higher concentrations of PYY and GLP-1 and also tended to have a higher fullness rating.

"Our findings give some insight into an aspect of modern-day food overconsumption, namely the fact that many people, pressed by demanding working and living conditions, eat faster and in greater amounts than in the past," said Kokkinos. "The warning we were given as children that 'wolfing down your food will make you fat,' may in fact have a physiological explanation."

Other researchers working on the study include Kleopatra Alexiadou, Nicholas Tentolouris, Despoina Kyriaki, Despoina Perrea and Nicholas Katsilambros of Athens University Medical School in Greece; and Carel le Roux, Royce Vincent, Mohammad Ghatei and Stephen Bloom of Imperial College in London, United Kingdom.

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Journal Reference:

1. Kokkinos et al. Eating Slowly Increases the Postprandial Response of the Anorexigenic Gut Hormones, Peptide YY and Glucagon-Like Peptide-1. Journal of Clinical Endocrinology & Metabolism, 2009; DOI: 10.1210/jc.2009-1018

Existing research shows that rates of binge eating among adult women is virtually identical across race. However, among college age women, it's a different story: Caucasian women are more apt to exhibit binge eating behaviors than African American women, according to a study presented at this month's annual scientific meeting of the Obesity Society.

"We are trying to figure out when the diet trajectory changes, and when it is that African-Americans start to exhibit these behaviors. It's important to look at the eating habits of this group as they may contribute to early onset weight gain and obesity," said Melissa Napolitano, clinical psychologist at the Center for Obesity Research and Education and associate professor of kinesiology in the College of Health Professions.

In the study, 715 female college students completed an on-line survey about health habits, behaviors and attitudes. Each woman self-reported her height and weight. Answers were then compared to the Eating Disorder Diagnostic Scale, a questionnaire that is used to diagnose a variety of eating disorders, and the Binge Eating Scale, to gauge the severity of binge eating symptoms.

Binge Eating Disorder is classified by eating amounts of food larger than most people would consider normal within a 2-hour period; a sense of loss of control during these eating periods; eating past the point of feeling comfortably full; and feelings of embarrassment, depression, anxiety or guilt after eating.

Overall, the African-American students were less likely than the Caucasian students to meet criteria for binge eating and had less severe symptoms. However, researchers found that the predictors of binge eating symptom severity were similar, including depressed mood, and the perception of feeling fat.

The researchers say it is possible that culture plays a role in the diagnosis and that consuming larger portions may not be labeled as such by African Americans.

"These women could be binge eating, but they may have less anxiety and distress surrounding their eating habits, so they don't recognize it as an issue," said Napolitano, adding that more studies are needed to look at differences in eating patterns and behaviors among different cultures.

About 31-33 percent of college students are overweight, and weight gain has been shown to increase during their academic career. In this study 22 percent of Caucasians and 37 percent of African-Americans were overweight or obese. Existing research suggests that binge eating could be a factor in weight gain over time.

Coupled with the fact that rates of obesity are especially high among African American females, Napolitano says it's critical to have tailored treatments and educational programs available for women of diverse backgrounds.

"College age women are at a critical stage in their development, and there's almost no research that looks at binge eating behaviors among African American women. We need to do a better job at understanding these eating practices to help design and evaluate both prevention and treatment efforts," she said.

The co-author of this study is Susan Himes, at the Mayo Clinic. Funding for this research was provided by Temple University.

Scientists led a rat to the fatty food, but they couldn’t make it eat. Using an animal model of binge eating, University of Missouri researchers discovered that deactivating the basolateral amygdala, a brain region involved in regulating emotion, specifically blocked consumption of a fatty diet. Surprisingly, it had no effect on the rat wanting to look for the food repeatedly.

“It appears that two different brain circuits control the motivation to seek and consume,” said Matthew Will, assistant professor of psychological sciences in the MU College of Arts and Science and investigator in the Christopher S. Bond Life Sciences Center. “Understanding how this circuit in the brain works may provide insight into the exact networks and chemicals in our brain that determine the factors influencing our feeding habits.”

The release of opioids, pleasure chemicals that can lead to euphoria, into the brain produces binge eating in non-hungry rats. Will and his team of researchers determined that deactivating the basolateral amygdala blocked this type of binge eating.

“A key to curbing the obesity epidemic in America is controlling the desire to binge eat,” Will said. “Humans have more programming to start and continue eating than to stop eating, especially when they have a bowl of ice cream in front of them. Most of us would finish it even if we weren’t hungry.”

Deactivating the basolateral amygdala had no effect on feeding in rats that were simply deprived of food for 24 hours. This suggests that the basolateral amygdala is specifically involved in the overconsumption of food based on its palatability or pleasure driven by opioids, rather than the level of hunger.

“The finding that the basolateral amygdala only appears involved in the opioid produced consumption was the most surprising part of the study,” Will said. “Normally, if a rat stops eating, they will go lay down and take it easy. In this case, they showed all signs of still wanting to eat, but didn’t.”

In the past when food availability was scarce, humans may have needed this “binge eating” regulation to eat enough food when it was available. Now, when humans have access to foods high in sugar and fat 24 hours a day, this regulation can cause humans to overeat.

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Journal Reference:

1. Will et al. Behavioral characterization of amygdala involvement in mediating intra-accumbens opioid-driven feeding behavior.. Behavioral Neuroscience, 2009; 123 (4): 781 DOI: 10.1037/a0016060

Childhood obesity has quadrupled in the last 40 years, which may mean today's children become the first generation to have a shorter lifespan than their parents, a leading obesity expert told the American Psychological Association.

However, parents can help stave off this impending crisis if they help their children to eat better and exercise, according to Edward Abramson, PhD. Abramson, professor emeritus at California State University-Chico, teaches psychology and is author of the books "Body Intelligence" and "Emotional Eating."

In the last decade, "we've seen a [tenfold] increase in Type-2 diabetes and psychological and social consequences, such as prejudice, rejection, discrimination and low self-esteem in children," Abramson said at APA's 117th Annual Convention. "More than 60 percent of overweight children have one risk factor for cardiovascular disease and 20 percent have two or more risk factors."

Bad eating habits can start with "emotional eating," or eating when one is not hungry, or from following a strict diet, Abramson said. "This can lead to a weight problem or an eating disorder," he added. "Parents' attitudes and behaviors also have an influence on children's eating, and mothers more than fathers affect children's eating habits and body image."

Many factors contribute to mothers' concern about their children's risk for obesity, Abramson said. "For example, there is evidence that minority parents (e.g., African-American, Hispanic) are less concerned about their children's weight," he said. "Often, when a mother is struggling with her own weight, she becomes more involved in regulating her daughter's eating. In general, mothers are more concerned than fathers about their child's weight, especially their daughter's, and are more likely to restrict foods."

While everyone, including children, is entitled to have food preferences, infants are born with genetic predispositions toward sweet and salty tastes and against sour and bitter tastes and unfamiliar foods, Abramson said. "For these children, it may take several repetitions (10 or more) to have a child try a new food, but parents should retreat gracefully and try again another day rather than get into a battle of wills when the child refuses a food," he said.

Parents can increase the odds of getting a child to try a new food by having the child see them enjoying the food and having the child help prepare the unfamiliar food, said Abramson. "If the child is in the kitchen cooking with Mom or Dad, it's unlikely that he/she will refuse the food that they've helped prepare."

Physical activity can also help prevent obesity even when there is a tendency to gain weight due to genetics, Abramson said. Research has shown that 4- to 7-year-old children of active parents were six times as likely to be active. Exercise in school lowers the risk for obesity, whereas time spent watching TV or on the computer playing video games increases the risk.

Research has shown that most babies and toddlers start out liking their bodies, said Abramson. But this doesn't last for girls. By the time girls reach pre-adolescence, many start to suffer from warped body images. "Thirty percent of 9-year-old, 55 percent of 10-year-old and 65 percent of 11-year-old girls think they're fat," he said. "Entering puberty isn't as bad for boys. They're more satisfied with their bodies than before they entered puberty."

Parents can help their children have a healthy body image, he said. They need to understand how they feel about their child's physique and see how that is influencing their behavior. With young children, they should let them choose the clothes they want to wear. With pre-adolescents, parents should talk about the body changes that happen during puberty. And finally, they should encourage their children to have friendships with other children who are less concerned with appearance.

A new study of childhood obesity in the United States has found that some social factors, such as the presence of friends, may put overweight youths at greater risk of overeating.

The research, published in the August issue of the American Journal of Clinical Nutrition, demonstrates that friends may act as "permission givers" on children's food intake.

"These results are important, considering the role of friends as agents of change in childhood and adolescence," said Sarah Salvy, Ph.D., assistant professor in the Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences.

"Overweight children are more likely to find food more reinforcing than non-overweight youth," she continued. "Being in the company of overweight peers may give them the permission to eat more or may decrease their inhibitions, increasing what are seen as the norms of appropriate eating, or how much one should eat."

The study involved 23 overweight and 42 normal weight children between the ages of 9 and 15, who were randomized to participate with either a friend or an unfamiliar person of a similar age. After randomization, there were 33 friend pairs and 39 "unfamiliar" pairs.

Before taking part in the study experiment, participants listed what they had eaten in the past 24 hours to make sure they hadn't eaten anything during the previous two hours, and rated their hunger level.

Each participant pair spent 45 minutes in a room equipped with games, puzzles and individual bowls of low-calorie, "nutrient dense" baby carrots and grapes, and high-calorie "energy-dense" potato chips and cookies. The children were told they could eat as much or as little as they wanted, but were asked to eat from their own bowls only.

Researchers observed the children via closed-circuit television and recorded their activities. At the end of the session, they weighed the snacks that weren't eaten to determine how much each participant had consumed and to calculate calories.

Results showed that friends who ate together consumed more food than participants who were paired with someone they didn't know, and that friends were more likely to eat similar amounts than participants paired with a stranger.

However, overweight children who were paired with an overweight peer, whether friend or stranger, ate more than the overweight participants who were paired with a normal weight youth.

"These findings indicate that both overweight and normal weight participants eating with a friend ate significantly more than did participants eating in the presence of an unfamiliar peer," Salvy said. "These results are consistent with research in adults, which showed that eating among friends and family is distinctly different than eating among strangers.

"Given the impact of friends on eating behavior, it appears that if we hope to change the growing obesity epidemic among children, friends and family need to be involved," said Salvy. "If the environment in which children live doesn't change — if family meals remain high calorie and overeating is the norm — any progress children may make in their eating behavior won't last."

Salvy currently is investigating the influence of a parent versus a friend on children's and adolescents' eating behavior.

Marlana Howard and Erica Mele, UB bachelor's degree candidates who worked with Salvy, and Margaret Read, UB senior research specialist, also contributed to the study.

The research was supported by a grant to Salvy from the National Institute of Child Health and Human Development.

Anorexic patients drastically reduce food intake and are often not capable of changing their behavior. This can lead to life-threatening weight loss. Using MRI technology, scientists at Heidelberg University Hospital have discovered for the first time processes in brain metabolism that explain this disturbed eating behavior.

The research work of the Department of Psychosomatic and General Internal Medicine at Heidelberg University Hospital (Medical Director: Professor Dr. Wolfgang Herzog) arose in cooperation with the Heidelberg University Hospitals of General Psychiatry and Neurology.

Changes in brain activation associated with rigid behavior

Many young girls and women go on diets to achieve their ideal figure. Less than one percent of the population is affected by life-threatening anorexia. Despite intensive treatment, the course of the disorder is severe and chronic in 20 to 30 percent of the cases and about 10 percent of the patients die of the disease.

The Heidelberg researchers examined a total of 30 young women with and without anorexia by means of functional magnetic resonance imaging (MRI). The MRI device recorded the level of blood flow in various areas of the brain. Greater blood flow indicates higher metabolism and thus greater activity in this area of the brain.

The participants underwent a test that measured their capacity for flexible behavior modification of recently learned behavior. In this test, the subjects were shown a rapid sequence of various geometric shapes and asked to match them. After one test run, the matching principle was changed.

“In this study, we confirmed that anorexic patients cling to familiar behavioral responses more frequently than healthy subjects, thus suppressing alternative behavior," explained Dr. Hans-Christoph Friederich, head of the working group for eating disorders. The analysis of the MRI images also showed that in patients with anorexia compared with healthy subjects, a certain network pathway between the cortex and the diencephalon is less activated. This network pathway plays a decisive role in initiating and controlling actions under rapidly changing environmental demands.

New therapy approaches through brain research

The results of the study contribute decisively to a better understanding of anorexia. In particular, they make it clear that neurobiological factors are involved and sustain the clinical symptoms. Since psychological and neurobiological factors can influence each other, this may lead to new therapy approaches for anorexia.

"We have developed a treatment program for anorexia patients that specifically targets the flexible modification of behavioral responses,“ says Dr. Friederich.  In this way, the researchers hope to improve the success of psychotherapeutic treatment. The MRI examination of the brain could contribute to measure the success of treatment.

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Journal Reference:

1. Zastrow et al. Neural Correlates of Impaired Cognitive-Behavioral Flexibility in Anorexia Nervosa. American Journal of Psychiatry, 2009; 166 (5): 608 DOI: 10.1176/appi.ajp.2008.08050775

University of Minnesota Project Eating Among Teens (EAT) researchers have identified factors that may increase overweight adolescents' risk of engaging in extreme weight control behaviors such as self-induced vomiting, the use of diet pills, laxatives, and diuretics, as well as binge eating. Overweight youth with certain socio-environmental, psychological, and behavioral tendencies, such as reading magazine articles about dieting, reporting a lack of family connectedness, placing a high importance on weight, and reporting having participated in unhealthy weight control behaviors, are more likely to suffer from eating disorders.

Dianne Neumark-Sztainer, Ph.D., M.P.H., R.D., School of Public Health, and colleagues used data from Project EAT, an ongoing study that assessed eating and weight-related behaviors in 4,746 adolescents from 31 urban Minneapolis-St. Paul schools during the 1998-99 academic year. Youth were surveyed at two time points; the first occurring when participants were in middle school and high school, and the second occurring five years later.

Researchers found that disordered eating habits among overweight youth are linked to specific tendencies for both males and females, but a number of specific differences between genders were noticed. For example, increased hours of moderate to extreme physical activity and lower self-esteem predicted higher risk for disordered eating among females. For males, depressive symptoms, poor eating patterns, including high fast food and sweetened beverage intake, increased their risk of disordered eating. These findings link different patterns of behaviors and different potential motivators for overweight male and female adolescents to developing eating disorders.

"Further exploration of these gender differences may be important in understanding who is at highest risk for developing disordered eating behaviors and whether different intervention strategies may be needed to prevent disordered eating among males and females," said Nancy Sherwood, Ph.D., assistant professor at the University of Minnesota School of Public Health and a co-author of the study.

Findings from this study also suggest the importance of strong family relationships for overweight adolescents. These youth face pressures above and beyond those faced by their non-overweight peers due to strong social pressures to be thin. Lack of family connectedness, including not eating family meals together, was found to increase the risk of disordered eating behaviors in both young males and females.

While an important public health priority is to prevent obesity, it is also important to prevent the use of disordered eating behaviors among overweight adolescents. Findings from this study indicate the importance of working with overweight youth to prevent an unhealthy preoccupation with weight, promote a positive psychological well-being, avoid unhealthy weight control behaviors, and encourage family connectedness.

This study was supported by the Maternal and Child Health Bureau, Health Resources and Service Administration, and the U.S. Department of Health and Human Services.

Research to be presented at the Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB) shows that exposing rats to a context associated with eating chocolate activates a part of the brain’s reward system known as the orexin system. This finding helps explain why eating can be triggered by environmental cues even in the absence of hunger. The results have implications for the development of new drug treatments for overeating.  

The rate of obesity continues to rise within the United States and abroad, and over-consumption of tasty food is an obvious culprit. Little is known regarding how palatable foods affect the brain, but it seems that especially tasty foods elicit brain responses similar to those elicited by drugs of abuse such as cocaine and nicotine, pointing to a general involvement of the brain’s “reward” system.

A common factor may be activation of orexin neurons in the brain, which are recruited during of rewards such as a tasty food or a dose of cocaine.  “Our research program is focused on identifying brain systems that are activated by palatable food intake. The hypothalamic orexin system is known to promote wakefulness and arousal; however, it is now clear that this system also participates in the regulation of reward-related behaviors, including overconsumption of palatable foods,” says Derrick Choi, lead author. Because reward anticipation is a contributing factor to relapse to drug use, Choi hypothesizes that orexin is an ideal candidate system that may underlie the rewarding aspects of eating highly palatable foods, which clearly can lead to obesity.

In their current study, the researchers trained rats to expect a piece of Hershey’s milk chocolate in a unique environment. After training, rats were placed into the same environment, where no chocolate was present. The researchers found that the expectation of chocolate alone activated brain orexin systems.  The results could explain why individuals tend to overeat in contexts associated with prior experiences of eating good food. “It entirely possible that future treatments for obesity will involve a combination of lifestyle changes as well as pharmacological therapies aimed at orexin and other brain systems, to regulate food reward-related behaviors,” said Choi.

This research was supported by USARMY W81XWH-06-2-0019 and P01 DK056863-09.

The lead author was Derrick Choi, Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA. Co-authors were JF DAVIS, ME FITZGERALD, SC BENOIT. Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA.