Category Archives: Mental Health
CDC: Induced Births Down for the First Time in Two Decades
The rate for the induction of labor for single births is down for the first time in two decades, according to data from the U.S. Centers for Disease Control and Prevention. While the decrease is small—down to 23.3 percent in 2012 from 23.7 percent in 2011—it is also positive, as induced labor can increase the risk of cesarean section, neonatal infections and neonatal respiratory complications. Induction rates at 38 weeks were also lower for 36 states and the District of Columbia, ranging from a low of 5 percent to as high as 48 percent. Induced labor for non-medical reasons is not recommended before 39 weeks of gestation. Read more on maternal and infant health.
Study: Antidepressant Warnings Linked to Rise in Teen Suicide Attempts
An effort to improve public safety by warning patients about the potential dangers of antidepressants may have had the unintended consequence of actually increasing teen suicide attempts, according to a new study in the journal BMJ. Researchers determined that antidepressant prescriptions for young people dropped approximately 20 percent after the U.S. Food and Drug Administration’s (FDA) 2003 warning mandate. At the same time, teen suicide attempts climbed nearly 22 percent, with researchers pointing to untreated depression as a likely explanation. "To a certain extent, the FDA's black box warning was legitimate, but the media emphasis was really on suicide without noting the potential risk of undertreatment of depression,” said lead author Christine Lu, an instructor in population medicine at the Harvard Pilgrim Health Care Institute in Boston, according to HealthDay. “Because of that, there has been an overreaction, and that overreaction has sent alarming messages to parents and young people.” Read more on mental health.
FDA: Voluntary Recall of Generic High Blood Pressure Medication
India's Dr Reddy's Laboratories Ltd. has begun a voluntary recall of 13,560 bottles of a high blood pressure drug in the United States. The U.S. Food and Drug Administration (FDA) announced that the metoprolol succinate—which is a generic form of AstraZeneca Plc's Toprol XL—failed a dissolution test, which calculates how long it takes a drug’s active ingredient to be released into the body. The recall began on May 23. In March, Dr Reddy's recalled nearly 60,000 bottles of a heartburn drug because of microbial contamination. Read more on prescription drugs.
Study: Public Transportation Policy Often Doesn’t Take Public Health into Account
Many officials and planners continue to ignore public health issues such as air pollution, crime and numerous traffic hazards when designing transportation projects, according to a new study in the Journal of Planning Education and Research. This is especially true for non-white and poor neighborhoods, which often find themselves along major roads, making this a social justice issue, as well. “The public health effects of heavy traffic are broad,” said study author Carolyn McAndrews, PhD, assistant professor at the University of Colorado Denver’s College of Architecture and Planning. “Studies have found associations between high-traffic roads and high mortality rates, lung cancer, cardiovascular disease, respiratory disease, poor birth outcomes and traffic-related injuries.” The study was based on an analysis of Verona Road near Madison, Wisconsin, which can see nearly 60,000 vehicles per day and is in a neighborhood that is home to approximately 2,500 people. Read more on transportation.
CDC Report Finds Up, Downs in Risky Youth Behaviors
The latest Youth Risk Behavior Surveillance System (YRBSS) from the U.S. Centers for Disease Control and Prevention found that while teens are smoking fewer cigarettes and getting into fewer fights, they’re still texting and driving at dangerous rates. The YRBSS—conducted once every two years—monitors an array of risky teen behaviors at the national, state and local levels. It includes data from 42 states and 21 large urban school districts.
Among the findings from the 2013 report:
- Cigarette smoking rates among high school students have dropped to 15.7 percent, meeting the Healthy People 2020 objective of reducing adolescent cigarette use to 16 percent or less
- The percentage of high school students nationwide who had been in a physical fight at least once during the past 12 months decreased from 42 percent in 1991 to 25 percent in 2013
- Fights on school property have been cut in half during the past 20 years, from 16 percent in 1993 to 8 percent in 2013
- 41 percent of students who had driven a car or other vehicle during the past 30 days reported texting or emailing while driving
- The percentage of high school students who are currently sexually active has declined from 38 percent in 1991 to 34 percent in 2013
- Among the high school students who are currently sexually active, condom use also has declined from 63 percent in 2003 to 59 percent in 2013
Read more on pediatrics.
More Active Military Personnel Seeking Mental Health Treatments
The percentage of U.S. military personnel being treated for mental health conditions more than tripled between January 2000 and September 2013, climbing from 1 percent to 3.5 percent, according to a new study in the Medical Surveillance Monthly Report. That comes out to approximately 2,698,903 mental disorder-related treatment courses during the period. In 2012, approximately 232,184 individuals with at least one "initial" mental disorder diagnosis spent a total of 18,348,668 days in mental health disorder treatment. Researchers pointed toward the mental health toll of the terrorist attacks of Sept. 11, 2001, the war in Iraq and the war in Afghanistan—as well as an increased emphasis on getting soldiers who need help into treatment—as they main reasons for the increase. Read more on the military and mental health.
Mental Health Patients with Primary Care Physicians are Better at Managing their Health
Mental health patients who receive primary care from a physician’s office are generally more engaged in the active management of their mental health than are people who rely on outpatient clinics or emergency departments, according to a new study in the journal Health Education & Behavior. Using data from a large nationally representative survey, researchers assessed patient activation among patients diagnosed with depression in relation to variables such as the site of their usual source of care, community characteristics and other demographic characteristics. “Patients with mental disorders are less engaged in their health care than patients with other chronic diseases, so it is important to activate this group,” said Jie Chen, PhD, assistant professor in the department of health services administration at the University of Maryland School of Public Health. “In communities where patient activation is low, such as low-income communities with a large population of foreign-born individuals, there is an even greater need for interventions at mental health care institutions to engage residents in their health.” Read more on mental health.
Study: Low Cost of Food a Contributor to U.S. Obesity Epidemic
One of the driving factors in America’s growing obesity epidemic may very well be the increased access to cheap food, according to a new study. The average American spends only about one-tenth of their disposable income on food, compared to the 1930s, when the rate was about one-quarter. In addition, the average per capita consumption of calories has climbed approximately 20 percent since 1970. “Not only has food been getting cheaper, but it is easier to acquire and easier to prepare,” said Roland Sturm, lead author of the report and a senior economist at RAND, a nonprofit research organization. “It's not just that we may be eating more high-calorie food, but we are eating more of all types of food.” Possible public health solutions for this trend include imposing taxes on foods with low-nutritional value, as well as subsidies or discounts for healthier foods, according to the researchers. Read more on nutrition.
Expensive Co-pays a Barrier for Some Kids to Proper Asthma Treatments
Parents with higher health insurance co-pays report using less expensive asthma drugs, giving their children less medication than prescribed and even putting off doctor visits or trips to the emergency department for the respiratory disorder, according to a new study in the journal JAMA Pediatrics. Approximately 1 in 10 U.S. children suffer from asthma, and the prevalence of the illness is greater in low-income populations. "It is concerning that the children we deal with are sometimes more vulnerable in areas we didn't recognize," said Jefry Biehler, MD, chairman of pediatrics at Miami Children's Hospital in Florida. "We have to be careful that we don't create a void for those families that can't afford all the things they need for their child, but who are above the financial level that gives them government insurance that will provide everything at no or minimal cost.” Read more on pediatrics.
CDC: Many Annual Deaths Are Preventable
Each year, nearly 900,000 Americans die prematurely from the five leading causes of death—yet 20 to 40 percent of the deaths from each cause could be prevented, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke and unintentional injuries. Together they accounted for 63 percent of all U.S. deaths in 2010, with rates for each varying greatly from state to state. The study suggests that if all states had the lowest death rate observed for each cause, it would be possible to prevent:
- 34 percent of premature deaths from heart diseases, prolonging about 92,000 lives
- 21 percent of premature cancer deaths, prolonging about 84,500 lives
- 39 percent of premature deaths from chronic lower respiratory diseases, prolonging about 29,000 lives
- 33 percent of premature stroke deaths, prolonging about 17,000 lives
- 39 percent of premature deaths from unintentional injuries, prolonging about 37,000 lives
Modifiable risk factors such smoking and obesity are largely responsible for each of the leading causes of death, according to the CDC. Many of these risks are avoidable by making changes in personal behaviors, while others are due to social, demographic, environmental, economic and geographic disparities in the neighborhoods in which people live and work. Southeastern states had the highest number of preventable deaths for each of the five causes. The study authors suggest that states with higher rates can look to states with similar populations, but better outcomes, to see what they are doing differently to address leading causes of death. Read more on community health.
Cost of Fighting Wildfires Projected to Skyrocket this Year
The U.S. Department of the Interior (DOI) is projecting that fighting wildfires in 2014 will cost $470 more than is currently available."With climate change contributing to longer and more intense wildfire seasons, the dangers and costs of fighting those fires increase substantially," said DOI Assistant Secretary of Policy, Management and Budget Rhea Suh. Drought conditions in the West, especially in California, combine with other factors to predict a dangerous fire season. Last year, 34 wildfire firefighters died and wildfires burned 4.1 million acres and 1,000 homes. The department would have to divert funds from other programs, which it has previously done. Department officials say climate change is a factor in the increase in wildfires. Read more on the environment.
Starting Antidepressant Treatment at Highest Doses Increases Suicide Risks for Kids and Teens
Children and young adults who start antidepressant therapy at high doses, rather than at the typically prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment, according to a study in JAMA Internal Medicine. The rate of suicidal behavior among children and young adults who started antidepressant therapy at high doses was about twice as high compared with a control group of patients who received a typically prescribed dose. Read more on mental health.
Study: False-Positive Mammograms Have Minimal Effect on Anxiety
Women whose mammograms suggest the presence of breast cancer that is eventually ruled out by further testing experience slightly increased anxiety that does not affect their overall health, according to a new study in the Journal of American Medical Association (JAMA) Internal Medicine. Researchers from the Geisel School of Medicine at Dartmouth College compared 534 cancer-free women whose mammograms initially suggested breast cancer to 494 women whose screenings were negative. The women were interviewed after the first mammogram but before they were cleared of a cancer diagnosis and again a year later. Immediately after their first mammogram, the women who received false-positive results had more anxiety than those who received a clean bill of health but the anxiety leveled off after one year. There was no difference in overall health between the two groups of women. Read more on cancer.
Bullying Victims Feel Psychological Effects into Middle Age
Children who are bullied suffer the psychological affects for years to come, leading to increased risk of depression and other mental health issues, according to a new study in the American Journal of Psychiatry. British researchers have found that children bullied at the ages of 7 and 11 experienced feelings of poor general health at ages 23 and 50 and poor cognitive functioning at 50. The study used surveys that were conducted over 50 years, looking at children who said they were bullied occasionally or frequently at 7 and 11, and comparing the impact at ages 23, 45 and 50. Read more on mental health.
Earth Day: The Impact of the Environment on Health
April 22 is Earth Day and people across the country are taking action to protect and improve our environment. The quality of our environmental has significant effects on our overall health. Air pollution, such as ground-level ozone and airborne particles, can irritate the respiratory system, induce asthma and even lead to lung disease. In addition, UV exposure due to ozone layer depletion can lead to skin cancer, cataracts and suppression of the immune system. Below are tips to help create a healthier planet today:
- Conserve energy and improve air quality by turning off appliances and lights when you leave a room.
- Keep stoves and fireplaces well maintained to reduce air pollution.
- Plant deciduous trees near your home to provide shade from UV rays in the summer.
- Buy energy efficient appliances produced by low- or zero-pollution facilities.
Read more on environment.
Behavioral health was a frequent topic at this year’s Preparedness Summit in Atlanta for both presenters and attendees, who focus on helping people cope with stress during a disaster as well as on mental health conditions which can be exacerbated by the stress of an emergency. Thomas Bornemann, EdD, has been the director of mental health programs at the Carter Center in Atlanta since 2002. The Carter Center is the philanthropic foundation of former president Jimmy Carter and his wife, and focuses primarily on peace and health initiatives globally and in the United States.
NewPublicHealth spoke with Bornemann about the Center’s mental health programs and challenges that lie ahead. We spoke with Bornemann several days before the shooting this week at Fort Hood.
NewPublicHealth: What are the key mental health projects underway at the Carter Center?
Thomas Bornemann: We’re involved in a number of issues at the local level, national level and globally. One of our major global programs is a program in Liberia, West Africa, where we’ve been working on scaling up services in this post-conflict, low-income country. We are in our fourth year of five, and we’re providing three services: We’re training mental health workers because their mental health system was decimated after the war; we have helped them develop a national mental health policy plan and a national mental health law that will go to the legislature for approval this year we hope; and we’ve been working on the issues of stigma and discrimination against people with mental illnesses and helping to develop support for family caregivers who provide the lion’s share of the care.
In the United States we’ve been working for years on Mrs. Carter’s number one healthy policy priority, which has been the implementation of mental health parity legislation which passed in 2008. The U.S. Department of Health and Human Services has been working on final regulations since then which spell out the terms and conditions of parity. We’ve been working on monitoring that through the years, and we were very proud that in November Secretary Kathleen Sebelius came here to announce the release of the regulations out of respect for Mrs. Carter’s long commitment to parity legislation. We’ll continue to monitor the parity efforts as they become implemented through the Affordable Care Act.
HHS: Common Sports Injuries Mean High Costs for People Without Insurance
The ASPE Office of Health Policy, part of the U.S. Department of Health and Human Services (HHS), has released a new issue brief analyzing the incidence and average health care charges associated with common sports injuries. The injuries range from minor sprains and strains to more serious injuries such as broken bones and concussions, where direct medical bills can be significant, placing an especially heavy burden on people without health insurance. Such individuals could be made to pay not just out-of-pocket costs, but also providers’ full stated charges. Breaking down health care costs by age and sometimes gender, the brief found, for example, that the average cost to fix a leg fracture for a person 10-19 years old was $4,689 and for those ages 25-40 was $3,403. Read more on injury prevention.
CDC: Drexel Meningitis Death Linked to Princeton Outbreak
Researchers at the U.S. Centers for Disease Control and Prevention have confirmed through “genetic fingerprinting” that a Drexel University student who died March 10 from meningitis died from the same serogroup B meningococcal strain that previously caused an outbreak at Princeton University. Health department officials confirmed that the Drexel student had been in close contact with Princeton students a week before becoming ill, indicating that the strain may still be present in the Princeton University community. Health officials have already administered antibiotic prophylaxis to prevent additional cases of meningococcal disease in people who had been close to the Drexel student. No new cases have since been reported. Read more on infectious diseases.
Study: ICU Survivors Face Heightened Risk for Mental Health Problems
Critically ill people who survive a stay in a hospital intensive care unit (ICU) are at heightened risk for mental health problems such as depression and anxiety in the following months, according to a new study in the Journal of the American Medical Association. Examining the records of more than 24,000 Danish ICU patients, researchers found that in the three months post-discharge that about 0.5 percent had a new diagnosis—which was 22 times higher than the rate in the general population. Approximately 13 percent received a new prescription for a psychiatric medication, including antidepressants and drugs for anxiety and insomnia, during that period. Researchers said the findings indicate that as doctors become better at saving the lives of critically ill patients, more people will also be at risk for problems beyond their physical health. Read more on mental health.
A recent report from the Institute of Medicine found that young athletes in the United States face a "culture of resistance" to reporting when they might have a concussion and to complying with treatment decisions. That culture can result in students heading back to school too quickly—when they should be resting their brains to prevent short- and long-term complications.
"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chair of the committee and director of the national program office for Aligning Forces for Quality, at George Washington University, Washington, D.C. (Aligning Forces is a program of the Robert Wood Johnson Foundation.) "However,” says Graham, “there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."
Recently, Righttime Medical Care, a chain of urgent care centers in Maryland, opened a number of HeadFirst sports injury and concussion centers in the state, staffed with health professionals who can assess injuries for concussions as well as evaluate students for return to play—in consolation with a team of experts who work with HeadFirst staff. HeadFirst will this year be presenting and publishing data on the more than 10,000 youth it has examined and treated for concussion in just the past two years.
NewPublicHealth recently spoke with Robert Graw, MD, head of Righttime and HeadFirst, about the need for better prevention, evaluation and treatment of concussions to prevent long-term health problems and disability.
NewPublicHealth: Why did Righttime add concussion care to the services provided?
Robert Graw: My son is an orthopedic surgeon and talked to me about the number of injuries he was seeing. We decided a few years ago that we’d learn as much as we could about preventing head injury and the consequences of head injury, and then promote that information through Righttime’s call center and through the visits that people made to our sites.
In the process of learning as much as we could we realized that the knowledge base of how people evaluate and manage concussions had changed drastically in the last five years as people have done more research. So, we then gathered together a group of consultant physicians and neuropsychologists to determine best practices. We met with them frequently, and then had them train our provider staff so that all of them became much more informed about what a concussion really is, the best way to evaluate them and the guidelines for management going forward.
Army, NIH Studies Look at Mental Health Risks, Resilience in U.S. Soldiers
JAMA Psychiatry has released a collection of three articles detailing the findings of a large-scale study of mental health risk and resilience in members of the U.S. Military. Among the findings of The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS):
- The rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed.
- Nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment.
- Soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.
“These studies provide knowledge on suicide risk and potentially protective factors in a military population that can also help us better understand how to prevent suicide in the public at large,” said National Institute of Mental Health (NIMH) Director Thomas R. Insel, M.D.
The emphasis on mental health in the military comes at the same time as a small group of Vietnam veterans has filed suit against the U.S. government, alleging they received other-than-honorable discharges for violations that the psychiatric community and Army now understand were attributable to post-traumatic stress. The veterans say the government has resisted their attempts to upgrade the discharges. Read more on mental health.
NIH: Allergy Prevalence Consistent Across U.S. Regions, Although Type Varies
Allergy prevalence of allergies is consistent across all regions of the United States in every demographic except for children age 5 years and younger, according to a new study from the U.S. National Institutes of Health (NIH). Researchers analyzed blood serum data from approximately 10,000 Americans between 2005 and 2006. “Before this study, if you would have asked 10 allergy specialists if allergy prevalence varied depending on where people live, all 10 of them would have said yes, because allergen exposures tend to be more common in certain regions of the U.S.,” said Darryl Zeldin, MD, scientific director of the National Institute of Environmental Health Sciences (NIEHS), part of NIH, in a release. “This study suggests that people prone to developing allergies are going to develop an allergy to whatever is in their environment. It’s what people become allergic to that differs.” The comprehensive study also examined and outlined risk factors that would make a person more likely to develop an allergy. Read more on the environment.
Study: SNAP for Just 6 Months Increases Kids’ Food Security Significantly
Children in households that participate in the Supplemental Nutrition Assistance Program (SNAP)—previously known as the Food Stamp Program—for just six months experience significant increases in their “food security,” according to a new study in the journal Pediatrics. Food insecurity—or lack of easy access—is tied to a range of health and developmental problems. The study concluded that “SNAP serves a vital role in improving the health and well-being of low-income children by increasing food security” and that “Future research is needed to determine whether specific groups of children experience differential improvements in food security.” SNAP provided assistance to approximately 47 million people in 2013, with about half of those children. Read more on nutrition.
With the passage of the Mental Health Parity Act and the implementation of the Affordable Care Act (ACA), behavioral health experts are pushing to improve the quality of that care so that people seeking help—some for the first time—receive evidence-based care that best suits their individual needs. As part of that conversation, the U.S. Senate Health, Education, Labor and Pension committee held a hearing this week on mental health treatment trends in the United States.
Sen. Tom Harkin (D-Iowa) the committee chair opened the hearing by “pointing to disturbing new trends [including]...significant increases in the prescribing of psychotropic medications, while the use of behavioral and psychological treatments among children and youth has increased only slightly, and has actually decreased among adults.”
According to committee research on recent use of psychotropic drugs, use of antipsychotic medications has increased eight-fold among children and five-fold among adolescents, and has doubled among adults between 1993 and 2009.
The key witness at the hearing was William Cooper, MD, MPH, a professor of pediatrics and health policy at the Vanderbilt University School of Medicine who conducts population-based studies of medication use in children. Cooper told the committee about a nine-year-old boy he treated for weight gain—which turned out to be a side effect of a psychotropic drug the child had been prescribed by a primary care provider given for disturbing the classroom. No mental illness diagnosis had been made for the child, and no mental illness was detected after evaluation at Vanderbilt.
Cooper said that in recent years the United States has seen a tremendous increase in the numbers of children diagnosed with mental health disorders.
“Whether this is a result of increased awareness, improved diagnosis, or other factors is not clearly understood,” said Cooper, who added that “while we must acknowledge that a part of the increase could be due to over-diagnosis, there is no disputing the fact that a large number of children and their families suffer significantly because of mental illness.”
Furthermore, added Cooper, given the fact that suicide is the second leading cause of death for children ages 12-17, “tragic consequences of childhood mental health disorders highlight our sense of urgency in addressing this important problem.”
Cooper added that treating mental health disorders can be challenging and that 50-75 percent of the care for children with mental health disorders occurs in primary care settings “making it critical that consultation and communication between primary care professionals and experts in mental health be enhanced.”
Significantly, Cooper told the panel that despite guidelines, much of the mental health care for children occurs in a manner “inconsistent with optimal practice,” including:
- Use of medications for diagnoses for which there is little evidence of benefit.
- Use of multiple medications at the same time, especially among particularly vulnerable children such as children in foster care, where a recent study found multiple psychiatric medications in up to 75 percent of children being treated.
- Use of medications alone without proven psychotherapies.
Cooper attributed the problems to several factors, among them:
- Many general practice doctors are unaware of current mental health treatment guidelines.
- Inadequate mental health resources to provide best treatments.
- Too few professionals with training in providing mental health care to children.
- Barriers to treatment, including cost or the need to travel long distances.
- Stigma associated with mental illness, which may reduce families’ willingness to acknowledge a mental health disorder and seek treatment.
The HELP committee plans to hold additional hearings to address mental health issues. Other attention to the issues addressed at the hearing include a recent meeting in Washington, D.C. among professionals who conduct psychiatric clinical trials. They stressed the need to involve patients and families more in trial design and access, as well as to work with trial designers on mental health needs not currently being met.
The Substance Abuse and Mental Health Services Administration, a federal agency, recently announced several new funding grants to help individual groups facing mental health concerns including:
- A grant program for residential treatment of pregnant and postpartum women.
- A grant program to expand and sustain comprehensive community mental health services for children and their families, in order to improve behavioral health outcomes for children and youth with serious emotional disturbances, as well as improve the health and well-being of their families.
- A grant program to provide tribal and urban American Indian and Alaskan Native communities with tools and resources to plan and design a holistic, community-based coordinated system of care approach to support mental health and wellness for children, youth and families.
Read more about mental health on NewPublicHealth.