Category Archives: Mental Health
Cold Winter Raises Concerns about Energy Insecurity
A new brief by researchers at the Mailman School of Public Health at Columbia University looks at energy insecurity (EI), which is measured by the proportion of household energy expenditures relative to household income. EI tends to impact low-income families in part because they often live in older homes and apartments that haven’t been constructed to conserve heat.
Key findings of the brief include:
- More than half of families affected by economic EI are living in poverty (below 100 percent of the federal poverty level) and about one third are extremely poor.
- Approximately half of all households facing economic EI are black/African-American and about one-third are white.
- Geographically, the largest proportion (46 percent) of children in households with economic EI resides in the South.
- Over half of families with economic EI are renters; 41 percent are homeowners.
According to the Mailman researchers, the main safety net program for EI, the Low-Income Home Energy Assistance Program (LIHEAP), covers only a fraction of the overall need. Of the estimated 10-15 million homes eligible for benefits in 2012, 5.5 million received assistance for reasons such as lack of awareness by people who could benefit and program budget cuts. Read more on poverty.
Many Adults with Depression Symptoms Have Not Consulted a Professional
A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) finds that close to 40 percent of the 15 million American adults who experienced a major depressive episode in the past year did not talk to a counselor or health provider. A major depressive episode is defined as a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of seven additional symptoms reflecting the criteria as described in the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of the Mental Disorders (DSM-IV). “This report shows that too many Americans still needlessly suffer in silence instead of reaching out to providers for help in getting them on the road to recovery through effective treatment and supports,” said Paolo del Vecchio, the director of SAMHSA’s Center for Mental Health Services. “We are raising awareness about the hope for recovery from these conditions, helping communities identify their behavioral health needs, and increasing education about access to treatment for all Americans through the Affordable Care Act and the new parity protections for insurance coverage.” Read more about mental health.
EPA Proposes New Safety Measures to Protect Farm Workers from Pesticide Exposure
The U.S. Environmental Protection Agency (EPA) has announced proposed revisions to the Worker Protection Standard to protect the nation’s two million farm workers and their families from pesticide exposure. The EPA is proposing significant improvements to worker training regarding the safe usage of pesticides, including how to prevent and effectively treat pesticide exposure. Increased training and signage will inform farm workers about their protections under the law. The EPA has also proposed that children under 16 be legally barred from handling all pesticides, with an exemption for family farms. The revisions are based on more than a decade of extensive stakeholder input by federal and state partners and from across the agricultural community including farm workers, farmers and industry. Read more on the Environmental Protection Agency.
IOM Report: More Evidence-Based Practices Needed to Help Treat and Prevent Psychological Disorders among Service Members and Families
Between 2000 and 2011, almost 1 million service members or former service members were diagnosed with at least one psychological disorder either during or after deployment, according to recent research by the Institute of Medicine (IOM). As a follow up, the U.S. Department of Defense (DOD) asked the IOM to evaluate the department’s efforts to prevent psychological disorders among active-duty service members and their families. That report was recently released.
The report includes recommendations on how the DOD can improve care.
Finding 1: DOD has implemented numerous resilience and prevention programs for service members and their families, but it faces a number of challenges, including an insufficient evidence base to support its interventions and a lack of systematic evaluation and performance measures.
Recommendation 1: By targeting resources to develop the evidence base and disseminate that evidence, DOD’s prevention efforts can be both more effective and cost effective.
Finding 2: There is a need for DOD to improve approaches for identifying and intervening with service members and their members who may already have or may be at risk for developing a psychological disorder.
Recommendation 2: DOD should dedicate funding, staffing and logistical support for data analysis and evaluation to support performance monitoring of programs for accountability and continuous improvement.
Finding 3: Screening, assessment and treatment approaches for psychological health problems are not always implemented between and within the DOD and the U.S. Department of Veterans Affairs (VA) in a consistent manner or aligned with the evidence base, which threatens the delivery of high-quality care and hampers evaluation efforts.
- There are opportunities to improve processes of training and evaluating clinicians, including the incorporation of continuing education and supervision; standardized periodic evaluation; and a greater emphasis on coordination and interdisciplinarity.
- The DOD and VA should invest in research to determine the efficacy of treatments that do not have a strong evidence base.
- Both departments should conduct systematic assessments to determine whether screening and treatment interventions are being implemented according to clinical guidelines and departmental policy.
- Accessible inter-department data systems should be developed to assess treatment outcomes, variations among treatment facilities and barriers to the use of evidence-based treatment.
- Read the complete report.
- Read a NewPublicHealth interview with Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs about the National Prevention Strategy.
- Learn more about the state of mental health in the military from this infographic from the American Psychiatric Association embedded below.
A recent essay by columnist Nicholas Kristof of The New York Times looked at a critical problem faced by jails across the country, which often double as behavioral health treatment centers. For many inmates, mental health problems have been the significant factor in committing a crime, with some even purposely flouting the law in the hopes of getting into jail where they can get free treatment. As a result, the United States has a national inmate population where half of all male inmates and three quarters of all female inmates have a behavioral health condition.
Solutions are beginning to emerge, though critical problems remain. At a recent health initiatives forum convened by the National Association of Counties and held in San Diego, county health officials talked about the promise of the Affordable Care Act, which will allow jail health specialists to help enroll inmates in coverage in advance of their discharge to help continue care—behavioral and physical—outside of jail.
Read the full column here.
>>Bonus Link: Read NewPublicHealth’s coverage of the recent NACo Health Initiatives Forum.
While behavioral and physical health have generally been separate entities in the United States, new rules under the Affordable Care Act are bringing them together—both to reduce costs and to integrate care in millions of people who face behavioral and physical health issues.
Experts at last week’s Healthy Communities Initiative forum, convened by the National Association of Counties (NACo), and this week’s AcademyHealth National Policy Conference, meeting in Washington D.C., presented strategies for combining the two. Some pilot projects are beginning. The pace is picking up largely because many people now covered under the states that have created Medicaid expansion have a range of behavioral and physical health needs. They will benefit from integration because the two are often connected—for example, diabetes has been linked to depression—and because connecting the two can reduce health care costs and reduce the number of provider visits a patient has to make.
“Behavioral health is a driving force in why people don’t get where they want to be,” said Donna Skoda, Assistant Health Commissioner of Summit County, Ohio, who spoke at the NACo forum.
Several public health officers at the forum presented ideas of what works in their communities, including:
- Hiring nurses to be care providers to assess both behavioral and physical health needs
- Retraining behavioral health specialists, including psychiatrists, to use blood pressure cuffs and other medical equipment
- Integrating patient files with information on mental and physical health baselines and changes
- Opting, when possible, to deliver care in physical health offices rather than counseling offices, since physical practitioner clinics already have devices needed such as scales
Presenters at the AcademyHealth policy conference stressed cost savings. For example, Washington state will participate in a federal demonstration project for beneficiaries dually eligible for Medicare and Medicaid. Under the demonstration, the health plans will be responsible for a full range of services—including mental health; chemical dependency; long-term services and supports; and medical care—under a single capped rate.
“Integrated care needs to be the rule, not the exception,” said Charlene Le Fauve, a deputy director of the National Institute of Mental Health.
Le Fauve said new technologies can be an important factor in delivering care including mobile devices and internet tools, which can be used at provider offices, clinics, and in homes if communities provide those services.
Other ideas being funded include training community workers for brief interventions which may be able to keep many people with mental illness out of both the emergency room and the hospital. Phone intervention is also being studied, said Le Fauve.
Arab Countries at Risk of Halting Progress in Life Expectancy, Child Mortality
If left unaddressed, the increasing problems of chronic disease, diet-related risk factors and road injury deaths could hamper the progress that countries in the Arab world have made in life expectancy and child mortality over the past two decades, according to a new study in The Lancet. The Institute for Health Metrics and Evaluation (IHME)-led study analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), finding that all 22 nations of the Arab League saw life expectancy increase for women from 1990 to 2010, and all but one saw increases for men (Kuwait, which was already at 76.8 in 1990 and dipped to only 76.1). However, societal changes linked to income levels are also bringing with them new issues. For example, higher-income countries where food is more abundant are seeing poorer diets and decreased physical activity. “The Arab countries are in transition from places where infectious diseases are the main cause of concern to places where heart disease, cancer, and diabetes are the main worries,” said IHME Director Christopher Murray, MD. “Right now, in the low-income countries, they are suffering from a double burden of non-communicable and infectious diseases. And that causes an incredible strain on their health systems.” Read more on global health.
Study: Cutting Fast Food Not Enough—Education Nutrition Also Needed to Combat Childhood Obesity
Cutting back or even cutting out fast food alone is not enough to combat the childhood obesity epidemic, with increased focus on the rest of diet also necessary, including proper education on nutrition, according to a new study in the American Journal of Clinical Nutrition. The study was supported by the Robert Wood Johnson Foundation. Researchers analyzed data from the U.S. National Health and Nutrition Examination Survey, looking at information on nearly 4,500 U.S. kids ages 2 to 18 from 2007 to 2010. The study found that nearly 40 percent of kids consumed up to 30 percent of their total calories from fast food, with 10 percent consuming more than 30 percent. They also found that kids who ate more fast food also tended to make unhealthy eating choices outside of fast food restaurants. "The fact that fast-food diners—especially adolescents—tend to choose nutrient-poor foods outside of the fast-food meal demonstrates the need for better nutrition education and a focus on the whole diet to meet health needs," said Connie Diekman, director of university nutrition at Washington University in St. Louis. Read more on nutrition.
FDA Approves First Post-natal Test to Diagnose Development Delays, Intellectual Disabilities
The U.S. Food and Drug Administration (FDA) has granted approval for the marketing of a first-of-its-kind test to help diagnose developmental delays and intellectual disabilities in children. The post-natal blood test analyzes the entire genome in search of chromosomal variations of different types, sizes, and genome locations; disabilities such as Down syndrome and DiGeorge syndrome are linked to chromosomal variations. “This new tool may help in the identification of possible causes of a child’s developmental delay or intellectual disability, allowing health care providers and parents to intervene with appropriate care and support for the child,” said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. Read more on mental health.
USDA: Americans Are Eating Healthier
A new report from the U.S. Department of Agriculture finds that American diets improved between 2005 and 2010. The report, which relied on responses to the National Health Examination and Nutrition Survey, found that American adults are making better use of available nutrition information; consuming fewer calories coming from fat and saturated fat; consuming less cholesterol; and eating more fiber. Daily calorie intake declined by 78 calories per day between 2005 and 2010. The report also found declines in calories from total fat (3.3 percent), saturated fat (5.9 percent), and intake of cholesterol (7.9 percent). Overall fiber intake increased by 1.2 grams per day (7.5 percent). Read more on nutrition.
ACEP Emergency Care Report Card Gives Public Health a ‘C’
Public health and injury prevention received a “C” grade in the new "America's Emergency Care Environment: A State-by-State Report Card." The nation overall received a “D” in the American College of Emergency Physicians report, which looks at the conditions and policies under which emergency care is being delivered, not the quality of the care. Public health and prevention was one of five categories of 136 total measures used to grade the quality of emergency care, along with access to emergency care; quality and patient safety; medical liability and environment; and disaster preparedness. Read more on access to health care.
Mental Health Problems in Middle Aged and Older Adults May be Underreported
A new study by researchers at the Johns Hopkins School of Public Health and published in JAMA Psychiatry finds than the number of people in middle and old age with mental health disorders may be higher than previously thought. The study was based on a survey of just over 1,000 adults who were part of a long-term longitudinal study. The participants were asked questions about mental health disorders and then were also given an assessment for the disorders by health professionals. The survey found that while the responders underreported mental health issues, they were fairly accurate when reporting physical health problems. Read more on mental health.
New Interventions Needed to Reduce Underage Drinking
Strategies recommended by the Surgeon General to reduce underage drinking have shown promise when put into practice, according to scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The approaches include nighttime restrictions on young drivers and strict license suspension policies; partnerships between college campuses and the community; and routine screening by doctors to identify and counsel underage drinkers. However, Ralph Hingson, SCD, director of NIAAA's Division of Epidemiology and Prevention Research says that “while progress has been made in addressing underage drinking, the consequences still remain unacceptably high. We must continue research to develop new interventions and implement existing strategies that have been shown to be effective.” According to Hingson, new research areas could include more studies of the effects of alcohol on the developing brain, legal penalties for providing alcohol to minors and parent-family alcohol interventions. Preliminary NIAAA research also shows that interventions aimed at strengthening family relationships in the middle-school years can have a lasting effect on students’ drinking behavior. Underage drinking is linked to 5,000 injury deaths per year, poor academic performance, potential damage to the developing brain, and risky sexual behavior. Read more on alcohol.
HHS: Guides, Tools to Improve Safe Use of EHRs
The U.S. Department of Health and Human Services (HHS) has released a new set of guides and interactive tools to assist health care providers in more safely using and managing electronic health information technology products, such as electronic health records (EHRs). The resources—which include checklists, practice worksheets and recommended practices to assess and optimize the safe use of EHRs—are available at HealthIT.gov. Each guide is available as an interactive online tool or a downloadable PDF. The new tools are part of HHS’s plan to implement its Health IT Patient Safety Action and Surveillance Plan, released last July. Read more on technology.
Traumatic Brain Injury Linked to Higher Risk of Early Death
Traumatic brain injury (TBI) is linked to a higher risk of premature death, according to a new study in the journal JAMA Psychiatry. Researchers from the University of Oxford, United Kingdom, analyzed the records of all patients born in 1954 or later in Sweden who were diagnosed with TBI from 1969 to 2009, finding an increased risk of dying among patients who survived six months after TBI compared to those without TBI, with the risk remaining for years afterward. In particular, the study found an increased risk of death from external causes such as suicide, injury and assault, also was higher. “Current clinical guidelines may need revision to reduce mortality risks beyond the first few months after injury and address high rates of psychiatric comorbidity and substance abuse,” wrote the study authors. Read more on mental health.
Heavy Drinking During Middle Age Can Cause Earlier Memory Loss in Men
Heavy drinking during middle age can bring on earlier deterioration of memory, attention and reasoning skills in men, according to a new study in the journal Neurology. Researchers studied data on 5,000 men and 2,000 women whose alcohol consumption was assessed three times over a 10-year period before also taking three tests of memory, attention and reasoning, with the first test happening at the average age of 56. They found that men who drank at least 2.5 servings of alcohol a day experienced mental declines between 1.5 and 6 years earlier than the other participants. "Heavy alcohol consumption is known to be detrimental for health, so the results were not surprising...they just add that [it's] also detrimental for the brain and the effects can be observed as [early] as 55 years old," said study author Severine Sabia, a research associate in the department of epidemiology and public health at University College London. Read more on alcohol.
Tips on Staying Warm During the ‘Polar Vortex’
As much of the country faces record lows due to a polar vortex, with many areas suffering through below-zero temperatures, experts are offering advice on how to stay warm and healthy. The first tip is staying indoors. "It's best to limit your outdoor activity as much as possible, since prolonged exposure can lead to frostbite and hypothermia," said John Marshall, MD, chair of emergency medicine at Maimonides Medical Center in New York City. "Both of these conditions can become serious, and even life-threatening if untreated." However, when you must go outside, follow these tips:
- Dress warmly — Layer clothing to retain body heat, and a non-permeable outer layer will help against strong winds.
- Protect your extremities — Wear extra socks. Also go with mittens over gloves, since fingers stay warmer when they’re next to each other.
- Wear a hat — And cover the ears and nose if possible.
- Wear properly fitted winter boots — If they’re too tight they can cut off circulation. Also go for a pair that’s insulated with treads.
- Stay hydrated — Drink fluids to replenish the energy your body spends to stay warm.
- Stay dry — Get out of wet clothing as soon as possible.
Read more on preparedness.
Study: Health Care Spending Remained Low as Economy Struggled
Health care spending has now stayed relatively steady—and low—for four consecutive years, rising by 3.7 percent in 2012 to $2.8 trillion. according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS). The study, published in Health Affairs, found that faster growth in hospital, physician and clinical services was somewhat offset by slower growth in prescription drug and nursing home services prices. Spending growth and growth in private health insurance for Medicaid were also near historic lows. "The low rates of national health spending growth and relative stability since 2009 primarily reflect the lagged impacts of the recent severe economic recession," said Anne B. Martin, an economist in the Office of the Actuary at CMS and the study’s lead author. "Additionally, 2012 was impacted by the mostly one-time effects of a large number of blockbuster prescription drugs losing patent protection and a Medicare payment reduction to skilled nursing facilities." Read more on budgets.
Study: Newer Antidepressant Drugs All Carry About Equal Risk of Suicidal Thoughts
New antidepressants all come with about the same level of risk for suicidal thoughts and behaviors in children, according to a new study in the journal Pediatrics. Previous studies identified the increased risk, especially within the first few weeks of treatment, but there were still questions of whether some drugs came with higher risks. The study analyzed the medical histories of almost 37,000 children, average age 14, enrolled in Tennessee's Medicaid program between 1995 and 2006. Each child was a new user of one of six antidepressants: Prozac, Zoloft, Paxil, Celexa, Lexapro or Effexor. The study found little difference in the rate of suicidal thoughts and attempts before and after they began the medications. However, they did note that children on multiple medications were at higher risk, though that could also be a result of more severe depression. Read more on mental health.
HHS Moves to Strengthen Federal Background Checks for Gun Ownership
The U.S. Department of Health and Human Services (HHS) is taking steps to strengthen the federal background check system for the purchase of firearms by removing legal barriers under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule that could stop states from reporting information to the National Instant Criminal Background Check System (NICS). The NICS is designed to ensure that felons, people convicted of domestic violence and people involuntarily committed to a mental institution cannot purchase firearms. A 2012 Government Accountability Office report found that 17 states had submitted fewer than 10 records of people prohibited from owning a firearm for mental health reasons. “There is a strong public safety need for this information to be accessible to the NICS, and some states are currently under-reporting or not reporting certain information to the NICS at all,” said HHS Secretary Kathleen Sebelius. “This proposed rulemaking is carefully balanced to protect and preserve individuals’ privacy interests, the patient-provider relationship, and the public’s health and safety.” Read more on mental health.
CDC: ‘Widespread’ Flu Activity in Almost Half of the Country
Half of the 50 U.S. states are already reporting influenza cases this season, according to the U.S. Centers for Disease Control and Prevention (CDC). The majority of the cases have been attributed to the H1N1 virus, which killed an estimated 284,000 people across 74 countries in 2009-2010. Almost half of the country has also classified flu activity as “widespread” this season. Texas, which on December 20 issued an “influenza health alert,” has already seen 25 deaths, according to health officials. "We are seeing a big uptick in disease in the past couple of weeks. The virus is all around the United States right now," said Joe Bresee, MD, chief of Epidemiology and Prevention in the CDC's Influenza Division, adding, "There is still a lot of season to come. If folks haven't been vaccinated, we recommend they do it now.” Read more on influenza.
Slower Eating Leads to Fewer Calories
Normal-weight individuals looking for methods to maintain their healthy weight should consider simply eating slower, according to a new study in the Journal of the Academy of Nutrition and Dietetics. Researchers found that both normal-weight and obese or overweight people who ate at relaxed, slow-speed conditions reported feeling less hungry afterward than they did after eating fast-paced meals. However, only the normal-weight study participants consumed “significantly” fewer calories during the slower meals, according to the researchers: 88 fewer calories, compared to 58 fewer calories for obese or overweight participants. Study author Meena Shah, a professor in the department of kinesiology at Texas Christian University, in Fort Worth, said one explanation for the findings could be that “slower eating allows people to better sense their feelings of hunger and fullness.” Read more on obesity.
Black Women Have Highest Rates of High Blood Pressure
More black women have high blood pressure than black men and white men and women, according to a new study in Circulation: Cardiovascular Quality and Outcomes.
The study included 70,000 people in the 12 southeastern states that are often referred to as the “stroke belt” because they collectively have a high rate of stroke incidence. Among the study participants, the high blood pressure rate among black women was 64 percent. Among white women the rate was 52 percent and among both black and white men the rate was 51 percent.
“For many years, the focus for high blood pressure was on middle-aged men who smoked; now we know better,” said Uchechukwu Sampson, MD, MPH. MBA, a lead author of the study and assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn. “We should look for [high blood pressure] in everyone and it should be treated aggressively — especially in women, who have traditionally gotten less attention in this regard.”
Dr. Sampson’s work was supported in part by the Harold Amos Medical Faculty Award of the Robert Wood Johnson Foundation. Read more on health disparities.
Over 40 Million Americans Experienced Mental Illness in 2012
Nearly one in five American adults, or 43.7 million people, experienced a diagnosable mental illness in 2012, a similar number to 2011, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).
SAMHSA also reported that, consistent with 2011, less than half (41 percent) of these adults received any mental health services in the past year. And among adults with mental illness who reported an unmet need for treatment, the top three reasons given for not receiving help were:
- they could not afford the cost;
- they thought they could handle the problem without treatment; and
- they did not know where to go for services.
The Department of Health and Human Services recently launched MentalHealth.gov to help people find easy-to-understand information about basic signs of mental health problems, how to talk about mental health and mental illness, and how to locate help.
The recent SAMHSA report also found that 9 million American adults 18 and older (3.9 percent) had serious thoughts of suicide in the past year; 2.7 million (1.1 percent) made suicide plans and 1.3 million (0.6 percent) attempted suicide. People in crisis or who know someone they believe may be at immediate risk of attempting suicide can call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or go to SuicidePreventionLifeline.org, which provides immediate, free and confidential round-the-clock counseling to anyone in need throughout the country, every day of the year. Read more on mental health.
NHTSA Extends Its Partnership with Auto Makers on Technology to Stop Drunk Drivers
The U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) has extended, for five years, its agreement with the Automotive Coalition for Traffic Safety (ACTS), made up of 15 auto makers, to continue researching advanced alcohol detection technology that could prevent vehicles from being driven by a drunk driver.
Under the partnership, NHTSA is working with ACTS to develop a car system that could accurately and reliably detect when a driver is above the legal alcohol limit of 0.08 BAC adopted by all 50 States and territories. The automatic system would be enabled every time the car is started, but not pose an inconvenience to a non-intoxicated driver.
“In this age of innovation, smart technology may be the breakthrough we need to prevent drunk drivers from getting behind the wheel and endangering the safety of others on our roads,” said NHTSA Administrator David Strickland. “The research program has shown significant promise to date, offering real potential in the future to prevent several thousand deaths annually.”
NHTSA expects to have models ready for testing in 2015. In 2012, deaths in crashes involving drunk drivers increased 4.6 percent, resulting in 10,322 deaths — up from 9,865 in 2011. Read about NHTSA’s “Drive Sober or Get Pulled Over" campaign.