Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Mental Health. Show all posts
Showing posts with label Mental Health. Show all posts

Thursday, March 7, 2024

Canada Postpones Plan to Allow Euthanasia for Mentally Ill

Craig McCulloh
Voice of America News
Originally posted 8 Feb 24

The Canadian government is delaying access to medically assisted death for people with mental illness.

Those suffering from mental illness were supposed to be able to access Medical Assistance in Dying — also known as MAID — starting March 17. The recent announcement by the government of Canadian Prime Minister Justin Trudeau was the second delay after original legislation authorizing the practice passed in 2021.

The delay came in response to a recommendation by a majority of the members of a committee made up of senators and members of Parliament.

One of the most high-profile proponents of MAID is British Columbia-based lawyer Chris Considine. In the mid-1990s, he represented Sue Rodriguez, who was dying from amyotrophic lateral sclerosis, commonly known as ALS.

Their bid for approval of a medically assisted death was rejected at the time by the Supreme Court of Canada. But a law passed in 2016 legalized euthanasia for individuals with terminal conditions. From then until 2022, more than 45,000 people chose to die.


Summary:

Canada originally planned to expand its Medical Assistance in Dying (MAiD) program to include individuals with mental illnesses in March 2024.
  • This plan has been postponed until 2027 due to concerns about the healthcare system's readiness and potential ethical issues.
  • The original legislation passed in 2021, but concerns about safeguards and mental health support led to delays.
  • This issue is complex and ethically charged, with advocates arguing for individual autonomy and opponents raising concerns about coercion and vulnerability.
I would be concerned about the following issues:
  • Vulnerability: Mental illness can impair judgement, raising concerns about informed consent and potential coercion.
  • Safeguards: Concerns exist about insufficient safeguards to prevent abuse or exploitation.
  • Mental health access: Limited access to adequate mental health treatment could contribute to undue pressure towards MAiD.
  • Social inequalities: Concerns exist about disproportionate access to MAiD based on socioeconomic background.

Sunday, February 25, 2024

Characteristics of Mental Health Specialists Who Shifted Their Practice Entirely to Telemedicine

Hailu, R., Huskamp, H. A., et al. (2024).
JAMA, 5(1), e234982. 

Introduction

The COVID-19 pandemic–related shift to telemedicine has been particularly prominent and sustained in mental health care. In 2021, more than one-third of mental health visits were conducted via telemedicine. While most mental health specialists have in-person and telemedicine visits, some have transitioned to fully virtual practice, perhaps for greater work-life flexibility (including avoiding commuting) and eliminating expenses of maintaining a physical clinic. The decision by some clinicians to practice only via telemedicine has gained importance due to Medicare’s upcoming requirement, effective in 2025, that patients have an annual in-person visit to receive telemedicine visits for mental illness and new requirements from some state Medicaid programs that clinicians offer in-person visits. We assessed the number and characteristics of mental health specialists who have shifted fully to telemedicine.

Discussion

In 2022, 13.0% of mental health specialists serving commercially insured or Medicare Advantage
enrollees had shifted to telemedicine only. Rates were higher among female clinicians and those
working in densely populated counties with higher real estate prices. A virtual-only practice allowing
clinicians to work from home may be more attractive to female clinicians, who report spending more
time on familial responsibilities, and those facing long commutes and higher office-space costs.
It is unclear how telemedicine-only clinicians will navigate new Medicare and Medicaid
requirements for in-person care. While clinicians and patients may prefer in-person care,
introducing in-person requirements for visits and prescribing could cause care interruptions,
particularly for conditions such as opioid use disorder.

Our analysis is limited to clinicians treating patients with commercial insurance or Medicare
Advantage and therefore may lack generalizability. We were also unable to determine where
clinicians physically practiced, particularly if they had transitioned to virtual-health companies. Given the shortage of mental health clinicians, future research should explore whether a virtual-only model
affects clinician burnout or workforce retention.

Saturday, February 24, 2024

Living in an abortion ban state is bad for mental health

Keren Landman
vox.com
Originally posted 20 Feb 24

Here is an excerpt:

What they found was, frankly, predictable: Before the Court’s decision, anxiety and depression scores were already higher in trigger states — a population-wide average of 3.5 compared with 3.3 in non-trigger states. After the decision, that difference widened significantly, largely due to changes in the mental health of women 18 to 45, what the authors defined as childbearing age. Among this subgroup, anxiety and depression scores subtly ticked up in those living in trigger states (from 4.62 to 4.76) — and dropped in those living in non-trigger states (from 4.57 to 4.49). There was no similar effect in older women, nor in men.

These differences were small but statistically meaningful, especially since they sampled the entire population, not just women considering an abortion. Moreover, they were consistent across trigger states, whether their policies and political battles around abortion had been high- or low-profile. Even when the researchers omitted data from states with particularly severe restrictions on women’s reproductive health (looking at you, Texas), the results held up.

It’s notable that the different levels of mental distress across states after Roe was overturned weren’t just a consequence of worsened anxiety and depression in states with trigger bans. Also contributing: an improvement in these symptoms in states without these bans. We can’t tell from the study exactly why that is, but it seems plausible that women living in states that protect their right to access necessary health care simply feel some relief.


Here is the citation to the study:

Thornburg B, Kennedy-Hendricks A, Rosen JD, Eisenberg MD. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA. 2024;331(4):294–301. doi:10.1001/jama.2023.25599

Conclusions and Relevance  In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

Sunday, January 28, 2024

Americans are lonely and it’s killing them. How the US can combat this new epidemic.

Adrianna Rodriguez
USA Today
Originally posted 24 Dec 23

America has a new epidemic. It can’t be treated using traditional therapies even though it has debilitating and even deadly consequences.

The problem seeping in at the corners of our communities is loneliness and U.S. Surgeon General Dr. Vivek Murthy is hoping to generate awareness and offer remedies before it claims more lives.

“Most of us probably think of loneliness as just a bad feeling,” he told USA TODAY. “It turns out that loneliness has far greater implications for our health when we struggle with a sense of social disconnection, being lonely or isolated.”

Loneliness is detrimental to mental and physical health, experts say, leading to an increased risk of heart disease, dementia, stroke and premature death. As researchers track record levels of self-reported loneliness, public health leaders are banding together to develop a public health framework to address the epidemic.

“The world is becoming lonelier and there’s some very, very worrisome consequences,” said Dr. Jeremy Nobel, founder of The Foundation for Art and Healing, a nonprofit that addresses public health concerns through creative expression, which launched an initiative called Project Unlonely.

“It won’t just make you miserable, but loneliness will kill you," he said. "And that’s why it’s a crisis."


Key points:
  • Loneliness Crisis: America faces a growing epidemic of loneliness impacting mental and physical health, leading to increased risks of heart disease, dementia, stroke, and premature death.
  • Diverse and Widespread: Loneliness affects various demographics, from young adults to older populations, and isn't limited by social media interaction.
  • Health Risks: The Surgeon General reports loneliness raises risk of premature death by 26%, equivalent to smoking 15 cigarettes daily. Heart disease and stroke risks also increase significantly.
  • Causes: Numerous factors contribute, including societal changes, technology overuse, remote work, and lack of genuine social connection.
  • Solutions: Individual actions like reaching out and mindful interactions help. Additionally, public health strategies like "social prescribing" and community initiatives are crucial.
  • Collective Effort Needed: Overcoming the epidemic requires collaboration across sectors, fostering stronger social connections within communities and digital spaces.

Friday, January 19, 2024

Asexuality Is Finally Breaking Free from Medical Stigma

Allison Parshall
Scientific American
Originally posted 1 Jan 24

Here is an excerpt:

Over the past two decades psychological studies have shown that asexuality should be classified not as a disorder but as a stable sexual orientation akin to homosexuality or heterosexuality. Both cultural awareness and clinical medicine have been slow to catch on. It's only recently that academic researchers have begun to look at asexuality not as an indicator of health problems but as a legitimate, underexplored way of being human.

In biology, the word “asexual” typically gets used in reference to species that reproduce without sex, such as bacteria and aphids. But in some species that do require mating to have offspring, such as sheep and rodents, scientists have observed individuals that don't appear driven to engage in the act.

This behavior is more analogous to human asexuality, a concept rarely mentioned in medical literature until recently. In a pamphlet published in 1896, pioneering German sexologist Magnus Hirschfeld described people without sexual desire, a state he called “anesthesia sexualis.” In 1907 Reverend Carl Schlegel, an early gay rights activist, advocated for the “same laws” for “the homosexuals, heterosexuals, bisexuals [and] asexuals.” When sexologist Alfred Kinsey devised his scale of sexual orientation in the 1940s, he created a “Category X” for the respondents who unexpectedly reported no sociosexual contacts or reactions—exceptions from his model whom he estimated made up 1.5 percent of all males between the ages of 16 and 55 in the U.S. Asexuality was largely absent from scientific research over the subsequent decades, although it was occasionally referenced by activists and scholars in the gay liberation movement.


Here are some quick bullet points:
  • Asexuality is a sexual orientation characterized by a lack of sexual attraction to others.
  • In the past, asexuality was often misunderstood and misdiagnosed as a mental health disorder.
  • Today, asexuality is increasingly recognized as a legitimate sexual orientation.
  • People who identify as asexual may or may not experience sexual attraction, and there is a spectrum of asexuality.
  • Asexual people can face challenges in getting proper medical care, as some healthcare providers may not be familiar with asexuality.

Tuesday, December 5, 2023

On Edge: Understanding and Preventing Young Adults’ Mental Health Challenges

Making Caring Common. (2023).


From the Executive Summary

Our recent data suggests that the young adults of Generation Z are experiencing emotional struggles at alarming rates. While the emotional struggles of teens have been in the national spotlight since the pandemic—and this attention has been vital—according to our nationally representative survey, young adults report roughly twice the rates of anxiety and depression as teens. Compared to 18% of teens, a whopping 36% of young adults in our survey reported anxiety; in contrast to 15% of teens, 29% of young adults reported depression. Far too many young adults report that they feel on edge, lonely, unmoored, directionless, and that they worry about financial security. Many are “achieving to achieve” and find little meaning in either school or work. Yet these struggles of young adults have been largely off the public radar.

From the Press Release:

The report identifies a variety of stressors that may be driving young adults’ high rates of anxiety and
depression. The top drivers of young adults’ mental health challenges include:
  • A lack of meaning, purpose, and direction: Nearly 3 in 5 young adults (58%) reported that they lacked “meaning or purpose” in their lives in the previous month. Half of young adults reported that their mental health was negatively influenced by “not knowing what to do with my life.
  • Financial worries and achievement pressure: More than half of young adults reported that financial worries (56%) and achievement pressure (51%) were negatively impacting their mental health.
  • A perception that the world is unraveling: Forty-five percent (45%) of young adults reported that a general "sense that things are falling apart” was impairing their mental health.
  • Relationship deficits: Forty-four percent (44%) of young adults reported a sense of not mattering to others and 34% reported loneliness.
  • Social and political issues: Forty-two percent (42%) reported the negative influence on their mental health of gun violence in schools, 34% cited climate change, and 30% cited worries that our political leaders are incompetent or corrupt.
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The report also suggests strategies for promoting young adults’ mental health and mitigating their
emotional challenges. These include:
  • Cultivating meaning and purpose in young people, including by engaging them in caring for
  • others and service;
  • Supporting young people in developing gratifying and durable relationships; and
  • Helping young people experience their lives as more than the sum of their achievements.
“We need to do much more to support young adults’ mental health and devote more resources to prevention,” said Kiran Bhai, MCC’s Schools & Parenting Programs Director and a co-author of the
report. “This includes reducing the stressors that young people are facing and helping them develop
the skills they need to thrive.”

Monday, November 13, 2023

Prosociality should be a public health priority

Kubzansky, L.D., Epel, E.S. & Davidson, R.J. 
Nat Hum Behav (2023).
https://doi.org/10.1038/s41562-023-01717-3

Standfirst:

Hopelessness and despair threaten health and longevity. We urgently need strategies to counteract these effects and improve population health. Prosociality contributes to better mental and physical health for individuals, and for the communities in which they live. We propose that prosociality should be a public health priority.

Comment:

The COVID-19 pandemic produced high levels of stress, loneliness, and mental health problems, magnifying global trends in health disparities.1 Hopelessness and despair are growing problems particularly in the U.S. The sharp increase in rates of poor mental health is problematic in its own right, but poor mental health also contributes to greater morbidity and mortality. Without action, we will see steep declines in global population health and related costs to society. An approach that is “more of the same” is insufficient to stem the cascading effects of emotional ill-being. Something new is desperately needed.

To this point, recent work called on the discipline of psychiatry to contribute more meaningfully to the deaths of despair framework (i.e., conceptualizing rises in suicide, drug poisoning and alcoholic liver disease as due to misery of difficult social and economic circumstances).2 Recognizing that simply expanding mental health services cannot address the problem, the authors noted the importance of population-level prevention and targeting macro-level causes for intervention. This requires identifying upstream factors causally related to these deaths. However, factors explaining population health trends are poorly delineated and focus on risks and deficits (e.g., adverse childhood experiences, unemployment). A ‘deficit-based’ approach has limits as the absence of a risk factor does not inevitably indicate presence of a protective asset; we also need an ‘assetbased’ approach to understanding more comprehensively the forces that shape good health and buffer harmful effects of stress and adversity.


My take:

Prosociality refers to positive behaviors and beliefs that benefit others. It is a broad concept that encompasses many different qualities, such as altruism, trust, reciprocity, compassion, and empathy.

Research has shown that prosociality has a number of benefits for both individuals and communities. For individuals, prosociality can lead to improved mental and physical health, greater life satisfaction, and stronger social relationships. For communities, prosociality can lead to increased trust and cooperation, reduced crime rates, and improved overall well-being.

The authors of the article argue that prosociality should be a public health priority. They point out that prosociality can help to address a number of major public health challenges, such as loneliness, social isolation, and mental illness. They also argue that prosociality can help to build stronger communities and create a more just and equitable society.

Saturday, October 21, 2023

Should Trackable Pill Technologies Be Used to Facilitate Adherence Among Patients Without Insight?

Tahir Rahman
AMA J Ethics. 2019;21(4):E332-336.
doi: 10.1001/amajethics.2019.332.

Abstract

Aripiprazole tablets with sensor offer a new wireless trackable form of aripiprazole that represents a clear departure from existing drug delivery systems, routes, or formulations. This tracking technology raises concerns about the ethical treatment of patients with psychosis when it could introduce unintended treatment challenges. The use of “trackable” pills and other “smart” drugs or nanodrugs assumes renewed importance given that physicians are responsible for determining patients’ decision-making capacity. Psychiatrists are uniquely positioned in society to advocate on behalf of vulnerable patients with mental health disorders. The case presented here focuses on guidance for capacity determination and informed consent for such nanodrugs.

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Ethics and Nanodrug Prescribing

Clinicians often struggle with improving treatment adherence in patients with psychosis who lack insight and decision-making capacity, so trackable nanodrugs, even though not proven to improve compliance, are worth considering. At the same time, guidelines are lacking to help clinicians determine which patients are appropriate for trackable nanodrug prescribing. The introduction of an actual tracking device in a patient who suffers from delusions of an imagined tracking device, like Mr A, raises specific ethical concerns. Clinicians have widely accepted the premise that confronting delusions is countertherapeuti The introduction of trackable pill technology could similarly introduce unintended harms. Paul Appelbaum has argued that “with paranoid patients often worried about being monitored or tracked, giving them a pill that does exactly that is an odd approach to treatment. The fear of invasion of privacy might discourage some patients from being compliant with their medical care and thus foster distrust of all psychiatric services. A good therapeutic relationship (often with family, friends, or a guardian involved) is critical to the patient’s engaging in ongoing psychiatric services.

The use of trackable pill technology to improve compliance deserves further scrutiny, as continued reliance on informal, physician determinations of decision-making capacity remain a standard practice. Most patients are not yet accustomed to the idea of ingesting a trackable pill. Therefore, explanation of the intervention must be incorporated into the informed consent process, assuming the patient has decision-making capacity. Since patients may have concerns about the collected data being stored on a device, clinicians might have to answer questions regarding potential breaches of confidentiality. They will also have to contend with clinical implications of acquiring patient treatment compliance data and justifying decisions based on such information. Below is a practical guide to aid clinicians in appropriate use of this technology.

Sunday, October 1, 2023

US Surgeons Are Killing Themselves at an Alarming Rate

Christina Frangou
The Guardian
Originally published 26 Sept 23

Here is an excerpt:

Fifty years ago, in a landmark report called The Sick Physician, the American Medical Association declared physician impairment by psychiatric disorders, alcoholism and drug use a widespread problem. Even then, physicians had rates of narcotic addiction 30 to 100 times higher than the general population, and about 100 doctors a year in the US died by suicide.

The report called for better support for physicians who were struggling with mental health or addictions. Too many doctors hid their ailments because they worried about losing their licenses or the respect of their communities, according to the medical association.

Following the publication, state medical societies in the US, the organizations that give physicians license to practice, created confidential programs to help sick and impaired doctors. Physician health programs have a dual purpose: they connect doctors to treatment, and they assess the physician to ensure that patients are safe in their care. If a doctor’s condition is considered a threat to patient safety, the program may recommend that a doctor immediately cease practice, or they may recommend that a physician undergo drug and alcohol monitoring for three to five years in order to maintain their license. The client must sign an agreement not to participate in patient care until their personal health is addressed.

In rare and extreme cases, the physician health program will report the doctor to the state medical board to revoke their license.


Here is my summary:

The article sheds light on a distressing phenomenon in the United States: an alarming increase in suicide rates among surgeons. It underscores the severity of this issue by featuring a courageous surgeon who has taken the initiative to address it openly. The article suggests that the mental health and well-being of surgeons are under significant strain, potentially due to the demanding nature of their profession, and it calls for greater awareness and support to tackle this growing crisis. The featured surgeon's decision to speak out serves as a poignant reminder of the urgent need to address the mental health challenges faced by medical professionals.

The article underscores the critical issue of high suicide rates among U.S. surgeons, with a particular focus on the brave act of a surgeon who has chosen to raise awareness about this problem. It highlights the pressing need for comprehensive mental health support within the medical community to address the unique stressors that surgeons encounter in their line of work.

Tuesday, September 5, 2023

How does marijuana affect the brain?

Heather Stringer
Monitor on Psychology
Vol. 54, No. 5, p. 20

Here is an excerpt:

Mixing marijuana with mental health issues

Psychologists also share a sense of urgency to clarify how cannabis affects people who suffer from preexisting mental health conditions. Many veterans who suffer from PTSD view cannabis as a safe alternative to other drugs to alleviate their symptoms (Wilkinson, S. T., et al., Psychiatric Quarterly, Vol. 87. No. 1, 2016). To investigate whether marijuana does in fact provide relief for PTSD symptoms, Jane Metrik, PhD, a professor of behavioral and social sciences at the Brown University School of Public Health and a core faculty member at the university’s Center for Alcohol and Addiction Studies, and colleagues followed more than 350 veterans for a year. They found that more frequent cannabis use worsened trauma-related intrusion symptoms—such as upsetting memories and nightmares—over time (Psychological Medicine, Vol. 52, No. 3, 2022). A PTSD diagnosis was also strongly linked with cannabis use disorder a year later. “Cannabis may give temporary relief from PTSD because there is a numbing feeling, but this fades and then people want to use again,” Metrik said. “Cannabis seems to worsen PTSD and lead to greater dependence on the drug.”

Metrik, who also works as a psychologist at the Providence VA Medical Center, has also been studying the effects of using cannabis and alcohol at the same time. “We need to understand whether cannabis can act as a substitute for alcohol or if it leads to heavier drinking,” she said. “What should we tell patients who are in treatment for problem drinking but are unwilling to stop using cannabis? Is some mild cannabis use OK? What types of cannabis formulations are helpful or harmful for people who have alcohol use disorder?”

Though there are still many unanswered questions, Metrik has seen cases that suggest adding cannabis to heavy drinking behavior is risky. Sometimes people can successfully quit drinking but are unable to stop using cannabis, which can also intensify depression and lead to cannabis hyperemesis syndrome—repeated and severe bouts of vomiting that can occur in heavy cannabis users, she said. Cannabis withdrawal symptoms such as irritability, anxiety, increased cravings, aggression, and restlessness usually subside after 1 to 2 weeks of abstinence, but insomnia tends to persist longer than the other symptoms, she said.

Cannabis may also interfere with pharmaceutical medications patients are taking to treat mental health issues. Cannabidiol (CBD) can inhibit the liver enzymes that metabolize medications such as antidepressants and antipsychotics, said Ryan Vandrey, PhD, a professor of psychiatry and behavioral sciences at Johns Hopkins University and president of APA’s Division 28 (Psychopharmacology and Substance Abuse). “This could lead to side effects because the medication is in the body longer and at higher concentrations,” he said. In a recent study, he found that a high dose of oral CBD also inhibited the metabolism of THC, so the impairment and the subjective “high” was significantly stronger and lasted for a longer time (JAMA Network Open, Vol. 6, No. 2, 2023). This contradicts the common conception that high levels of CBD reduce the effects of THC, he said. “This interaction could lead to more adverse events, such as people feeling sedated, dizzy, [or] nervous, or experiencing low blood pressure for longer periods of time,” Vandrey said.

The interactions between CBD, THC, and pharmaceutical medications also depend on the dosing and the route of administration (oral, topical, or inhalation). Vandrey is advocating for more accurate labeling to inform the public about the health risks and benefits of different products. “Cannabis is the only drug approved for therapeutic use through legislative measures rather than clinical trials,” he said. “It’s really challenging for patients and medical providers to know what dose and frequency will be effective for a specific condition.”

Tuesday, August 29, 2023

Yale University settles lawsuit alleging it pressured students with mental health issues to withdraw

Associated Press
Originally posted 25 Aug 23

Yale University and a student group announced Friday that they've reached a settlement in a federal lawsuit that accused the Ivy League school of discriminating against students with mental health disabilities, including pressuring them to withdraw.

Under the agreement, Yale will modify its policies regarding medical leaves of absence, including streamlining the reinstatement process for students who return to campus. The student group, which also represents alumni, had argued the process was onerous, discouraging students for decades from taking medical leave when they needed it most.

The settlement is a “watershed moment” for the university and mental health patients, said 2019 graduate Rishi Mirchandani, a co-founder of Elis for Rachael, the group that sued. It was formed to help students with mental health issues in honor of a Yale student who took her own life.

“This historic settlement affirms that students with mental health needs truly belong," Mirchandani said.

A joint statement from Elis for Rachael and Yale, released on Friday, confirmed the agreement "to resolve a lawsuit filed last November in federal district court related to policies and practices impacting students with mental health disabilities.”

Under the agreement, Yale will allow students to study part-time if they have urgent medical needs. Elis for Rachael said it marks the first time the university has offered such an option. Students granted the accommodation at the beginning of a new term will receive a 50% reduction in tuition.

“Although Yale describes the circumstances for this accommodation as ‘rare,’ this change still represents a consequential departure from the traditional all-or-nothing attitude towards participation in academic life at Yale,” the group said in a statement.

The dean of Yale College, Pericles Lewis, said he was “pleased with today’s outcome.”


The potential good news: The lawsuit against Yale is a step towards ensuring that students with mental health disabilities have the same opportunities as other students. It is also a reminder that colleges and universities have a responsibility to create a supportive environment for all students, regardless of their mental health status.

Monday, July 31, 2023

Top Arkansas psychiatrist accused of falsely imprisoning patients and Medicaid fraud

Laura Strickler & Stephanie Gosk
NBCnews.com
Originally posted July 23, 2023

Here is an excerpt:

The man who led the unit at the time, Dr. Brian Hyatt, was one of the most prominent psychiatrists in Arkansas and the chairman of the board that disciplines physicians. But he’s now under investigation by state and federal authorities who are probing allegations ranging from Medicaid fraud to false imprisonment.

VanWhy’s release marked the second time in two months that a patient was released from Hyatt’s unit only after a sheriff’s deputy showed up with a court order, according to court records.

“I think that they were running a scheme to hold people as long as possible, to bill their insurance as long as possible before kicking them out the door, and then filling the bed with someone else,” said Aaron Cash, a lawyer who represents VanWhy.

VanWhy and at least 25 other former patients have sued Hyatt, alleging that they were held against their will in his unit for days and sometimes weeks. And Arkansas Attorney General Tim Griffin’s office has accused Hyatt of running an insurance scam, claiming to treat patients he rarely saw and then billing Medicaid at “the highest severity code on every patient,” according to a search warrant affidavit.

As the lawsuits piled up, Hyatt remained chairman of the Arkansas State Medical Board. But he resigned from the board in late May after Drug Enforcement Administration agents executed a search warrant at his private practice. 

“I am not resigning because of any wrongdoing on my part but so that the Board may continue its important work without delay or distraction,” he wrote in a letter. “I will continue to defend myself in the proper forum against the false allegations being made against me.”

Northwest Medical Center in Springdale “abruptly terminated” Hyatt’s contract in May 2022, according to the attorney general’s search warrant affidavit. 

In April, the hospital agreed to pay $1.1 million in a settlement with the Arkansas Attorney General’s Office. Northwest Medical Center could not provide sufficient documentation that justified the hospitalization of 246 patients who were held in Hyatt’s unit, according to the attorney general’s office. 

As part of the settlement, the hospital denied any wrongdoing.

Sunday, June 18, 2023

Gender-Affirming Care for Trans Youth Is Neither New nor Experimental: A Timeline and Compilation of Studies

Julia Serano
Medium.com
Originally posted 16 May 23

Trans and gender-diverse people are a pancultural and transhistorical phenomenon. It is widely understood that we, like LGBTQ+ people more generally, arise due to natural variation rather than the result of pathology, modernity, or the latest conspiracy theory.

Gender-affirming healthcare has a long history. The first trans-related surgeries were carried out in the 1910s–1930s (Meyerowitz, 2002, pp. 16–21). While some doctors were supportive early on, most were wary. Throughout the mid-twentieth century, these skeptical doctors subjected trans people to all sorts of alternate treatments — from perpetual psychoanalysis, to aversion and electroshock therapies, to administering assigned-sex-consistent hormones (e.g., testosterone for trans female/feminine people), and so on — but none of them worked. The only treatment that reliably allowed trans people to live happy and healthy lives was allowing them to transition. While doctors were initially worried that many would eventually come to regret that decision, study after study has shown that gender-affirming care has a far lower regret rate (typically around 1 or 2 percent) than virtually any other medical procedure. Given all this, plus the fact that there is no test for being trans (medical, psychological, or otherwise), around the turn of the century, doctors began moving away from strict gatekeeping and toward an informed consent model for trans adults to attain gender-affirming care.

Trans children have always existed — indeed most trans adults can tell you about their trans childhoods. During the twentieth century, while some trans kids did socially transition (Gill-Peterson, 2018), most had their gender identities disaffirmed, either by parents who disbelieved them or by doctors who subjected them to “gender reparative” or “conversion” therapies. The rationale behind the latter was a belief at that time that gender identity was flexible and subject to change during early childhood, but we now know that this is not true (see e.g., Diamond & Sigmundson, 1997; Reiner & Gearhart, 2004). Over the years, it became clear that these conversion efforts were not only ineffective, but they caused real harm — this is why most health professional organizations oppose them today.

Given the harm caused by gender-disaffirming approaches, around the turn of the century, doctors and gender clinics began moving toward what has come to be known as the gender affirmative model — here’s how I briefly described this approach in my 2016 essay Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates:

Rather than being shamed by their families and coerced into gender conformity, these children are given the space to explore their genders. If they consistently, persistently, and insistently identify as a gender other than the one they were assigned at birth, then their identity is respected, and they are given the opportunity to live as a member of that gender. If they remain happy in their identified gender, then they may later be placed on puberty blockers to stave off unwanted bodily changes until they are old enough (often at age sixteen) to make an informed decision about whether or not to hormonally transition. If they change their minds at any point along the way, then they are free to make the appropriate life changes and/or seek out other identities.

Tuesday, May 23, 2023

Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies

Joel, S., Eastwick, P. W., et al. (2020).
PNAS of the United States of America,
117(32), 19061–19071.

Abstract

Given the powerful implications of relationship quality for health and well-being, a central mission of relationship science is explaining why some romantic relationships thrive more than others. This large-scale project used machine learning (i.e., Random Forests) to 1) quantify the extent to which relationship quality is predictable and 2) identify which constructs reliably predict relationship quality. Across 43 dyadic longitudinal datasets from 29 laboratories, the top relationship-specific predictors of relationship quality were perceived-partner commitment, appreciation, sexual satisfaction, perceived-partner satisfaction, and conflict. The top individual-difference predictors were life satisfaction, negative affect, depression, attachment avoidance, and attachment anxiety. Overall, relationship-specific variables predicted up to 45% of variance at baseline, and up to 18% of variance at the end of each study. Individual differences also performed well (21% and 12%, respectively). Actor-reported variables (i.e., own relationship-specific and individual-difference variables) predicted two to four times more variance than partner-reported variables (i.e., the partner’s ratings on those variables). Importantly, individual differences and partner reports had no predictive effects beyond actor-reported relationship-specific variables alone. These findings imply that the sum of all individual differences and partner experiences exert their influence on relationship quality via a person’s own relationship-specific experiences, and effects due to moderation by individual differences and moderation by partner-reports may be quite small. Finally, relationship-quality change (i.e., increases or decreases in relationship quality over the course of a study) was largely unpredictable from any combination of self-report variables. This collective effort should guide future models of relationships.

Significance

What predicts how happy people are with their romantic relationships? Relationship science—an interdisciplinary field spanning psychology, sociology, economics, family studies, and communication—has identified hundreds of variables that purportedly shape romantic relationship quality. The current project used machine learning to directly quantify and compare the predictive power of many such variables among 11,196 romantic couples. People’s own judgments about the relationship itself—such as how satisfied and committed they perceived their partners to be, and how appreciative they felt toward their partners—explained approximately 45% of their current satisfaction. The partner’s judgments did not add information, nor did either person’s personalities or traits. Furthermore, none of these variables could predict whose relationship quality would increase versus decrease over time.

Conclusion

From a public interest standpoint, this study provides provisional answers to the perennial question “What predicts how satisfied and committed I will be with my relationship partner?” Experiencing negative affect, depression, or insecure attachment are surely relationship risk factors. But if people nevertheless manage to establish a relationship characterized by appreciation, sexual satisfaction, and a lack of conflict—and they perceive their partner to be committed and responsive—those individual risk factors may matter little. That is, relationship quality is predictable from a variety of constructs, but some matter more than others, and the most proximal predictors are features that characterize a person’s perception of the relationship itself.

Thursday, March 30, 2023

Institutional Courage Buffers Against Institutional Betrayal, Protects Employee Health, and Fosters Organizational Commitment Following Workplace Sexual Harassment

Smidt, A. M., Adams-Clark, A. A., & Freyd, J. J. (2023).
PLOS ONE, 18(1), e0278830. 
https://doi.org/10.1371/journal.pone.0278830

Abstract

Workplace sexual harassment is associated with negative psychological and physical outcomes. Recent research suggests that harmful institutional responses to reports of wrongdoing–called institutional betrayal—are associated with additional psychological and physical harm. It has been theorized that supportive responses and an institutional climate characterized by transparency and proactiveness—called institutional courage—may buffer against these negative effects. The current study examined the association of institutional betrayal and institutional courage with workplace outcomes and psychological and physical health among employees reporting exposure to workplace sexual harassment. Adults who were employed full-time for at least six months were recruited through Amazon’s Mechanical Turk platform and completed an online survey (N = 805). Of the full sample, 317 participants reported experiences with workplace sexual harassment, and only this subset of participants were included in analyses. We used existing survey instruments and developed the Institutional Courage Questionnaire-Specific to assess individual experiences of institutional courage within the context of workplace sexual harassment. Of participants who experienced workplace sexual harassment, nearly 55% also experienced institutional betrayal, and 76% experienced institutional courage. Results of correlational analyses indicated that institutional betrayal was associated with decreased job satisfaction, organizational commitment, and increased somatic symptoms. Institutional courage was associated with the reverse. Furthermore, results of multiple regression analyses indicated that institutional courage appeared to attenuate negative outcomes. Overall, our results suggest that institutional courage is important in the context of workplace sexual harassment. These results are in line with previous research on institutional betrayal, may inform policies and procedures related to workplace sexual harassment, and provide a starting point for research on institutional courage.

Conclusion

Underlying all research on institutional betrayal and institutional courage is the idea that how one responds to a negative event—whether sexual harassment, sexual assault, and other types of victimization—is often as important or more important for future outcomes as the original event itself. In other words, it’s not only about what happens; it’s also about what happens next. In this study, institutional betrayal and institutional courage appear to have a tangible association with employee workplace and health outcomes. Furthermore, institutional courage appears to attenuate negative outcomes in both the employee workplace and health domains.

While we once again find that institutional betrayal is harmful, this study indicates that institutional courage can buffer against those harms. The ultimate goal of this research is to eliminate institutional betrayal at all levels of institutions by replacing it with institutional courage. The current study provides a starting point to achieving that goal by introducing a new measure of institutional courage to be used in future investigations and by reporting findings that demonstrate the power of institutional courage with respect to workplace sexual harassment.

Sunday, March 12, 2023

Growth of AI in mental health raises fears of its ability to run wild

Sabrina Moreno
Axios.com
Originally posted 9 MAR 23

Here's how it begins:

The rise of AI in mental health care has providers and researchers increasingly concerned over whether glitchy algorithms, privacy gaps and other perils could outweigh the technology's promise and lead to dangerous patient outcomes.

Why it matters: As the Pew Research Center recently found, there's widespread skepticism over whether using AI to diagnose and treat conditions will complicate a worsening mental health crisis.

  • Mental health apps are also proliferating so quickly that regulators are hard-pressed to keep up.
  • The American Psychiatric Association estimates there are more than 10,000 mental health apps circulating on app stores. Nearly all are unapproved.

What's happening: AI-enabled chatbots like Wysa and FDA-approved apps are helping ease a shortage of mental health and substance use counselors.

  • The technology is being deployed to analyze patient conversations and sift through text messages to make recommendations based on what we tell doctors.
  • It's also predicting opioid addiction risk, detecting mental health disorders like depression and could soon design drugs to treat opioid use disorder.

Driving the news: The fear is now concentrated around whether the technology is beginning to cross a line and make clinical decisions, and what the Food and Drug Administration is doing to prevent safety risks to patients.

  • KoKo, a mental health nonprofit, recently used ChatGPT as a mental health counselor for about 4,000 people who weren't aware the answers were generated by AI, sparking criticism from ethicists.
  • Other people are turning to ChatGPT as a personal therapist despite warnings from the platform saying it's not intended to be used for treatment.