Recurrent maternal depressive symptoms when children are toddlers are linked to behavioral problems at age 5 years, but formal child care at age 2 years may ameliorate this effect, according to the results of a questionnaire study reported Online First June 13 in Pediatrics.
"Maternal depression in toddlerhood has been linked to increased behavior problems in children," write Lynne C. Giles, PhD, from the Lifecourse and Intergenerational Health Research Group at the University of Adelaide in Adelaide, South Australia, and colleagues. "However, there is little information on whether nonmaternal child care in toddlerhood may ameliorate the effect of maternal depression on subsequent child behavior."
The investigators assessed the effect of maternal depressive symptoms during toddlerhood on children's behavior at age 5 years, as well as any moderating influence on this association of formal or informal child care during toddlerhood. The study sample consisted of 438 mothers and their children (227 girls and 211 boys). Questionnaires were administered to the mothers when their children were infants, toddlers, and 5 years old.
Internalizing, externalizing, and total behavior problems at age 5 years were significantly associated with recurrent, but not intermittent, maternal depressive symptoms when the children were 2 years old and 3.5 years old.
For children who received formal child care at 2 years, there was an ameliorating influence on the effect of recurrent maternal depressive symptoms on total behavioral problems at age 5 years. However, informal child care in toddlerhood was not associated with any significant benefit on subsequent behavioral problems.
"Recurrent, but not intermittent, maternal depressive symptoms when children were toddlers were associated with child behavior problems at age 5 years," the study authors write. "As little as half a day in formal child care at the age of 2 years significantly modified the effect of recurrent maternal depressive symptoms on total behavior problems. Formal child care for toddlers of depressed mothers may have positive benefits for the child's subsequent behavior."
Limitations of this study include those inherent in use of the Center for Epidemiologic Studies Depression Scale to measure maternal depressive symptoms, reliance on maternal reports of child behavior at age 5 years, and failure to measure the quality of nonmaternal care.
"In addition to a clinical response, it is important to consider public health responses to maternal depression and promote other pragmatic ways to improve mental health outcomes for both mother and child," the study authors conclude. "Policy-makers must recognize that the 'early years' of a child's life extend beyond infancy, with critical developmental stages (and parenting demands) occurring for at least another 2 years.... If replicated in other studies, our findings indicate that an extension of the perinatal depression–screening program for another few years after infancy warrants consideration."
The National Health and Medical Research Council supported this study. Dr. Giles's salary was funded in part by a Centre for Intergenerational Health Postdoctoral Fellowship and the National Health and Medical Research Council Australian Based Public Health Training Fellowship. The other study authors have disclosed no relevant financial relationships.
Monday, June 27, 2011
Thursday, June 16, 2011
Low Vitamin D: A Contributor to Mental Disorders in Children?
Children with severe mental health disorders, including psychosis, have twice the rate of vitamin D insufficiency as mentally healthy children, new research suggests.
A study presented here at the American Psychiatric Association 2011 Annual Meeting by investigators at the Oregon Health & Science University in Portland showed 21% of children with severe psychiatric symptoms requiring residential care had serum 25-hydroxyvitamin D (25[OH]D) levels lower than 20 ng/mL (the American Academy of Pediatrics [AAP] minimum recommended level) compared with 14% of children who were participants in the National Health and Nutrition Examination Survey III (NHANES III), a population-based study designed to assess the health and nutritional status of children and adults in the United States.
"The prevalence of vitamin D deficiency (43%) was most common in children with psychotic disorders compared to other mental health disorders," said first study author Mini Zhang, MA.
Vitamin D insufficiency is associated with a range of adverse medical outcomes, most commonly endocrine function and bone health, but more recently has also been linked to a variety of other medical conditions, including gastrointestinal disorders, asthma, cancer, and diabetes, added Ms. Zhang.
Furthermore, she said, recent research has linked low vitamin D levels to the development of psychiatric disorders, including depressive symptoms, schizophrenia, and bipolar disorder.
In addition, there is a controversial hypothesis by researcher John Cannell, MD, who heads The Vitamin D Council, a nonprofit educational group, that vitamin D deficiency is linked to autism.
A study presented here at the American Psychiatric Association 2011 Annual Meeting by investigators at the Oregon Health & Science University in Portland showed 21% of children with severe psychiatric symptoms requiring residential care had serum 25-hydroxyvitamin D (25[OH]D) levels lower than 20 ng/mL (the American Academy of Pediatrics [AAP] minimum recommended level) compared with 14% of children who were participants in the National Health and Nutrition Examination Survey III (NHANES III), a population-based study designed to assess the health and nutritional status of children and adults in the United States.
"The prevalence of vitamin D deficiency (43%) was most common in children with psychotic disorders compared to other mental health disorders," said first study author Mini Zhang, MA.
Vitamin D insufficiency is associated with a range of adverse medical outcomes, most commonly endocrine function and bone health, but more recently has also been linked to a variety of other medical conditions, including gastrointestinal disorders, asthma, cancer, and diabetes, added Ms. Zhang.
Furthermore, she said, recent research has linked low vitamin D levels to the development of psychiatric disorders, including depressive symptoms, schizophrenia, and bipolar disorder.
In addition, there is a controversial hypothesis by researcher John Cannell, MD, who heads The Vitamin D Council, a nonprofit educational group, that vitamin D deficiency is linked to autism.
Thursday, June 9, 2011
Mobile Phone Use and Stress, Sleep Disturbances, and Symptoms of Depression among Young Adults
Abstract
Background: Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults.
Methods: The study group consisted of young adults 20–24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately.
Results: There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women.
Conclusions: High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others' accessibility.
Background: Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults.
Methods: The study group consisted of young adults 20–24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately.
Results: There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women.
Conclusions: High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others' accessibility.
Tuesday, June 7, 2011
Unhealthy, Unsafe Behaviors More Common in LGB Youth
Lesbian, gay, and bisexual youth have higher prevalence rates of risky health behaviors compared with heterosexual students, a new population-based study from the Centers for Disease Control and Prevention (CDC) shows.
With a median of 63.8% for all risk behaviors measured, the prevalence of health risk behaviors among gay or lesbian students was higher than rates in heterosexual students. Further, the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median 76% of all the risk behaviors measured.
The study also showed gay or lesbian students were more likely than their heterosexual counterparts to report behaviors related to violence, attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management.
"This report should be a wake-up call for families, schools, and communities that we need to do a much better job of supporting these young people. Any effort to promote adolescent health and safety must take into account the additional stressors these youth experience because of their sexual orientation, such as stigma, discrimination, and victimization. We are very concerned that these students face such dramatic disparities for so many different health risks," study author Howard Wechsler, EdD, MPH, director of CDC's Division of Adolescent and School Health (DASH), said in a statement.
The findings are published June 6 in the Morbidity and Mortality Weekly Report Surveillance Summary.
According to the study authors, there is a need for population-based data on the health risk behaviors practiced by sexual minority youths at the state and local levels to "effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population."
In what is reportedly the first time the federal government has conducted such a large and wide-ranging analysis, the researchers analyzed data from youth risk behavior surveys conducted among grade 9 to 12 students from 2001 to 2009 in 7 states, including Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin, as well as 6 large urban school districts in Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco.
The surveys assessed 76 health risks in the following 10 categories:
Behaviors that contribute to unintentional injuries;
Behaviors that contribute to violence;
Behaviors related to attempted suicide;
Tobacco use;
Alcohol use;
Other drug use;
Sexual behaviors;
Dietary behaviors;
Physical activity and sedentary behaviors; and
Weight management.
Across the sites that assessed sexual identity, gay or lesbian students had higher prevalence rates for 49% to 90% of all health risks measured. Similarly, bisexual students had higher prevalence rates for 57% to 86% of all health risks measure.
"For youth to thrive in their schools and communities, they need to feel socially, emotionally, and physically safe and supported," said Laura Kann, PhD, chief, Surveillance and Evaluation Research Branch, DASH.
"Schools and communities should take concrete steps to promote healthy environments for all students, such as prohibiting violence and bullying, creating safe spaces where young people can receive support from caring adults, and improving health education and health services to meet the needs of lesbian, gay and bisexual youth."
With a median of 63.8% for all risk behaviors measured, the prevalence of health risk behaviors among gay or lesbian students was higher than rates in heterosexual students. Further, the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median 76% of all the risk behaviors measured.
The study also showed gay or lesbian students were more likely than their heterosexual counterparts to report behaviors related to violence, attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management.
"This report should be a wake-up call for families, schools, and communities that we need to do a much better job of supporting these young people. Any effort to promote adolescent health and safety must take into account the additional stressors these youth experience because of their sexual orientation, such as stigma, discrimination, and victimization. We are very concerned that these students face such dramatic disparities for so many different health risks," study author Howard Wechsler, EdD, MPH, director of CDC's Division of Adolescent and School Health (DASH), said in a statement.
The findings are published June 6 in the Morbidity and Mortality Weekly Report Surveillance Summary.
According to the study authors, there is a need for population-based data on the health risk behaviors practiced by sexual minority youths at the state and local levels to "effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population."
In what is reportedly the first time the federal government has conducted such a large and wide-ranging analysis, the researchers analyzed data from youth risk behavior surveys conducted among grade 9 to 12 students from 2001 to 2009 in 7 states, including Connecticut, Delaware, Maine, Massachusetts, Rhode Island, Vermont, and Wisconsin, as well as 6 large urban school districts in Boston, Chicago, Milwaukee, New York City, San Diego, and San Francisco.
The surveys assessed 76 health risks in the following 10 categories:
Behaviors that contribute to unintentional injuries;
Behaviors that contribute to violence;
Behaviors related to attempted suicide;
Tobacco use;
Alcohol use;
Other drug use;
Sexual behaviors;
Dietary behaviors;
Physical activity and sedentary behaviors; and
Weight management.
Across the sites that assessed sexual identity, gay or lesbian students had higher prevalence rates for 49% to 90% of all health risks measured. Similarly, bisexual students had higher prevalence rates for 57% to 86% of all health risks measure.
"For youth to thrive in their schools and communities, they need to feel socially, emotionally, and physically safe and supported," said Laura Kann, PhD, chief, Surveillance and Evaluation Research Branch, DASH.
"Schools and communities should take concrete steps to promote healthy environments for all students, such as prohibiting violence and bullying, creating safe spaces where young people can receive support from caring adults, and improving health education and health services to meet the needs of lesbian, gay and bisexual youth."
Saturday, June 4, 2011
PTSD May Be Linked To Heart Disease Risk And Premature Death
PTSD, or Post-Traumatic Stress Disorder is a kind of anxiety that is triggered by a traumatic event. The individual with PTSD might have experienced or witnessed an event that caused extreme shock, fear or a feeling of helplessness. We all, at some time in our lives experience a period of difficulty adjusting and coping with traumatic events, but we eventually get over it. In some cases, however, the symptoms just worsen and may persist for several months, or even years. If the person's life becomes completely disrupted he/she may have PTSD. Proper and effective treatment can help prevent the PTSD from becoming a chronic (long-term) illness.
Some soldiers returning from Afghanistan or Iraq may have developed PTSD.
Ramin Ebrahimi, MD, from the Greater Los Angeles Veterans Administration Medical Center, and team found that among mentally troubled veterans, their coronary artery disease had progressed farther compared to other individuals, making them more likely to die from any cause within 42 months compared to their mentally healthy peers.
The authors say better interventions are required to prevent these diseases from developing.
Reports of vets returning from active service developing depression, avoidant behavior and other mental issues are common, and the military has been under constant pressure to set up a more effective strategy to help those with PTSD.
The NIMH (National Institute of Mental Health) estimates that approximately 1 in every 30 US adults develops PTSD every year. The risk for war vets is significantly greater.
The authors say their findings highlight the urgency for a proper system of integrated medical and psychological therapy for vets with PTSD, which can rapidly identify those at risk of heart disease.
The researchers screened 637 vets for signs of coronary artery disease from PTSD. Most of them were male (12.2% female) and their average age was 60 years. 88 of them had the signs and symptoms of PTSD.
Calcium imaging scans of their hearts revealed that most of them had some accumulation of plaque in their arteries. Over three-quarters of the vets with PTSD had coronary atherosclerosis, versus 59% among the other vets.
They were then monitored for three and a half years. By the end of that period 17% of those with PTSD had died, compared to 10% of those without the disorder.
The authors also noted that risk of death was higher for PTSD vets whose plaque build-up was identical to other vets without PTSD.
Further studies are required to confirm that PTSD causes heart disease, the scientists added. However, they insist that their findings suggest that treating the disorder as just a mental one is not enough anymore.
Signs and symptoms of PTSD
Most people who are exposed to a traumatic event will experience some of the signs and symptoms listed below. In most cases they gradually taper off. For some, though, they persist and may get worse:
A feeling of detachment, estrangement from others
A feeling that the event is happening again
Alcohol abuse
Avoiding situations that remind the person of the event
Being over-alert to possible dangers
Chest pains
Depression
Disturbing and frightening thoughts
Dizziness, light headedness
Drug dependency
Feeling mentally and emotionally numbed
Flight/fight syndrome
General aches and pains
Guilt
Headaches
Higher risk of infection
Insomnia
Irritability
Less interest in life in general
Mood changes
Nightmares
Not being able to remember some aspects of the event
Not wanting to talk about the event
Outbursts of rage or anger
Persistent behavioral traits
Phobias
Problems focusing
Relationship breakdowns
Stomach problems
Sweating and trembling
Work problems
Some soldiers returning from Afghanistan or Iraq may have developed PTSD.
Ramin Ebrahimi, MD, from the Greater Los Angeles Veterans Administration Medical Center, and team found that among mentally troubled veterans, their coronary artery disease had progressed farther compared to other individuals, making them more likely to die from any cause within 42 months compared to their mentally healthy peers.
The authors say better interventions are required to prevent these diseases from developing.
Reports of vets returning from active service developing depression, avoidant behavior and other mental issues are common, and the military has been under constant pressure to set up a more effective strategy to help those with PTSD.
The NIMH (National Institute of Mental Health) estimates that approximately 1 in every 30 US adults develops PTSD every year. The risk for war vets is significantly greater.
The authors say their findings highlight the urgency for a proper system of integrated medical and psychological therapy for vets with PTSD, which can rapidly identify those at risk of heart disease.
The researchers screened 637 vets for signs of coronary artery disease from PTSD. Most of them were male (12.2% female) and their average age was 60 years. 88 of them had the signs and symptoms of PTSD.
Calcium imaging scans of their hearts revealed that most of them had some accumulation of plaque in their arteries. Over three-quarters of the vets with PTSD had coronary atherosclerosis, versus 59% among the other vets.
They were then monitored for three and a half years. By the end of that period 17% of those with PTSD had died, compared to 10% of those without the disorder.
The authors also noted that risk of death was higher for PTSD vets whose plaque build-up was identical to other vets without PTSD.
Further studies are required to confirm that PTSD causes heart disease, the scientists added. However, they insist that their findings suggest that treating the disorder as just a mental one is not enough anymore.
Signs and symptoms of PTSD
Most people who are exposed to a traumatic event will experience some of the signs and symptoms listed below. In most cases they gradually taper off. For some, though, they persist and may get worse:
A feeling of detachment, estrangement from others
A feeling that the event is happening again
Alcohol abuse
Avoiding situations that remind the person of the event
Being over-alert to possible dangers
Chest pains
Depression
Disturbing and frightening thoughts
Dizziness, light headedness
Drug dependency
Feeling mentally and emotionally numbed
Flight/fight syndrome
General aches and pains
Guilt
Headaches
Higher risk of infection
Insomnia
Irritability
Less interest in life in general
Mood changes
Nightmares
Not being able to remember some aspects of the event
Not wanting to talk about the event
Outbursts of rage or anger
Persistent behavioral traits
Phobias
Problems focusing
Relationship breakdowns
Stomach problems
Sweating and trembling
Work problems
Culture’s role in mental health is overlooked
When I mention to people that I have clinical and research interests in cultural psychiatry, I’m surprised by how many questions I get about “koro” – the belief that one’s genitalia is shrinking – or some other culture-specific condition. I will admit, it makes for some lively dinner discussions, but it does raise an issue: There is comparably less interest in discussing the prevalent issues in one’s own culture.
I generally attribute the lack of curiosity to the assumptions that mental illness is rare or equates to “madness,” and only people suffering from severe mental illness, such as schizophrenia, should seek help from psychiatrists. More common mental disorders – such as depression and anxiety – are often regarded as character or moral weaknesses that should be corrected rather than treated. The immense role of culture on the etiology and treatment of mental health issues has, unfortunately, been overlooked.
At North York General Hospital, our patient population reflects the diversity of our community. In my day-to-day psychiatric practice with immigrants and Canadian-born members of racial and ethnic minority communities, I deal with roughly the same spectrum of disorders in each population. The challenge of my area of focus, and that of the entire hospital, is to deliver culturally appropriate services to ensure the best possible care. In essence, the hospital has become a quasi-research facility for diverse community care.
Take my area of study: suicidality in Chinese Canadian women. Recent studies have highlighted gender-role stress as a key contributor to suicidal thoughts and behaviour in Chinese-born women and women of Chinese descent residing in North America. Rigid gender roles may lead to conflict with parents, partner, in-laws and other community members. The core of the tension is between expectations of a woman’s role and a woman’s own desires and expectations. Chinese immigrants abroad face the added pressure of conflict between traditional and Western female roles. The stress is immense.
Seeking help isn’t easy. There is even more stigma and misunderstanding attached to psychiatric disorders in Chinese communities. This leads to a delay and/or refusal of treatment. Even if a woman does seek treatment, there is a severe lack of mental health service providers, treatment and follow-up programs offered in Chinese. Obviously, language is key in expressing mental health issues. In Ontario, some psychotherapy services in Chinese currently have a waiting list of one to two years.
Also prevalent is the under-recognition and under-treatment of more common mental health issues (depression, anxiety, insomnia, etc.) by primary care physicians in the Chinese community. A woman may feel more comfortable seeking treatment for the physical symptoms of depression – aches, decreased appetite and energy – rather than a low mood, which is considered an inherent character flaw.
A multipronged approach is required. Ideally, health service providers – especially primary care physicians – in the Chinese community should be made more aware of the physical impact of depression and anxiety. As well, a push to attract Chinese-speaking physicians to pursue careers in mental health is critical.
From the system perspective, more funding for mental health programs in Chinese would enhance the treatment and community care of these patients. Toronto’s Hong Fook Mental Health Association – an organization that helps people with linguistic barriers gain access to mental health services – is an excellent example. Having adequate mental health specialty services would also encourage primary care physicians to refer patients to these services.
Last, but not least, public mental health education in the Chinese community would be instrumental. The mass media is one avenue, while mental health education for respected community leaders, such as clergy members, could significantly assist in both recognition of mental health issues and adherence to treatment.
Ongoing research efforts between North York General and St. Michael’s Hospital in Toronto endeavour to further delineate gender-role stress in the Chinese community. These efforts may lead to better identification of and culturally appropriate service provision for those at risk for suicide, while providing a framework for examining and developing culturally sensitive suicide prevention strategies for at-risk Canadians.
Misunderstanding and mistreating psychiatric disorders is certainly not limited to the Chinese community. We have only begun to understand their impact on our entire population. As we slowly chip away at the stigma of mental health, it’s important to remember and truly appreciate just how deeply interwoven it is with cultural identity.
I generally attribute the lack of curiosity to the assumptions that mental illness is rare or equates to “madness,” and only people suffering from severe mental illness, such as schizophrenia, should seek help from psychiatrists. More common mental disorders – such as depression and anxiety – are often regarded as character or moral weaknesses that should be corrected rather than treated. The immense role of culture on the etiology and treatment of mental health issues has, unfortunately, been overlooked.
At North York General Hospital, our patient population reflects the diversity of our community. In my day-to-day psychiatric practice with immigrants and Canadian-born members of racial and ethnic minority communities, I deal with roughly the same spectrum of disorders in each population. The challenge of my area of focus, and that of the entire hospital, is to deliver culturally appropriate services to ensure the best possible care. In essence, the hospital has become a quasi-research facility for diverse community care.
Take my area of study: suicidality in Chinese Canadian women. Recent studies have highlighted gender-role stress as a key contributor to suicidal thoughts and behaviour in Chinese-born women and women of Chinese descent residing in North America. Rigid gender roles may lead to conflict with parents, partner, in-laws and other community members. The core of the tension is between expectations of a woman’s role and a woman’s own desires and expectations. Chinese immigrants abroad face the added pressure of conflict between traditional and Western female roles. The stress is immense.
Seeking help isn’t easy. There is even more stigma and misunderstanding attached to psychiatric disorders in Chinese communities. This leads to a delay and/or refusal of treatment. Even if a woman does seek treatment, there is a severe lack of mental health service providers, treatment and follow-up programs offered in Chinese. Obviously, language is key in expressing mental health issues. In Ontario, some psychotherapy services in Chinese currently have a waiting list of one to two years.
Also prevalent is the under-recognition and under-treatment of more common mental health issues (depression, anxiety, insomnia, etc.) by primary care physicians in the Chinese community. A woman may feel more comfortable seeking treatment for the physical symptoms of depression – aches, decreased appetite and energy – rather than a low mood, which is considered an inherent character flaw.
A multipronged approach is required. Ideally, health service providers – especially primary care physicians – in the Chinese community should be made more aware of the physical impact of depression and anxiety. As well, a push to attract Chinese-speaking physicians to pursue careers in mental health is critical.
From the system perspective, more funding for mental health programs in Chinese would enhance the treatment and community care of these patients. Toronto’s Hong Fook Mental Health Association – an organization that helps people with linguistic barriers gain access to mental health services – is an excellent example. Having adequate mental health specialty services would also encourage primary care physicians to refer patients to these services.
Last, but not least, public mental health education in the Chinese community would be instrumental. The mass media is one avenue, while mental health education for respected community leaders, such as clergy members, could significantly assist in both recognition of mental health issues and adherence to treatment.
Ongoing research efforts between North York General and St. Michael’s Hospital in Toronto endeavour to further delineate gender-role stress in the Chinese community. These efforts may lead to better identification of and culturally appropriate service provision for those at risk for suicide, while providing a framework for examining and developing culturally sensitive suicide prevention strategies for at-risk Canadians.
Misunderstanding and mistreating psychiatric disorders is certainly not limited to the Chinese community. We have only begun to understand their impact on our entire population. As we slowly chip away at the stigma of mental health, it’s important to remember and truly appreciate just how deeply interwoven it is with cultural identity.
Wednesday, June 1, 2011
Bad Memories Not Necessarily Forever
Bad memories aren't necessarily forever. Canadian researchers have shown that using metyrapone to lower cortisol levels before recalling a negative memory can lessen the emotional strength of that memory, with lasting effects, while leaving neutral memories intact.
"This study shows that even if you have a bad memory engraved in your brain for a while, you may have a second window of opportunity to change it," Marie-France Marin, a PhD student from the Centre for Studies on Human Stress of Louis-H. Lafontaine Hospital, University of Montreal, Quebec, Canada, told Medscape Medical News.
She is hopeful that, with further study, this finding may eventually help individuals with posttraumatic stress disorder (PTSD).
"People with PTSD have memories that preclude them from leading a normal life. If we can decrease emotional memories for these people, this has a lot of implications, particularly in people for whom PTSD therapies do not work or are not optimal," she said.
"If we can combine therapy with lowering cortisol levels, this might help them alter the traumatic memory trace and ease the process. We are not there yet, but this is a first step," Ms. Marin added.
The study was published online May 18 in the Journal of Clinical Endocrinology and Metabolism.
Finding New but Not Unexpected
Cortisol is a stress hormone involved in memory recall. For a long time, it was thought that once a memory was formed in the brain, it could not be changed. Animal studies challenged this theory by showing that every time a memory is recalled, the memory trace is unstable and it can be altered.
It's known that cortisol can modulate the process of memory retrieval. Tony Buchanan, PhD, assistant professor, Department of Psychology, Saint Louis University, Missouri, who was not involved in the research, said the findings by Ms. Marin and colleagues are new "but not unexpected."
"What has been shown in the past is the enhancing effects of cortisol on emotional memory. The new bit here is the ability to reduce negative memories specifically by reducing cortisol levels," he told Medscape Medical News.
Ms. Marin and colleagues assessed the effect of cortisol inhibition on retrieval of neutral and emotional memory using the drug metyrapone, which significantly decreases cortisol levels.
Thirty-three healthy men watched a computer-narrated story composed of neutral and emotionally negative events. Three days later, the men were divided into 3 groups and given a single 750-mg dose of metyrapone, a double dose of metyrapone (750 mg followed by 750 mg 3 hours later), or placebo. They were then asked to recall as much information as possible from the story at a time when the metyrapone group's cortisol levels were expected to be at their lowest.
According to the researchers, men in the group who received double-dose metyrapone recalled significantly less emotional material from the story than men in the other 2 groups; "they had less emotional memory of the story," Ms. Marin said.
"Surprisingly," she added, the decreased memory of negative information was still present 4 days later when cortisol levels had recovered. No acute or long-term effects of metyrapone were observed in recalling the neutral parts of the story.
Strong Indication of Neural Change
"The key strength," Dr. Buchanan said, "is the finding that these effects persist 4 days after metyrapone was administered. That's a pretty strong indication that a neural change has occurred and it's not just some side effect of the presence of the drug in the system."
Dr. Buchanan added that this strategy is potentially useful in the clinical setting but more research is needed.
Ms. Marin and colleagues agree. Although the results have "clear" potential for pharmacologic easing of painful memories in patients with PTSD, the study was not performed in traumatized individuals, and it remains to be seen whether similar results can be achieved.
In addition, metyrapone is no longer commercially marketed, but other compounds are known to decrease cortisol levels, and "it remains to be seen whether other compounds have the same effect," said Ms. Marin.
It will also be important to replicate these findings in women, "given that some studies report important sex differences in response to catecholamine or cortisol modulation on memory traces," the researchers write.
It's also important to note that metyrapone likely changes the concentrations of other hormones besides cortisol; therefore, it's not possible to conclude for certain that the observed effects could be explained only by lowering cortisol concentrations.
"By using different compounds and by measuring multiple hormones, future studies will be able to better understand the exact mechanism underlying the current results," the researchers note.
The study was supported by the Canadian Institutes of Health Research. The study authors and Dr. Buchanan have disclosed no relevant financial relationships.
"This study shows that even if you have a bad memory engraved in your brain for a while, you may have a second window of opportunity to change it," Marie-France Marin, a PhD student from the Centre for Studies on Human Stress of Louis-H. Lafontaine Hospital, University of Montreal, Quebec, Canada, told Medscape Medical News.
She is hopeful that, with further study, this finding may eventually help individuals with posttraumatic stress disorder (PTSD).
"People with PTSD have memories that preclude them from leading a normal life. If we can decrease emotional memories for these people, this has a lot of implications, particularly in people for whom PTSD therapies do not work or are not optimal," she said.
"If we can combine therapy with lowering cortisol levels, this might help them alter the traumatic memory trace and ease the process. We are not there yet, but this is a first step," Ms. Marin added.
The study was published online May 18 in the Journal of Clinical Endocrinology and Metabolism.
Finding New but Not Unexpected
Cortisol is a stress hormone involved in memory recall. For a long time, it was thought that once a memory was formed in the brain, it could not be changed. Animal studies challenged this theory by showing that every time a memory is recalled, the memory trace is unstable and it can be altered.
It's known that cortisol can modulate the process of memory retrieval. Tony Buchanan, PhD, assistant professor, Department of Psychology, Saint Louis University, Missouri, who was not involved in the research, said the findings by Ms. Marin and colleagues are new "but not unexpected."
"What has been shown in the past is the enhancing effects of cortisol on emotional memory. The new bit here is the ability to reduce negative memories specifically by reducing cortisol levels," he told Medscape Medical News.
Ms. Marin and colleagues assessed the effect of cortisol inhibition on retrieval of neutral and emotional memory using the drug metyrapone, which significantly decreases cortisol levels.
Thirty-three healthy men watched a computer-narrated story composed of neutral and emotionally negative events. Three days later, the men were divided into 3 groups and given a single 750-mg dose of metyrapone, a double dose of metyrapone (750 mg followed by 750 mg 3 hours later), or placebo. They were then asked to recall as much information as possible from the story at a time when the metyrapone group's cortisol levels were expected to be at their lowest.
According to the researchers, men in the group who received double-dose metyrapone recalled significantly less emotional material from the story than men in the other 2 groups; "they had less emotional memory of the story," Ms. Marin said.
"Surprisingly," she added, the decreased memory of negative information was still present 4 days later when cortisol levels had recovered. No acute or long-term effects of metyrapone were observed in recalling the neutral parts of the story.
Strong Indication of Neural Change
"The key strength," Dr. Buchanan said, "is the finding that these effects persist 4 days after metyrapone was administered. That's a pretty strong indication that a neural change has occurred and it's not just some side effect of the presence of the drug in the system."
Dr. Buchanan added that this strategy is potentially useful in the clinical setting but more research is needed.
Ms. Marin and colleagues agree. Although the results have "clear" potential for pharmacologic easing of painful memories in patients with PTSD, the study was not performed in traumatized individuals, and it remains to be seen whether similar results can be achieved.
In addition, metyrapone is no longer commercially marketed, but other compounds are known to decrease cortisol levels, and "it remains to be seen whether other compounds have the same effect," said Ms. Marin.
It will also be important to replicate these findings in women, "given that some studies report important sex differences in response to catecholamine or cortisol modulation on memory traces," the researchers write.
It's also important to note that metyrapone likely changes the concentrations of other hormones besides cortisol; therefore, it's not possible to conclude for certain that the observed effects could be explained only by lowering cortisol concentrations.
"By using different compounds and by measuring multiple hormones, future studies will be able to better understand the exact mechanism underlying the current results," the researchers note.
The study was supported by the Canadian Institutes of Health Research. The study authors and Dr. Buchanan have disclosed no relevant financial relationships.
Announcement
Moner Alo and all other clinic of Dr.Tirthankar Dasgupta & Rituparna Dasgupta will remain closed from 3rd June - 5th June.
Subscribe to:
Posts (Atom)