Category: Mental Health

Ode to Billie Joe: Suicide Rate Much Higher for Rural Youth

Bobbie Gentry’s 1967 country song tells the story of a boy who mysteriously “jumped off the Tallahatchie Bridge.” Even today, suicide still accounts for about 1 in 10 deaths among teenagers. Although national rates of youth suicide have decreased since 1991, a study published this week in JAMA Pediatrics reveals the disparities between rural and urban youth suicide mortality.

According to the study, the suicide rate for male youths in rural counties (almost 20 per 100,000) is almost double the rate of male youths in the most urban counties (about 10 per 100,000). While rural suicides have been more common since at least the 1990s, the gap between rural and urban suicides has only widened with time, at least for males. Regardless of where one lives, youth suicides by firearms have decreased, while suicides by other methods like hanging have increased.

It is difficult to pinpoint exactly why rural youths are committing more suicides. The study’s senior author Dr. John Campo believes accessibility may be a major problem, as “it’s especially difficult to receive psychotherapy in a rural area” (Source: OSU press release). There may also be cultural issues at play; when there is more stigmatization surrounding mental illness, people may be less inclined to seek help, according to the press release. Identifying the reasons behind these tragic statistics should be the next aim for public health policymakers and healthcare professionals.

Photo credit: Victor Reynolds via Flickr

Got cabin fever?

Feeling like this is your house?  Hang on, spring really is coming.

Feeling like this is your house? Hang on, spring really is coming.

The people who write this blog are located in north-central North Carolina, which has lately experienced a lot of snow.

This isn’t normal.

Of course, other regions of the United States are experiencing record-setting snow this year.  A representative of the normally hardy Bostonians used words like “desperate,” “hammered” and “drained” in a New York Times op-ed to describe their reaction to their Alpine accumulations.

One of the consequences of this kind of weather is that people have to stay indoors more than usual.  They get what’s known as “cabin fever.”

It’s not a precise term, but if you’re having it, you might be “irritable, unmotivated, and lethargic” according to WebMD, or feeling “dissatisfaction at home, restlessness, boredom, irritability, and needing to break routine” according to a 1984 paper in the Journal of Social Psychology.  (That one comes from the University of Minnesota, where presumably they know from cabin fever.  They definitely know from snow.)

If you’re hemmed in by a mountain of fluffy or crunchy white stuff and haven’t been out of the house in days, you might be a bit grumpy—understandably so.  WebMD suggests:

  • Don’t overdose on the news
  • Use a relaxation technique to unwind
  • Limit your intake of alcohol
  • Maintain contact with your friends
  • Exercise regularly

And if your grump persists, or starts intensifying, see a doctor.

The National Institute of Mental Health differentiates between cabin fever and depression.  Their excellent article on depression begins with the acknowledgement that “Everyone occasionally feels blue or sad.  But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you.  Depression is a common but serious illness.”

We’ll talk about depression in more depth in a future post.

Pro-sanity Sundays: Bipolar people’s press

The cover of the latest issue of bp magazine, written by and for people with bipolar disorder.

The cover of the latest issue of bp magazine, written by and for people with bipolar disorder.

A magazine for people with bipolar disorder is celebrating its 10th anniversary with an issue in mailboxes now.

bp magazine is a glossy quarterly with the tagline “hope and harmony for people with bipolar.”  Leaving off the “disorder” reflects the shortened version often used by people who have the condition—but it could also be an assertion that the condition doesn’t always have to “disorder” one’s life.

Formerly known as “manic depression,” bipolar disorder is characterized by extremes of energy, inspiration, grandiose thinking and behavior (mania or the highs) and opposite extremes of lethargy, poor self-concept and withdrawal (depression, or the lows).  The changes in mood typically repeat and can last for hours, days, weeks or months.  Lithium used to be the standard treatment, but the last 20 years have brought major advances in understanding the disorder and in treatments for it.

Issues of bp typically provide a cover story of a notable person who has bipolar, news of research advances in treatments for bipolar, letters and comments from an active online community of readers with bipolar (and their support people), tips and professional advice for coping with the many problems bipolar can cause, reviews of books about the condition, and columns from survivors.

Members of the bp staff took the opportunity of the 10th anniversary issue to comment on their jobs, using words like “powerful.”

“It’s the personal stories told in these pages that I think are so inspiring,” wrote news editor Paul Forsyth.  “They play a vital part in ‘normalizing’ mental illness, and it’s uplifting to read how people whose lives had often spiraled into destruction and despair can reclaim their futures and tell their stories with such dignity, courage, and in many cases, even humor.”

For more information on bp, go to http://www.bphope.com/.

The Battle Within: PTSD alters the body’s response to stress

Post-Traumatic Stress Disorder (PTSD) can arise in people after they have experienced a traumatic event, such as being in combat or suffering physical or sexual abuse. It can be a debilitating psychological condition, as symptoms – which include intrusive flashbacks of the trauma, chronic hyperarousal, and avoidance behaviors – greatly decrease a patient’s quality of life. But how does this illness actually affect the body during stress?

To answer this question, researchers used an experimental technique called the Trier Social Stress Test. In this study, currently in press at Psychoneuroendocrinology, both healthy females and those with PTSD completed the task. Participants were asked to prepare a speech, deliver it in front of a panel of stoic judges, and then perform mental arithmetic out loud, being careful not to make any mistakes. This task might seem nightmarish to many readers, but it is frequently used as a reliable way to induce stress. While all PTSD participants reported much greater psychological distress than their healthy counterparts, some of these patients’ biological stress responses – as measured by cortisol levels – were actually lower than normal throughout the task.

Why is it that PTSD would cause blunted cortisol release in some patients but not others? Although the authors’ data could not provide any definitive answers, the study suggests that there may be a subtype of PTSD patients in which stress hormones are particularly dysfunctional. This subgroup had overall greater symptom severity and different patterns of cortisol-related gene expression. Knowledge of distinct PTSD subgroups may help inform individually-tailored pharmacotherapy treatments – eventually giving patients a better chance not just to survive, but to thrive as well.

Pro-sanity Sundays: iTherapy?

photo of iPad2Online cognitive behavioral therapy for depression could become a “useful strategy to reduce suicidal ideation,” according to a pair of Australian researchers.

 

Their study, which appeared in the January 2015 Journal of Affective Disorders, followed the progress of 484 depressed patients who were prescribed internet cognitive behavioral therapy (iCBT).  More than half (56.8 %) finished all six iCBT lessons.  At the study’s outset, half of the patients had suicidal ideation (the visualization of or actual plans for a suicide attempt, which is considered a danger signal for suicide); at the completion of the study, only 27% had it.  The prevalence of major depression went from 71% at the outset to 28% at completion.

 

The authors, Louise Mewton and Gavin Andrews, note that iCBT is “a strategy which can be implemented on a large scale without enacting major structural change at the societal level.” The patient data were de-identified, but more than half of the referring clinicians were based in rural areas of Australia (55.6%) and almost half were general practitioners (45.2%).  This implies that iCBT therapy could be practical and effective in situations where there is a dearth of mental health specialists, or where patient transportation is an issue.

 

The study was “practice-based”; that is, data from an established practice were analyzed.  The gold standard in the medical field is a randomized double-blind clinical trial, and the authors advocate for iCBT to be so tested.  But the Mewton and Andrews report is an indication that rural and underserved mental health patients may soon have another way to access badly-needed treatment.

Art and Nature: “Awe”-some for health!

When it hits you – your eyes widen and a tingle runs down your spine – you’ve encountered something that fills you with wonder and awe. It might be from gazing at the Milky Way on a camping trip, admiring the passionate brush strokes of Van Gogh, or attending a church service to worship a higher power. However it happens, experiencing the emotion of awe may not just be awesome; it may also be good for your health.

A recent paper published in the journal Emotion found that positive emotions – and especially awe – were associated with lower levels of IL-6, a marker for inflammation. Proinflammatory cytokines like IL-6 are normally important when the body is exposed to infection or injury, as they help the body to heal. However, chronic levels of inflammation are implicated in the progression of diseases such as diabetes, cardiovascular disease, and certain types of cancer.

While stress can increase the body’s level of inflammation, this study suggests that positive emotions like awe can act as a counterbalance. This study supports previous research that has shown that other positive psychological processes – such as finding value in one’s life and making meaningful social connections – are associated with gene expression profiles indicative of lower levels of inflammation. Because positive emotions may prompt us to explore and connect with others, they may help us identify resources that help protect us against adversity. So get going and see the world, for both your mind and your body.

Image credit: Robert Couse-Baker via Flickr

Conference to examine economic, health links

brochuretn-232x300Expanding Medicaid was at or near the top of the list of actions that Moral Monday participants urged on leaders of the North Carolina Legislature on Wednesday (Jan. 28) this past week. The protesters say Medicaid expansion would make health care more available to more poor people, in a state with more than 300,000 households living below the poverty level.

The 36th Annual Minority Health Conference, taking place on Friday, Feb. 27 at the William and Ida Friday Center for Continuing Education, will focus on the ways strategies like Medicaid expansion could contribute to North Carolina’s overall economic health.  “Reaching for the American Dream: Economic Mobility and Minority Health” is the conference theme. William A. “Sandy” Darity Jr., Ph.D., the Samuel DuBois Cook Professor of Public Policy, African and African American Studies, and Economics at Duke University, will give the William T. Small Jr. Keynote Lecture at 9:30 a.m.  That lecture will subsequently be webcast to partner conferences and remote sites at 2 p.m. ET, followed by a live Q&A with Dr. Darity.

Conference breakout sessions will cover topics such as e-Health and Health Literacy, Refugee Health, and Income Disparities and Mental Health.

The registration deadline is Friday, Feb. 13.  Click here for more information or to register.