Meta-analysis of risk factors for suicide after psychiatric discharge and meta-regression of the duration of follow-up

Tai, A., Pincham, H., Basu, A., & Large, M. (2025).

The Australian and New Zealand journal of psychiatry,

48674251348372. Advance online publication.

https://doi.org/10.1177/00048674251348372

Abstract

Background: Rates of suicide following discharge from psychiatric hospitals are extraordinarily high in the first week post-discharge and then decline steeply over time. The aim of this meta-analysis is to evaluate the strength of risk factors for suicide after psychiatric discharge and to investigate the association between the strength of risk factors and duration of study follow-up.

Methods: A PROSPERO-registered meta-analysis of observational studies was performed in accordance with PRISMA guidelines. Post-discharge suicide risk factors reported five or more times were synthesised using a random-effects model. Mixed-effects meta-regression was used to examine whether the strength of suicide risk factors could be explained by duration of study follow-up.

Results: Searches located 83 primary studies. From this, 63 risk estimates were meta-analysed. The strongest risk factors were previous self-harm (odds ratio = 2.75, 95% confidence interval = [2.37, 3.19]), suicidal ideation (odds ratio = 2.15, 95% confidence interval = [1.73, 2.68]), depressive symptoms (odds ratio = 1.84, 95% confidence interval = [1.48, 2.30]), and high-risk categorisation (odds ratio = 7.65, 95% confidence interval = [5.48, 10.67]). Significantly protective factors included age ⩽30, age ⩾65, post-traumatic stress disorder, and dementia. The effect sizes for the strongest post-discharge suicide risk factors did not decline over longer periods of follow-up.

Conclusion: The effect sizes of post-discharge suicide risk factors were generally modest, suggesting that clinical risk factors may have limited value in distinguishing between high-risk and low-risk groups. The highly elevated rates of suicide immediately after discharge and their subsequent decline remain unexplained.

Religion, Spirituality, and Suicide

Knapp, S. (2024, September 25).

Society for the Advancement of Psychotherapy.

Article Link is here.

When evaluating suicidal patients, it is often indicated to ask them about their religious beliefs about suicide because many patients believe that their spiritual or religious beliefs1 are closely linked to their mental health (Yamada et al., 2020). For example, some patients in significant emotional distress say they would not kill themselves because their religion strongly condemns it. For them, religion includes a life-protecting belief that prohibits them from attempting suicide.  

Nonetheless, the relationship between religion, spirituality, and suicide goes deeper than just prohibitions against suicide. Instead, religious and spiritual beliefs influence how people care for themselves, interact with others, think about themselves, and interpret their life histories. For example, some people have religious or spiritual beliefs that command them to live their lives productively, express their talents and abilities, and show love for others while experiencing joy. For them, religion includes life-promoting beliefs that encourage them to flourish and thrive. 

The goals for treating suicidal patients are to keep them alive and to help them create lives worth living. While life-protecting beliefs may help keep many patients alive (at least temporarily), life-promoting beliefs help keep patients alive and also help them to create lives worth living. This article suggests ways psychologists can encourage life-promoting beliefs when working with suicidal patients.

The entire article is here.

Here are some thoughts:

The article explores the complex relationship between religious and spiritual beliefs and suicide risk. It highlights that while religious affiliation and spiritual practices can offer protective benefits against suicidal ideation and behavior, the impact varies based on individual experiences and contexts. Positive religious coping mechanisms—such as finding meaning, community support, and hope—are associated with reduced suicide risk. Conversely, negative religious coping, including feelings of punishment or abandonment by a higher power, may exacerbate distress and increase risk. The article emphasizes the importance for mental health professionals to assess and integrate clients' spiritual and religious dimensions into therapy, tailoring interventions to support each individual's unique belief system.

Mental health apps need a complete redesign

Benjamin Kaveladze

Statnews.com

Originally posted 9 Dec 2024

The internet has transformed the ways we access mental health support. Today, anyone with a computer or smartphone can use digital mental health interventions (DMHIs) like Calm for insomnia, PTSD Coach for post-traumatic stress, and Sesame Street’s Breathe, Think, Do with Sesame for anxious kids. Given that most people facing mental illness don’t access professional help through traditional sources like therapists or psychiatrists, DMHIs’ promise to provide effective and trustworthy support globally and equitably is a big deal.

But before consumer DMHIs can transform access to effective support, they must overcome an urgent problem: Most people don’t want to use them. Our best estimate is that 96% of people who download a mental health app will have entirely stopped using it just 15 days later. The field of digital mental health has been trying to tackle this profound engagement problem for years, with little progress. As a result, the wave of pandemic-era excitement and funding for digital mental health is drying up. To advance DMHIs toward their promise of global impact, we need a revolution in these tools’ design.

The article is here.

Here are some thoughts:

This article highlights the critical engagement challenges faced by digital mental health interventions (DMHIs), with 96% of users discontinuing app use within 15 days. This striking statistic points to a need for a fundamental redesign of mental health apps, which currently rely heavily on outdated and conventional approaches reminiscent of 1990s self-help handbooks. The author argues that DMHIs suffer from a lack of creative innovation, as developers have been constrained by traditional therapeutic frameworks, failing to explore the broader potential of technology to effect psychological change.

To address these issues, Kaveladze calls for a radical shift in DMHI design, advocating for the integration of insights from fields like video game design, advertising, and social media content creation. These disciplines excel in engaging users and could provide valuable strategies for creating more appealing and effective mental health tools. This opinion piece also emphasizes the importance of rigorous evaluation processes to ensure new DMHIs are not only effective but also safe, protecting users from potential harms, including privacy breaches and unintended psychological effects.

Psychologists should take note of these concerns and opportunities. When recommending mental health apps to clients, clinicians must critically assess the app's ability to sustain engagement and its adherence to evidence-based practices. Privacy and safety should be paramount considerations, particularly given the sensitive nature of mental health data. Furthermore, psychologists have an essential role to play in guiding the development and evaluation of DMHIs to ensure they meet ethical and clinical standards. Collaborative efforts between clinicians and technology developers could lead to tools that are both innovative and aligned with the needs of diverse populations, including those with limited access to traditional mental health services.

Are Large Language Models More Empathetic than Humans?

Welivita, A., and Pu, P. (2024, June 7).

arXiv.org.

https://arxiv.org/html/2406.05063v1

Abstract

With the emergence of large language models (LLMs), investigating if they can surpass humans in areas such as emotion recognition and empathetic responding has become a focal point of research. This paper presents a comprehensive study exploring the empathetic responding capabilities of four state-of-the-art LLMs: GPT-4, LLaMA-2-70B-Chat, Gemini-1.0-Pro, and Mixtral-8x7B-Instruct in comparison to a human baseline. We engaged 1,000 participants in a between-subjects user study, assessing the empathetic quality of responses generated by humans and the four LLMs to 2,000 emotional dialogue prompts meticulously selected to cover a broad spectrum of 32 distinct positive and negative emotions. Our findings reveal a statistically significant superiority of the empathetic responding capability of LLMs over humans. GPT-4 emerged as the most empathetic, marking ≈31% increase in responses rated as Good compared to the human benchmark. It was followed by LLaMA-2, Mixtral-8x7B, and Gemini-Pro, which showed increases of approximately 24%, 21%, and 10% in Good ratings, respectively. We further analyzed the response ratings at a finer granularity and discovered that some LLMs are significantly better at responding to specific emotions compared to others. The suggested evaluation framework offers a scalable and adaptable approach for assessing the empathy of new LLMs, avoiding the need to replicate this study’s findings in future research.

The research is here.

Here are some thoughts:

The research presents a groundbreaking study exploring the empathetic responding capabilities of large language models (LLMs), specifically comparing GPT-4, LLaMA-2-70B-Chat, Gemini-1.0-Pro, and Mixtral-8x7B-Instruct against human responses. The researchers designed a comprehensive between-subjects user study involving 1,000 participants who evaluated responses to 2,000 emotional dialogue prompts covering 32 distinct emotions.

By utilizing the EmpatheticDialogues dataset, the study meticulously selected dialogue prompts to ensure equal distribution across positive and negative emotional spectrums. The researchers developed a nuanced approach to evaluating empathy, defining it through cognitive, affective, and compassionate components. They provided LLMs with specific instructions emphasizing the multifaceted nature of empathetic communication, which went beyond traditional linguistic proficiency to capture deeper emotional understanding.

The findings revealed statistically significant superiority in LLMs' empathetic responding capabilities. GPT-4 emerged as the most empathetic, demonstrating approximately a 31% increase in responses rated as "Good" compared to the human baseline. Other models like LLaMA-2, Mixtral-8x7B, and Gemini-Pro showed increases of 24%, 21%, and 10% respectively. Notably, the study also discovered that different LLMs exhibited varying capabilities in responding to specific emotions, highlighting the complexity of artificial empathy.

This research represents a significant advancement in understanding AI's potential for nuanced emotional communication, offering a scalable and adaptable framework for assessing empathy in emerging language models.

Assessing Empathy in Large Language Models with Real-World Physician-Patient Interactions

Luo, M., et al. (2024, May 26).

arXiv.org.

https://arxiv.org/abs/2405.16402

Abstract

The integration of Large Language Models (LLMs) into the healthcare domain has the potential to significantly enhance patient care and support through the development of empathetic, patient-facing chatbots. This study investigates an intriguing question Can ChatGPT respond with a greater degree of empathy than those typically offered by physicians? To answer this question, we collect a de-identified dataset of patient messages and physician responses from Mayo Clinic and generate alternative replies using ChatGPT. Our analyses incorporate novel empathy ranking evaluation (EMRank) involving both automated metrics and human assessments to gauge the empathy level of responses. Our findings indicate that LLM-powered chatbots have the potential to surpass human physicians in delivering empathetic communication, suggesting a promising avenue for enhancing patient care and reducing professional burnout. The study not only highlights the importance of empathy in patient interactions but also proposes a set of effective automatic empathy ranking metrics, paving the way for the broader adoption of LLMs in healthcare.

A preprint is here.

Here are some thoughts:

The research explores an innovative approach to assessing empathy in healthcare communication by comparing responses from physicians and ChatGPT, a large language model (LLM). The study focuses on prostate cancer patient interactions, utilizing a real-world dataset from Mayo Clinic to investigate whether AI-powered chatbots can potentially deliver more empathetic responses than human physicians.

The researchers developed a novel methodology called EMRank, which employs multiple evaluation techniques to measure empathy. This approach includes both automated metrics using LLaMA (another language model) and human assessments. By using zero-shot, one-shot, and few-shot learning strategies, they created a flexible framework for ranking empathetic communication that could be generalized across different healthcare domains.

Key findings suggest that LLM-powered chatbots like ChatGPT have significant potential to surpass human physicians in delivering empathetic communication. The study's unique contributions include using real patient data, developing innovative automatic empathy ranking metrics, and incorporating patient evaluations to validate the assessment methods. By demonstrating the capability of AI to generate compassionate responses, the research opens new avenues for enhancing patient care and potentially reducing professional burnout among healthcare providers.

The methodology carefully addressed privacy concerns by de-identifying patient and physician information, and controlled for response length to ensure a fair comparison. Ultimately, the study represents a promising step towards integrating artificial intelligence into healthcare communication, highlighting the potential of LLMs to provide supportive, empathetic interactions in medical contexts.

Is suicide a mental health, public health or societal problem?

Goel, D., Dennis, B., & McKenzie, S. K. (2023).

Current Opinion in Psychiatry, 36(5), 352–359.

https://doi.org/10.1097/yco.0000000000000888

Abstract

Purpose of review 

Suicide is a complex phenomenon wherein multiple parameters intersect: psychological, medical, moral, religious, social, economic and political. Over the decades, however, it has been increasingly and almost exclusively come to be viewed through a biomedical prism. Colonized thus by health and more specifically mental health professionals, alternative and complimentary approaches have been excluded from the discourse. The review questions many basic premises, which have been taken as given in this context, particularly the ‘90 percent statistic’ derived from methodologically flawed psychological autopsy studies.

Recent findings

An alternative perspective posits that suicide is a societal problem which has been expropriated by health professionals, with little to show for the efficacy of public health interventions such as national suicide prevention plans, which continue to be ritually rolled out despite a consistent record of repeated failures. This view is supported by macro-level data from studies across national borders.

Summary

The current framing of suicide as a public health and mental health problem, amenable to biomedical interventions has stifled seminal discourse on the subject. We need to jettison this tunnel vision and move on to a more inclusive approach.

A pdf can be found here.

Here are some thoughts.

This article challenges the prevailing view of suicide as primarily a mental health issue, arguing instead that it's a complex societal problem. The authors criticize the methodological flaws in psychological autopsy studies, which underpin the widely cited "90 percent statistic" linking suicide to mental illness. They contend that focusing solely on biomedical interventions and risk assessment has been ineffective and that a more inclusive approach, considering socioeconomic factors and alternative perspectives like critical suicidology, is necessary. The paper supports its argument with data from various countries, highlighting the disconnect between suicide rates and access to mental healthcare. Ultimately, the authors call for a shift in perspective to address the societal roots of suicide.

Suicide-related emergencies underdetected among minority, male youth, and preteens, study finds

Will Houston

UCLA Health

Originally poste 29 OCT 24

A new study by UCLA Health reveals that hospital emergency departments may be missing signs of suicidal thoughts and behaviors in children, boys and Black and Hispanic youth. 

The research(Link is external) (Link opens in new window), published in the journal JAMA Open Network, analyzed electronic health records of nearly 3,000 children and teenagers presenting to two emergency departments in southern California for mental health reasons. Using machine learning algorithms, the researchers determined standard medical record surveillance methods miss youth with suicide-related emergencies. These methods disproportionately missed suicide-related visits among Black, Hispanic, male, and preteen youths, compared with other races and ethnicities, female youths, and adolescents. 

“Existing methods are missing kids, and not missing them at random,” said Dr. Juliet Edgcomb(Link opens in new window), study corresponding author, associate director of the UCLA Health Semel Institute for Mental Health Informatics and Data Science Hub(Link is external) (Link opens in new window) and assistant professor-in-residence in the UCLA Health Department of Psychiatry. “Without accurate and equitable detection of suicide-related emergencies, it is difficult for suicide prevention strategies to help the populations they aim to serve.” 

Here is the article.

Here is the research article.

Here are some thoughts:

A recent study by UCLA Health researchers found that emergency departments are not effectively identifying children and teenagers who are experiencing suicidal thoughts and behaviors. The study, which analyzed electronic health records of nearly 3,000 young patients, revealed that current methods for detecting suicidality are inadequate and disproportionately miss suicidal emergencies among minority youth, preteen youth, and boys. The study highlights the need for improved detection methods, particularly those incorporating artificial intelligence, to better address this growing mental health crisis and ensure that all youth at risk receive appropriate care.

A Call to Address AI “Hallucinations” and How Healthcare Professionals Can Mitigate Their Risks

Hatem, R., Simmons, B., & Thornton, J. E. (2023).

Cureus, 15(9), e44720.

https://doi.org/10.7759/cureus.44720

Abstract

Artificial intelligence (AI) has transformed society in many ways. AI in medicine has the potential to improve medical care and reduce healthcare professional burnout but we must be cautious of a phenomenon termed "AI hallucinations"and how this term can lead to the stigmatization of AI systems and persons who experience hallucinations. We believe the term "AI misinformation" to be more appropriate and avoids contributing to stigmatization. Healthcare professionals can play an important role in AI’s integration into medicine, especially regarding mental health services, so it is important that we continue to critically evaluate AI systems as they emerge.

The article is linked above.

Here are some thoughts:

In the rapidly evolving landscape of artificial intelligence, the phenomenon of AI inaccuracies—whether termed "hallucinations" or "misinformation"—represents a critical challenge that demands nuanced understanding and responsible management. While technological advancements are progressively reducing the frequency of these errors, with detection algorithms now capable of identifying inaccuracies with nearly 80% accuracy, the underlying issue remains complex and multifaceted.

The ethical implications of AI inaccuracies are profound, particularly in high-stakes domains like healthcare and legal services. Professionals must approach AI tools with a critical eye, understanding that these technologies are sophisticated assistants rather than infallible oracles. The responsibility lies not just with AI developers, but with users who must exercise judgment, validate outputs, and recognize the inherent limitations of current AI systems.

Ultimately, the journey toward more accurate AI is ongoing, requiring continuous learning, adaptation, and a commitment to ethical principles that prioritize human well-being and intellectual integrity. As AI becomes increasingly integrated into our professional and personal lives, our approach must be characterized by curiosity, critical thinking, and a deep respect for the complex interplay between human intelligence and artificial systems.

3% of US high schoolers identify as transgender, CDC survey shows

Kiara Alfonseca

abcnews.go.com

Originally posted 8 OCT 24

A first-of-its-kind survey has found that 3.3% of U.S. high school students identified as transgender in 2023, with another 2.2% identified as questioning.

The first nationally representative survey from the U.S. Centers for Disease Control and Prevention also highlights the multiple health disparities faced by transgender students who may experience gender dysphoria, stigma, discrimination, social marginalization or violence because they do not conform to social expectations of gender, the CDC reports.

These stressors increase the likelihood transgender youth and those who are questioning may experience mental health challenges, leading to disparities in health and well-being, according to the health agency.

Here are some of the findings:

More than a quarter (26%) of transgender and questioning students attempted suicide in the past year, compared to 5% of cisgender male and 11% of cisgender female students. The CDC urged schools to "create safer and more supportive environments for transgender and questioning students" to address these disparities, including inclusive activities, mental health and other health service referrals, and implementing policies that are LGBTQ-inclusive.

The info is here.

The CDC study is here.

Here are some thoughts:

Recent national data reveals that 3.3% of U.S. high school students identify as transgender, with an additional 2.2% questioning their gender identity. This groundbreaking study highlights significant disparities in the experiences of transgender and questioning youth compared to their cisgender peers. These students face higher rates of violence, discrimination, and mental health challenges, with approximately 25% skipping school due to safety concerns and 40% experiencing bullying. Alarmingly, 69-72% of transgender and questioning students report persistent feelings of sadness or hopelessness, and about 26% have attempted suicide in the past year. Additionally, transgender students are more likely to experience unstable housing, with 10.7% facing this challenge.

These disparities can be understood through the lens of Minority Stress Theory and the Gender Minority Stress Framework, which highlight how stigma, discrimination, and social marginalization contribute to poor outcomes. However, protective factors such as supportive families and peers, school connectedness, affirmed name and pronoun use, and a sense of pride in identity can buffer against these stressors and promote better mental health.

Given these findings, it is crucial for psychologists to develop multicultural competence to effectively support transgender and questioning youth. This includes enhancing knowledge about the unique challenges faced by this population, developing awareness of personal biases and societal stigma, and honing skills to create affirming environments and use appropriate interventions. Psychologists should also advocate for inclusive policies, consider intersectionality, engage with families, provide trauma-informed care, and collaborate with schools and community organizations. By enhancing multicultural competence, psychologists can play a vital role in improving outcomes and promoting resilience among transgender and questioning youth, addressing the urgent need for culturally sensitive and effective mental health support for this vulnerable population.

Death threats, legal risk and backlogs weigh on clinicians treating trans minors

Emma Davis

NBC news

Originally posted 28 August 24

Dr. Kade Goepferd has received death threats for their work treating transgender youths at Children’s Minnesota Hospital, but Goepferd said the harassment isn’t the most worrying part of the job. 

“The waitlist is what keeps me up at night,” said Goepferd, who uses they/them pronouns. “It has grown every year, and it got particularly long after the bans went into effect.”

Goepferd is the medical director of the hospital’s Gender Health Program, the only multispeciality pediatric gender clinic in Minnesota. The program has experienced a 30% increase in calls since surrounding states outlawed gender-affirming care for minors, and the waitlist is now at least a year for new patients, even after Goepferd hired additional staff to help the hundreds of trans youths requesting appointments.

Twenty-six states now have restrictions on transgender health care for minors, according to the LGBTQ think tank Movement Advancement Project. The laws have left those still able to provide this type of care, like Goepferd, struggling to keep up with demand.

NBC News spoke to a dozen clinicians in states where gender-affirming care for minors remains legal, from Connecticut to California, and found all are treating transgender youths fleeing bans. Not only does the surge in out-of-state and newly relocated patients create logistical challenges — from waitlists to insurance denials — it also presents a legal risk for health care professionals. Although some states have enacted protections for gender-affirming care providers, these shield laws remain untested in court, and they have done little to deter anti-trans attacks. Many doctors said they’ve had to take added security measures as transphobic rhetoric has intensified.

“There’s been a growing awareness over the last year that the environment is only getting more and more dangerous for providers,” said Kellan Baker, executive director of the Whitman-Walker Institute, a nonprofit advancing LGBTQ health care.

The info is here.

Here are some thoughts:

The situation described in this article raises significant concerns across multiple domains. The long waitlists and limited availability of gender-affirming care pose serious ethical issues, conflicting with the principle of beneficence in medical ethics and potentially exacerbating mental health issues among transgender youth.

The threats and harassment faced by healthcare providers not only raise concerns about their safety and wellbeing but also could deter professionals from offering essential care. The legal ambiguity surrounding gender-affirming care in different states puts providers in a difficult position, forcing them to navigate between professional judgment and legal risks. This hostile environment, combined with the constant legal uncertainties, is likely causing significant stress and burnout among healthcare providers, which could impact the quality of care they're able to provide.

The healthcare system itself faces numerous challenges, including strained resources due to the influx of out-of-state patients, insurance and cost barriers creating healthcare equity issues, and limitations on training opportunities for new providers potentially leading to future workforce shortages. These issues reflect broader societal concerns, including the politicization of healthcare and potential discrimination against transgender individuals, raising civil rights concerns.

The current state of transgender rights presents a complex interplay of ethical, psychological, and systemic challenges that require careful consideration and balanced approaches to ensure both patient care and provider safety. Moving forward, it will be crucial for policymakers, healthcare professionals, and society at large to engage in thoughtful dialogue and evidence-based decision-making to address these multifaceted issues.

Decoding loneliness: Can explainable AI help in understanding language differences in lonely older adults?

Wang, N., et al. (2024).

Psychiatry research, 339, 116078.

https://doi.org/10.1016/j.psychres.2024.116078

Abstract

Study objectives

Loneliness impacts the health of many older adults, yet effective and targeted interventions are lacking. Compared to surveys, speech data can capture the personalized experience of loneliness. In this proof-of-concept study, we used Natural Language Processing to extract novel linguistic features and AI approaches to identify linguistic features that distinguish lonely adults from non-lonely adults.

Methods

Participants completed UCLA loneliness scales and semi-structured interviews (sections: social relationships, loneliness, successful aging, meaning/purpose in life, wisdom, technology and successful aging). We used the Linguistic Inquiry and Word Count (LIWC-22) program to analyze linguistic features and built a classifier to predict loneliness. Each interview section was analyzed using an explainable AI (XAI) model to classify loneliness.

Results

The sample included 97 older adults (age 66–101 years, 65 % women). The model had high accuracy (Accuracy: 0.889, AUC: 0.8), precision (F1: 0.8), and recall (1.0). The sections on social relationships and loneliness were most important for classifying loneliness. Social themes, conversational fillers, and pronoun usage were important features for classifying loneliness.

Conclusions

XAI approaches can be used to detect loneliness through the analyses of unstructured speech and to better understand the experience of loneliness.

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Here are some thoughts.  AI has the potential to be helpful for mental health professionals.

Scientists have made a groundbreaking discovery in detecting loneliness through artificial intelligence (AI). A recent study published reveals that AI can identify loneliness by analyzing unstructured speech patterns. This innovative approach offers a promising solution for addressing loneliness, particularly among older adults.

The analysis showed that lonely individuals frequently referenced social status, religion, and expressed more negative emotions. In contrast, non-lonely individuals focused on social connections, family, and lifestyle. Additionally, lonely individuals used more first-person singular pronouns, indicating a self-focused perspective, whereas non-lonely individuals used more first-person plural pronouns, suggesting a sense of inclusion and connection.

Furthermore, the study found that conversational fillers, non-fluencies, and internet slang were more prevalent in the speech of lonely individuals. Lonely individuals also used more causation conjunctions, indicating a tendency to provide detailed explanations of their experiences. These findings suggest that the way people communicate may reflect their feelings about social relationships.

The AI model offers a scalable and less intrusive method for assessing loneliness, which can significantly impact mental and physical health, particularly in older adults. While the study has limitations, including a relatively small sample size, the researchers aim to expand their work to more diverse populations and explore how to better assess loneliness.

FDA Clears the First Digital Therapeutic for Depression, But Will Payers Cover It?

Frank Vinluan

MedCityNews.com

Originally posted 1 April 24

A software app that modifies behavior through a series of lessons and exercises has received FDA clearance for treating patients with major depressive disorder, making it the first prescription digital therapeutic for this indication.

The product, known as CT-152 during its development by partners Otsuka Pharmaceutical and Click Therapeutics, will be commercialized under the brand name Rejoyn.

Rejoyn is an alternative way to offer cognitive behavioral therapy, a type of talk therapy in which a patient works with a clinician in a series of in-person sessions. In Rejoyn, the cognitive behavioral therapy lessons, exercises, and reminders are digitized. The treatment is intended for use three times weekly for six weeks, though lessons may be revisited for an additional four weeks. The app was initially developed by Click Therapeutics, a startup that develops apps that use exercises and tasks to retrain and rewire the brain. In 2019, Otsuka and Click announced a collaboration in which the Japanese pharma company would fully fund development of the depression app.

The information is here.

Here is a quick summary:

Rejoyn is the first prescription digital therapeutic (PDT) authorized by the FDA for the adjunctive treatment of major depressive disorder (MDD) symptoms in adults. 

Rejoyn is a 6-week remote treatment program that combines clinically-validated cognitive emotional training exercises and brief therapeutic lessons to help enhance cognitive control of emotions. The app aims to improve connections in the brain regions affected by depression, allowing the areas responsible for processing and regulating emotions to work better together and reduce MDD symptoms. 

The FDA clearance for Rejoyn was based on data from a 13-week pivotal clinical trial that compared the app to a sham control app in 386 participants aged 22-64 with MDD who were taking antidepressants. The study found that Rejoyn users showed a statistically significant improvement in depression symptom severity compared to the control group, as measured by clinician-reported and patient-reported scales. No adverse effects were observed during the trial. 

Rejoyn is expected to be available for download on iOS and Android devices in the second half of 2024. It represents a novel, clinically-validated digital therapeutic option that can be used as an adjunct to traditional MDD treatments under the guidance of healthcare providers.

From a Psych Hospital to Harvard Law: One Black Woman’s Journey With Bipolar Disorder

Krista L. R. Cezair

Ms. Magazine

Originally posted 22 Feb 24

Here is an excerpt:

In the spring of 2018, I was so sick that I simply couldn’t consider my future performance on the bar exam. I desperately needed help. I had very little insight into my condition and had to be involuntarily hospitalized twice. I also had to make the decision of which law school to attend between trips to the psych ward while ragingly manic. I relied on my mother and a former professor who essentially told me I would be attending Harvard. Knowing my reduced capacity for decision‐making while manic, I did not put up a fight and informed Harvard that I would be attending. The next question was: When? Everyone in my community supported me in my decision to defer law school for a year to give myself time to recover—but would Harvard do the same?

Luckily, the answer was yes, and that fall, the fall of 2018, as my admitted class began school, I was admitted to the hospital again, for bipolar depression this time.

While there, I roomed with a sweet young woman of color who was diagnosed with schizophrenia, bipolar disorder and PTSD and was pregnant with her second child. She was unhoused and had nowhere to go should she be discharged from the hospital, which the hospital threatened to do because she refused medication. She worried that the drugs would harm her unborn child. She was out of options, and the hospital was firm. She was released before me. I wondered where she would go. She had expressed to me multiple times that she had nowhere to go, not her parents’ house, not the child’s father’s house, nowhere.

It was then that I decided I had to fight—for her and for myself. I had access to resources she couldn’t dream of, least of all shelter and a support system. I had to use these resources to get better and embark on a career that would make life better for people like her, like us.

After getting out of the hospital, I started to improve, and I could tell the depression was lifting. Unfortunately, a rockier rock bottom lay ahead of me as I started to feel too good, and the depression lifted too high. Recovery is not linear, and it seemed I was manic again.

The info is here.

Here are some thoughts:

In this powerful piece, Krista L. R. Cezair candidly shares her journey navigating bipolar disorder while achieving remarkable academic and professional success. She begins by describing her history of depression and suicidal thoughts, highlighting the pivotal moment of diagnosis and the challenges within mental health care facilities, particularly for marginalized groups. Cezair eloquently connects her personal experience with broader issues of systemic bias and lack of understanding around mental health, especially within prestigious institutions like Harvard Law School. Her article advocates for destigmatizing mental health struggles and recognizing the resilience and contributions of those living with mental illness.

Biden just signed the largest executive order focused on women’s health

Jennifer Gerson

GovExec.com

Originally posted 19 March 24

President Joe Biden on Monday signed an executive order directing the most comprehensive set of actions ever taken by the president’s office to expand and improve research on women’s health. In a statement, the president and First Lady Jill Biden also announced more than 20 new actions and commitments by a wide range of federal agencies for research on issues that emerge across a woman’s lifespan, from maternal health outcomes and mental health challenges to autoimmune diseases and menopause. 

The announcement follows the November creation of the White House Initiative on Women’s Health Research, led by Jill Biden and the White House Gender Policy Council. Currently, the National Institutes of Health (NIH) spends only 10.8% of its overall funding on women’s health research, a figure that includes conditions specific to women and those that predominantly affect women. 

Congress first ordered the NIH to include women in clinical trials in 1993; in 2016, the NIH strengthened its own standards so that its grantees must justify if women are not included in any specific clinical trial and explain how any effects on women will be studied and analyzed. Monday’s announcement seeks to ensure that this same kind of accountability is applied to every federal research program. 

Jennifer Klein, director of the White House Gender Policy Council, told The 19th that with Monday’s announcement, the Biden administration is seeking to close existing research gaps when it comes to women’s health so that women’s experiences with the health care system can be changed for the better. 

The info is here.

Here is my summary:

President Joe Biden recently signed a significant executive order focused on women's health, marking a historic move towards advancing women's healthcare research. The order includes over 20 new actions and commitments across various federal agencies, aiming to address research gaps in women's health. Key components of the order involve prioritizing women's health research, strengthening data standards, focusing on midlife health issues like heart attacks and Alzheimer's disease, and enhancing accountability in federal research programs. This initiative also emphasizes the importance of understanding conditions that uniquely affect women, such as endometriosis and menopause. Additionally, the order directs efforts towards addressing tribal beliefs related to menopause, improving mental health services for women, and conducting new research on nutritional needs. Biden's executive order underscores a comprehensive approach to women's health beyond reproductive care, highlighting the need for increased funding and research in areas where women have been historically underrepresented.

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.

The info is here.

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.

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

Hailu, R., Huskamp, H. A., et al. (2024).

JAMA, 5(1), e234982. 

https://doi.org/10.1001/jamahealthforum.2023.4982

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.

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.

The research is here.

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.

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."

The info is here.

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.

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.

The info is here.

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.

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

Making Caring Common. (2023).

https://mcc.gse.harvard.edu/reports/on-edge

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.

(cut)

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.”