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 Depression. Show all posts
Showing posts with label Depression. Show all posts

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, February 4, 2024

Psychoneuroimmunology: An Introduction to Immune-to-Brain Communication and Its Implications for Clinical Psychology

Julienne E. Bower and Kate R. Kuhlman
Annual Review of Clinical Psychology 2023 19:1, 331-359

Abstract

Research conducted over the past several decades has revolutionized our understanding of the role of the immune system in neural and psychological development and function across the life span. Our goal in this review is to introduce this dynamic area of research to a psychological audience and highlight its relevance for clinical psychology. We begin by introducing the basic physiology of immune-to-brain signaling and the neuroimmune network, focusing on inflammation. Drawing from preclinical and clinical research, we then examine effects of immune activation on key psychological domains, including positive and negative valence systems, social processes, cognition, and arousal (fatigue, sleep), as well as links with psychological disorders (depression, posttraumatic stress disorder, anxiety, schizophrenia). We also consider psychosocial stress as a critical modulator of neuroimmune activity and focus on early life adversity. Finally, we highlight psychosocial and mind–body interventions that influence the immune system and may promote neuroimmune resilience.


Here is a summary:

This research delves into the fascinating field of psychoneuroimmunology (PNI), exploring the intricate communication pathways between the brain, behavior, and immune system. It sheds light on how our mental and emotional states can influence our immune response, and vice versa, with profound implications for clinical psychology.

Key Insights:
  • Immune-to-brain communication: Inflammation, a crucial immune response, plays a central role in this dialogue. Immune cells release signaling molecules that reach the brain, impacting mood, cognition, and behavior.
  • Psychosocial stress and immunity: Stress acts as a potent modulator, amplifying inflammation and potentially leading to various physical and mental health issues like depression, anxiety, and even some neurodegenerative disorders.
  • Early life adversity and resilience: Early life experiences can leave lasting impressions on the neuroimmune system, influencing vulnerability or resilience to stress and disease later in life.
  • Implications for clinical psychology: Understanding PNI opens new avenues for intervention. Therapies targeting stress management, mindfulness, and social support could bolster neuroimmune resilience and improve mental health outcomes.
Future Directions:
  • Deciphering the complex mechanisms of immune-to-brain communication, particularly the role of specific molecules and brain regions.
  • Developing PNI-informed interventions for diverse clinical conditions, tailored to individual needs and vulnerabilities.
  • Integrating PNI knowledge into clinical training and practice to offer a more holistic understanding of mental health.

Monday, June 12, 2023

Why some mental health professionals avoid self-care

Dattilio, F. M. (2023).
Journal of Consulting and Clinical Psychology, 
91(5), 251–253.
https://doi.org/10.1037/ccp0000818

Abstract

This article briefly discusses reasons why some mental health professionals are resistant to self-care. These reasons include the savior complex, avoidance, and lack of collegial assiduity. Several proposed solutions are offered.

Here is an excerpt:

Savior Complex

One hypothesis used to explain professionals’ resistance is what some refer to as a “savior complex.” Certain MHPs may be engaging in the cognitive distortion that it is their duty to save as many people from suffering and demise as they can and in turn need to sacrifice their own psychological welfare for those facing distress. MHPs may be skewed in their thinking that they are also invulnerable to psychological and other stressors. Inherent in this distortion is their fear of being viewed as weak or ineffective, and as a result, they overcompensate by attempting to be stronger than others. This type of thinking may also involve a defense mechanism that develops early in their professional lives and emerges during the course of their work in the field. This may stem from preexisting components of their personality dynamics. 

Another reason may be that the extreme rewards that professionals experience from helping others in such a desperate state of need serve as a euphoric experience for them that can be addictive. In essence, the “high” that they obtain from helping others often spurs them on.
Avoidance

Another less complicated explanation for MHPs’ blindness to their own vulnerabilities may be their strong desire to avoid admitting to their own weaknesses and sense of vulnerability. The defense mechanism of rationalization that they are stronger and healthier than everyone else may embolden them to push on even when there are visible signs to others of the stress in their lives that is compromising their functioning. 

Avoidance is also a way of sidestepping the obvious and putting it off until later. This may be coupled with the need that has increased, particularly with the recent pandemic that has intensified the demand for mental health services.

Denial

The dismissal of MHPs’ own needs or what some may term as, “denial” is a deeper aspect that goes hand-in-hand with cognitive distortions that develop with MHPs, but involve a more complex level of blindness to the obvious (Bearse et al., 2013). It may also serve as a way for professionals to devalue their own emotional and psychological challenges. 

Denial may also stem from an underlying fear of being determined as incapacitated or not up to the challenge by their colleagues and thus prohibited from returning to their work or having to face limitations or restrictions. It can sometimes emanate from the fear of being reported as having engaged in unethical behavior by not seeking assistance sooner. This is particularly so with cases of MHPs who have become involved with illicit drug or alcohol abuse or addiction. 

Most ethical principles mandate that MHPs strive to remain cognizant of the potential effects that their work has on their own physical and mental health status while they are in the process of treating others and to recognize when their ability to be effective has been compromised. 

Last, in some cases, MHPs’ denial can even be a response to genuine and accurately perceived expectations in a variety of work contexts where they do not have control over their schedules. This may occur more commonly with facilities or institutions that do not support the disclosure of vulnerability and stress. It is for the aforementioned reasons that the American and Canadian Psychological Associations as well as other mental health organizations have mandated special education on this topic in graduate training programs (American Psychiatric Association, 2013; Maranzan et al., 2018).

Lack of Collegial Assiduity

A final reason may involve a lack of collegial assiduity, where fellow MHPs observe their colleagues enduring signs of stress but fail to confront the individual of concern and alert them to the obvious. It is often very awkward and uncomfortable for a colleague to address this issue and risk rebuke or a negative outcome. As a result, they simply avoid it altogether, thus leaving the issue of concern unaddressed.

The article is paywalled here, which is a complete shame.  We need more access to self-care resources.

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.

Saturday, February 18, 2023

More Physicians Are Experiencing Burnout and Depression

Christine Lehmann
Medscape.com
Originally poste 1 FEB 23

More than half of physicians reported feeling burned out this year and nearly 1 in 4 doctors reported feeling depressed — the highest percentages in 5 years, according to the 'I Cry but No One Cares': Physician Burnout & Depression Report 2023.

"Burnout leaves you feeling like someone you're not," said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.

"When someone is burned out, they experience extreme exhaustion in the workplace, depersonalization, and a sense that their best is no longer good enough. Over time, this may spill into the rest of their lives, affecting their relationships as well as their general health and well-being," said Sánchez.

When feelings of burnout continue without effective interventions, they can lead to depression, anxiety, and more, she said.

Burnout can persist for months to even years — nearly two thirds of doctors surveyed said their burnout lasted for at least 13 months, and another 30% said it lasted for more than 2 years.

The majority of doctors attributed their burnout to too many bureaucratic tasks, although more than one third said it was because their co-workers treated them with a lack of respect.

"This disrespect can take many forms from demeaning comments toward physicians in training to the undermining of a physicians' decade-long education and training to instances of rudeness or incivility in the exam room. Unfortunately, medical professionals can be the source of bad behavior and disrespect. They may be burned out too, and doing their best to work in a broken healthcare system during an extremely difficult time," said Sánchez.

Thursday, February 2, 2023

Yale Changes Mental Health Policies for Students in Crisis

William Wan
The Washington Post
Originally posted 18 JAN 23

Here are some excerpts:

In interviews with The Post, several students — who relied on Yale’s health insurance — described losing access to therapy and health care at the moment they needed it most.

The policy changes announced Wednesday reversed many of those practices.

By allowing students in mental crisis to take a leave of absence rather than withdraw, they will continue to have access to health insurance through Yale, university officials said. They can continue to work as a student employee, meet with career advisers, have access to campus and use library resources.

Finding a way to allow students to retain health insurance required overcoming significant logistical and financial hurdles, Lewis said, since New Haven and Connecticut are where most health providers in Yale’s system are located. But under the new policies, students on leave can switch to “affiliate coverage,” which would cover out-of-network care in other states.

In recent weeks, students and mental advocates questioned why Yale would not allow students struggling with mental health issues to take fewer classes. The new policies will now allow students to drop their course load to as low as two classes under special circumstances. But students can do so only if they require significant time for treatment and if their petition is approved.

In the past, withdrawn students had to submit an application for reinstatement, which included letters of recommendation, and proof they had remained “constructively occupied” during their time away. Under new policies, students returning from a medical leave of absence will submit a “simplified reinstatement request” that includes a letter from their clinician and a personal statement explaining why they left, the treatment they received and why they feel ready to return.

<cut>

In their updated online policies, the university made clear it still retained the right to impose an involuntary medical leave on students in cases of “a significant risk to the student’s health or safety, or to the health or safety of others.”

The changes were announced one day before Yale officials were scheduled to meet for settlement talks with the group of current and former students who filed a proposed class-action lawsuit against the university, demanding policy changes. 

<cut>

In a statement, one of the plaintiffs — a nonprofit group called Elis for Rachael, led by former Yale students — said they are still pushing for more to be done: “We remain in negotiations. We thank Yale for this first step. But if Yale were to receive a grade for its work on mental health, it would be an incomplete at best.”

But after decades of mental health advocacy with little change at the university, some students said they were surprised at the changes Yale has made already.

“I really didn’t think it would happen during my time here,” said Akweley Mazarae Lartey, a senior at Yale who has advocated for mental rights throughout his time at the school. 

“I started thinking of all the situations that I and people I care for have ended up in and how much we could have used these policies sooner.”

Wednesday, November 16, 2022

‘What if Yale finds out?’

William Wan
The Washington Post
Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.
Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

(cut)

In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

Tuesday, July 26, 2022

U.S. drug overdose deaths reached all-time high in 2021, CDC says

Berkeley Lovelace Jr.
NBC.com
Originally posted 11 MAY 22

More than 107,600 Americans died from drug overdoses last year, the highest annual death toll on record, the Centers for Disease Control and Prevention said Wednesday.

Overdose deaths increased 15 percent in 2021, up from an estimated 93,655 fatalities the year prior, according to a report from the CDC’s National Center for Health Statistics (NCHS), which collects data on a range of health topics, including drug use.

While the total number of deaths reached record highs, the increase appeared to slow compared to the change seen from 2019 to 2020, when overdose deaths rose 30 percent, according to the report.

It's still too early to say whether that slowdown will hold, said Farida Ahmad, a scientist at the health statistics center. The agency's latest report is considered provisional, meaning the data is incomplete and subject to change.

Even if the increase in overdose deaths is smaller compared to last year, the 2021 total is still a huge number, Ahmad said.

The data helps illustrate one of the consequences of the pandemic, which has seen an uptick in substance abuse amid widespread unemployment and more Americans reporting mental health issues.

Overdose-related deaths were already increasing before the pandemic, but there was "clearly a very sharp uptick during the pandemic," said Joseph Friedman, an addiction researcher at the University of California, Los Angeles. He published research in April that found drug overdose deaths among teenagers rose sharply over the last two years.

According to the NCHS report, fentanyl, a powerful synthetic opioid, was involved in the most overdose deaths in 2021: 71,238.

Tuesday, May 3, 2022

The Mystifying Rise of Child Suicide

Andrew Solomon
The New Yorker
Originally posted 4 APR 22

Here are two excerpts:

Every suicide creates a vacuum. Those left behind fill it with stories that aspire to rationalize their ultimately unfathomable plight. People may blame themselves or others, cling to small crumbs of comfort, or engage in pitiless self-laceration; many do all this and more. In a year of interviewing the people closest to Trevor, I saw all of these reactions and experienced some of them myself. I came to feel a love for Trevor, which I hadn’t felt when he was alive. The more I understood the depths of his vulnerability, the more I wished that I had encouraged my son, whose relationship with Trevor was often antagonistic, to befriend him. As I interviewed Trevor’s parents, my relationship with them changed. The need to write objectively without increasing their suffering made it more fraught—but it also became deeper and more loving. As the April 6th anniversary of Trevor’s death approached, I started to share their hope that this article would be a kind of memorial to him.

Angela was right that a larger issue is at stake. The average age of suicides has been falling for a long time while the rate of youth suicide has been rising. Between 1950 and 1988, the proportion of adolescents aged between fifteen and nineteen who killed themselves quadrupled. Between 2007 and 2017, the number of children aged ten to fourteen who did so more than doubled. It is extremely difficult to generalize about youth suicide, because the available data are so much sparser and more fragmentary than for adult mental illness, let alone in the broader field of developmental psychology. What studies there are have such varied parameters—of age range, sample size, and a host of demographic factors—as to make collating the information all but impossible. The blizzard of conflicting statistics points to our collective ignorance about an area in which more and better studies are urgently needed. Still, in 2020, according to the Centers for Disease Control and Prevention, in the United States suicide claimed the lives of more than five hundred children between the ages of ten and fourteen, and of six thousand young adults between fifteen and twenty-four. In the former group, it was the second leading cause of death (behind unintentional injury). This makes it as common a cause of death as car crashes.

(cut)

Perhaps the most unsettling aspect of child suicide is its unpredictability. A recent study published in the Journal of Affective Disorders found that about a third of child suicides occur seemingly without warning and without any predictive signs, such as a mental-health diagnosis, though sometimes a retrospective analysis points to signs that were simply missed. Jimmy Potash, the chair of the psychiatry department at Johns Hopkins, told me that a boy who survived a suicide attempt described the suddenness of the impulse: seeing a knife in the kitchen, he thought, I could stab myself with that, and had done so before he had time to think about it. When I spoke to Christine Yu Moutier, who is the chief medical officer at the American Foundation for Suicide Prevention, she told me that, in children, “the moment of acute suicidal urge is very short-lived. It’s almost like the brain can’t keep up that rigid state of narrowed cognition for long.” This may explain why access to means is so important; children living in homes with guns have suicide rates more than four times higher than those of other children.

Sunday, May 1, 2022

Why So Many Middle-Aged Women Are on Antidepressants—Scientists are gaining a better understanding of women’s midlife depression

Andrea Petersen
The Wall Street Journal
Originally posted 2 APR 22

For years, middle-aged women have had some of the country’s highest rates of antidepressant use. Now, scientists are starting to better understand why—and to develop more targeted treatments for women’s midlife depression.

About one in five women ages 40 to 59 and nearly one in four women ages 60 and over used antidepressants in the last 30 days during 2015 to 2018, according to the latest data from the National Center for Health Statistics. 

Among women ages 18 to 39, the figure was about one in 10. 

Among men, 8.4% of those ages 40 to 59 and 12.8% of those 60 and older used antidepressants in the last 30 days, according to the NCHS data.

The figures are drawing increasing attention from scientists and doctors. Many are alarmed at how high depression rates were among midlife women even before the pandemic, now that the past two years have exacerbated mental-health issues for many Americans. 

(cut)

Researchers at NIMH who have been following 90 women since 1988 have found that the incidence of women’s midlife depression is concentrated in the two years before and after the last menstrual period, says Dr. Schmidt. 

The quality of women’s midlife depression is distinct, too, Dr. Schmidt says, in that it often involves intense anxiety, irritability and sleep problems along with the more typical sadness and loss of pleasure in once-enjoyed activities.

Doctors speculate that antidepressant use among middle-aged women is being driven in part by the reluctance of women—and many of their physicians—in recent decades to use hormone-replacement therapy for menopausal symptoms. In 2002, a large study, the Women’s Health Initiative, was stopped after women taking hormone therapy had an increased risk of breast cancer, heart attacks and strokes. 

Later analyses found that the risks were largely concentrated among women who were older when they started hormone therapy. For women in their 50s, hormone therapy actually reduced the risk of heart disease and death from any cause. 

Hormone therapy, either estrogen alone or combined with a progestogen, is the most effective treatment for hot flashes and night sweats, according to the North American Menopause Society and the American College of Obstetricians and Gynecologists. 

Some research has found that it can also improve mood.

Friday, March 18, 2022

Parents think—incorrectly—that teaching their children that the world is a bad place is likely best for them

J. D. W. Clifton & Peter Meindl (2021)
The Journal of Positive Psychology
DOI: 10.1080/17439760.2021.2016907

Primal world beliefs (‘primals’) are beliefs about the world’s basic character, such as the world is dangerous. This article investigates probabilistic assumptions about the value of negative primals (e.g., seeing the world as dangerous keeps me safe). We first show such assumptions are common. For example, among 185 parents, 53% preferred dangerous world beliefs for their children. We then searched for evidence consistent with these intuitions in 3 national samples and 3 local samples of undergraduates, immigrants (African and Korean), and professionals (car salespeople, lawyers, and cops;), examining correlations between primals and eight life outcomes within 48 occupations (total N=4,535) . As predicted, regardless of occupation, more negative primals were almost never associated with better outcomes. Instead, they predicted less success, less job and life satisfaction, worse health, dramatically less flourishing, more negative emotion, more depression, and increased suicide attempts. We discuss why assumptions about the value of negative primals are nevertheless widespread and implications for future research.

From the General Discussion

When might very positive primals be damaging illusions (i.e., associated with negative outcomes)? Study 2 was a big-net search for these contexts. We examined eight outcomes, six samples, 4,535 unique subjects, and 48 occupations (n ≥ 30), including lawyers, doctors, police officers, professors, and so forth. This unearthed 1,860 significant correlations between primals and outcomes, and the overall pattern was clear. In 99.7% of these relationships, more negative primals were associated with worse outcomes, roughly categorized as slightly less job success, moderately less job satisfaction, much less life satisfaction, moderately worse health, much increased frequency of negative emotion and other depression symptoms, dramatically decreased psychological flourishing, and moderately increased likelihood of having attempted suicide. We also found no empirical justification for the popular moderation approach. In 297 of 297 significant differences in outcomes, those who saw the world as somewhat positive always experienced worse outcomes than those who saw the world as very positive. In sum, a robust correlational relationship exists between more negative primals and more negative outcomes, even when comparing positive beliefs to positive beliefs, even when comparing within occupation. The seemingly widespread meta-belief that associates negative primals with positive outcomes is unsupported.


Thursday, March 17, 2022

High rates of burnout among college mental health counselors is compromising quality of care, survey says

Brooke Migdon
thehill.com
Originally posted 17 FEB 22

College counselors and clinicians are reporting increasingly high levels of burnout and stress as the pandemic enters its third year. Experts say it’s going to get worse before it gets better.

Just under 93 percent of clinicians on college campuses reported feeling burned out and stressed during the fall semester this year, according to a survey by Mantra Health, a digital mental health clinic geared at young adults. More than 65 percent of respondents reported a heavier workload and longer hours worked compared to the fall semester in 2020. 

Another 60 percent said their workload had compromised the quality of care they were able to provide to students in the fall.

Caseloads aren’t expected to fall anytime soon, as overworked clinicians are leaving the field at a rate similar to that of students asking for help, according to David Walden, the director of Hamilton College’s counseling center. Qualified candidates are also hard to come by.

“Over the last year college counseling centers have seen an uptick in professionals leaving the field and a smaller pool of applicants to refill their positions while the demand from students seeking treatment continues to rise,” he said Thursday in a statement.

Walden noted that, importantly, clinicians are also contending with their own pandemic anxieties that impact their ability to care for themselves, let alone others.

It is “increasingly difficult for directors and clinicians to avoid burnout while institutions of higher education are having increasing trouble hiring and retaining quality mental health staff,” he said.

With college-aged students reporting alarming rates of depression, anxiety and substance abuse, providing quality on- and off-campus care is critical.

Sunday, November 14, 2021

A brain implant that zaps away negative thoughts

Nicole Karlis
Salon.com
Originally published 14 OCT 21

Here is an excerpt:

Still, the prospect of clinicians manipulating and redirecting one's thoughts, using electricity, raises potential ethical conundrums for researchers — and philosophical conundrums for patients. 

"A person implanted with a closed-loop system to target their depressive episodes could find themselves unable to experience some depressive phenomenology when it is perfectly normal to experience this outcome, such as a funeral," said Frederic Gilbert Ph.D. Senior Lecturer in Ethics at the University of Tasmania, in an email to Salon. "A system program to administer a therapeutic response when detecting a specific biomarker will not capture faithfully the appropriateness of some context; automated invasive systems implanted in the brain might constantly step up in your decision-making . . . as a result, it might compromise you as a freely thinking agent."

Gilbert added there is the potential for misuse — and that raises novel moral questions. 

"There are potential degrees of misuse of some of the neuro-data pumping out of the brain (some believe these neuro-data may be our hidden and secretive thoughts)," Gilbert said. "The possibility of biomarking neuronal activities with AI introduces the plausibility to identify a large range of future applications (e.g. predicting aggressive outburst, addictive impulse, etc). It raises questions about the moral, legal and medical obligations to prevent foreseeable and harmful behaviour."

For these reasons, Gilbert added, it's important "at all costs" to "keep human control in the loop," in both activation and control of one's own neuro-data. 

Monday, November 1, 2021

Social Media and Mental Health

Luca Braghieri, Ro’ee Levy, and Alexey Makarin
Independent Research
August 21

Abstract 

The diffusion of social media coincided with a worsening of mental health conditions among adolescents and young adults in the United States, giving rise to speculation that social media might be detrimental to mental health. In this paper, we provide the first quasi-experimental estimates of the impact of social media on mental health by leveraging a unique natural experiment: the staggered introduction of Facebook across U.S. colleges. Our analysis couples data on student mental health around the years of Facebook’s expansion with a generalized difference-in-differences empirical strategy. We find that the roll-out of Facebook at a college increased symptoms of poor mental health, especially depression, and led to increased utilization of mental healthcare services. We also find that, according to the students’ reports, the decline in mental health translated into worse academic performance. Additional evidence on mechanisms suggests the results are due to Facebook fostering unfavorable social comparisons. 

Discussion 

Implications for social media today 

Our estimates of the effects of social media on mental health rely on quasi-experimental variation in Facebook access among college students around the years 2004 to 2006. Such population and time window are directly relevant to the discussion about the severe worsening of mental health conditions among adolescents and young adults over the last two decades. In this section, we elaborate on the extent to which our findings have the potential to inform our understanding of the effects of social media on mental health today. 

Over the last two decades, Facebook underwent a host of important changes. Such changes include: i) the introduction of a personalized feed where posts are ranked by an algorithm; ii) the growth of Facebook’s user base from U.S. college students to almost three billion active users around the globe (Facebook, 2021); iii) video often replacing images and text; iv) increased usage of Facebook on mobile phones instead of computers; and v) the introduction of Facebook pages for brands, businesses, and organizations. 

The nature of the variation we are exploiting in this paper does not allow us to identify the impact of these features of social media. For example, the introduction of pages, along with other changes, made news consumption on Facebook more common over the last decade than it was at inception. Our estimates cannot shed light on whether the increased reliance on Facebook for news consumption has exacerbated or mitigated the effects of Facebook on mental health. 

Despite these caveats, we believe the estimates presented in this paper are still highly relevant today for two main reasons: first, the mechanisms whereby social media use might affect mental health arguably relate to core features of social media platforms that have been present since inception and that remain integral parts of those platforms today; second, the technological changes undergone by Facebook and related platforms might have amplified rather than mitigated the effect of those mechanisms. 

Friday, July 23, 2021

Women Carry An Undue Mental Health Burden. They Shouldn’t Have To

Rawan Hamadeh
Ms. Magazine
Originally posted 12 June 21

Here is an excerpt:

In developing countries, there is a huge gap in the availability and accessibility of specialized mental health services. Rather than visiting mental health specialists, women are more likely to seek mental health support in primary health care settings while accompanying their children or while attending consultations for other health issues. This leads to many mental health conditions going unidentified and therefore not treated. Often, women do not feel fully comfortable disclosing certain psychological and emotional distress because they fear stigmatization, confidentiality breaches or not being taken seriously.

COVID-19 has put the mental well-being of the entire world at risk. More adults are reporting struggles with mental health and substance use and are experiencing more symptoms of anxiety and depressive disorders. The stressors caused by the pandemic have affected the entire population; however, the effect on women and mothers specifically has been greater.

Women, the unsung heroes of the pandemic, face mounting pressures amid this global health crisis. Reports suggest that the long-term repercussions of COVID-19 could undo decades of progress for women and impose considerable additional burdens on them, threatening the difficult journey toward gender equality.

Unemployment, parenting responsibilities, homeschooling or caring for sick relatives are all additional burdens on women’s daily lives during the pandemic. It’s also important that we acknowledge the exponential need for mental health support for health care workers, and particularly health care mothers, who are juggling both their professional duties and their parenting responsibilities. They are the heroes on the front lines of the fight against the virus, and it’s crucial to prioritize their physical as well as their mental health.

Saturday, July 10, 2021

Is Burnout Depression by Another Name?

Bianchi R, Verkuilen J, Schonfeld IS, et al. 
Clinical Psychological Science. March 2021. 
doi:10.1177/2167702620979597

Abstract

There is no consensus on whether burnout constitutes a depressive condition or an original entity requiring specific medical and legal recognition. In this study, we examined burnout–depression overlap using 14 samples of individuals from various countries and occupational domains (N = 12,417). Meta-analytically pooled disattenuated correlations indicated (a) that exhaustion—burnout’s core—is more closely associated with depressive symptoms than with the other putative dimensions of burnout (detachment and efficacy) and (b) that the exhaustion–depression association is problematically strong from a discriminant validity standpoint (r = .80). The overlap of burnout’s core dimension with depression was further illuminated in 14 exploratory structural equation modeling bifactor analyses. Given their consistency across countries, languages, occupations, measures, and methods, our results offer a solid base of evidence in support of the view that burnout problematically overlaps with depression. We conclude by outlining avenues of research that depart from the use of the burnout construct.

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In essence, the core feature of burnout is depression.  However, burnout is not as debilitating as depression.

Sunday, June 27, 2021

On Top of Everything Else, the Pandemic Messed With Our Morals

Jonathan Moens
The Atlantic
Originally posted 8 June 21

Here is an excerpt:

The core features of moral injury are feelings of betrayal by colleagues, leaders, and institutions who forced people into moral quandaries, says Suzanne Shale, a medical ethicist. As a way to minimize exposure for the entire team, Kathleen Turner and other ICU nurses have had to take on multiple roles: cleaning rooms, conducting blood tests, running neurological exams, and standing in for families who can’t keep patients company. Juggling all those tasks has left Turner feeling abandoned and expendable. “It definitely exposes and highlights the power dynamics within health care of who gets to say ‘No, I'm too high risk; I can't go in that patient's room,’” she said. Kate Dupuis, a clinical neuropsychiatrist and researcher at Canada’s Sheridan College, also felt her moral foundations shaken after Ontario’s decision to shut down schools for in-person learning at the start of the pandemic. The closures have left her worrying about the potential mental-health consequences this will have on her children.

For some people dealing with moral injury right now, the future might hold what is known as “post-traumatic growth,” whereby people’s sense of purpose is reinforced during adverse events, says Victoria Williamson, a researcher who studies moral injury at Oxford University and King’s College London. Last spring, Ahmed Ali, an imam in Brooklyn, New York, felt his moral code violated when dead bodies that were sent to him to perform religious rituals were improperly handled and had blood spilling from detached IV tubes. The experience has invigorated his dedication to helping others in the name of God. “That was a spiritual feeling,” he said.

But moral injury may leave other people feeling befuddled and searching for some way to make sense of a very bad year. If moral injury is left unaddressed, Greenberg said, there’s a real risk that people will develop depression, alcohol misuse, and suicidality. People suffering from moral injury risk retreating into isolation, engaging in self-destructive behaviors, and disconnecting from their friends and family. In the U.K., moral injury among military veterans has been linked to a loss of faith in organized religion. The psychological cost of a traumatic event is largely determined by what happens afterward, meaning that a lack of support from family, friends, and experts who can help people process these events—now that some of us are clawing our way out of the pandemic—could have serious mental-health repercussions. “This phase that we’re in now is actually the phase that’s the most important,” Greenberg said.

Monday, April 5, 2021

Japan has appointed a 'Minister of Loneliness' after seeing suicide rates in the country increase for the first time in 11 years

Kaite Warren
Insider.com
Originally posted 22 Feb 21

Here is an excerpt:

Loneliness has long been an issue in Japan, often discussed alongside "hikikomori," or people who live in extreme social isolation. People have worked to create far-ranging solutions to this issue: Engineers in Japan previously designed a robot to hold someone's hand when they're lonely and one man charges people to "do nothing" except keep them company.

A rise in suicides during the pandemic

During the COVID-19 pandemic in 2020, with people more socially isolated than ever, Japan saw a rise in suicides for the first time in 11 years.

In October, more people died from suicide than had died from COVID-19 in Japan in all of 2020. There were 2,153 suicide deaths that month and 1,765 total virus deaths up to the end of October 2020, per the Japanese National Police Agency. (After a surge in new cases starting in December, Japan has now recorded 7,506 total coronavirus deaths as of February 22.) Studies show that loneliness has been linked to a higher risk of health issues like heart disease, dementia, and eating disorders.

Women in Japan, in particular, have contributed to the uptick in suicides. In October, 879 women died by suicide in Japan — a 70% increase compared to the same month in 2019. 

More and more single women live alone in Japan, but many of them don't have stable employment, Michiko Ueda, a Japanese professor who studies suicide in Japan, told the BBC last week.

"A lot of women are not married anymore," Ueda said. "They have to support their own lives and they don't have permanent jobs. So, when something happens, of course, they are hit very, very hard."

Saturday, February 20, 2021

How ecstasy and psilocybin are shaking up psychiatry

Paul Tullis
Nature.com
Originally posted 27 Jan 21

Here is an excerpt:

Psychedelic-assisted psychotherapy could provide needed options for debilitating mental-health disorders including PTSD, major depressive disorder, alcohol-use disorder, anorexia nervosa and more that kill thousands every year in the United States, and cost billions worldwide in lost productivity.

But the strategies represent a new frontier for regulators. “This is unexplored ground as far as a formally evaluated intervention for a psychiatric disorder,” says Walter Dunn, a psychiatrist at the University of California, Los Angeles, who sometimes advises the US Food and Drug Administration (FDA) on psychiatric drugs. Most drugs that treat depression and anxiety can be picked up at a neighbourhood pharmacy. These new approaches, by contrast, use a powerful substance in a therapeutic setting under the close watch of a trained psychotherapist, and regulators and treatment providers will need to grapple with how to implement that safely.

“The clinical trials that have been reported on depression have been done under highly circumscribed and controlled conditions,” says Bertha Madras, a psychobiologist at Harvard Medical School who is based at McLean Hospital in Belmont, Massachusetts. That will make interpreting results difficult. A treatment might show benefits in a trial because the experience is carefully coordinated, and everyone is well trained. Placebo controls pose another challenge because the drugs have such powerful effects.

And there are risks. In extremely rare instances, psychedelics such as psilocybin and LSD can evoke a lasting psychotic reaction, more often in people with a family history of psychosis. Those with schizophrenia, for example, are excluded from trials involving psychedelics as a result. MDMA, moreover, is an amphetamine derivative, so could come with risks for abuse.

But many researchers are excited. Several trials show dramatic results: in a study published in November 2020, for example, 71% of people who took psilocybin for major depressive disorder showed a greater than 50% reduction in symptoms after four weeks, and half of the participants entered remission1. Some follow-up studies after therapy, although small, have shown lasting benefits2,3.

Friday, January 15, 2021

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Menon NK, Shanafelt TD, Sinsky CA, et al. 
JAMA Netw Open. 2020;3(12):e2028780. 
doi:10.1001/jamanetworkopen.2020.28780

Key Points

Question  Is burnout associated with increased suicidal ideation and self-reported medical errors among physicians after accounting for depression?

Findings  In this cross-sectional study of 1354 US physicians, burnout was significantly associated with increased odds of suicidal ideation before but not after adjusting for depression and with increased odds of self-reported medical errors before and after adjusting for depression. In adjusted models, depression was significantly associated with increased odds of suicidal ideation but not self-reported medical errors.

Meaning  The findings suggest that depression but not burnout is directly associated with suicidal ideation among physicians.

Conclusions and Relevance  The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.