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2/3 of parents cite barriers in recognizing youth depression

Teens and preteens are no strangers to depression: 1 in 4 parents say their child knows a peer with depression; 1 in 10 say a child’s peer has committed suicide.

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Telling the difference between a teen’s normal ups and downs and something bigger is among top challenges parents face in identifying youth depression, a new poll suggests.

Though the majority of parents say they are confident they would recognize depression in their middle or high school aged child, two thirds acknowledge barriers to spotting specific signs and symptoms, according to the C.S. Mott Children’s Hospital National Poll on Children’s Health at the University of Michigan in the US.

Forty percent of parents struggle to differentiate between normal mood swings and signs of depression, while 30% say their child is good at hiding feelings.

“In many families, the preteen and teen years bring dramatic changes both in youth behavior and in the dynamic between parents and children,” says poll co-director Sarah Clark. “These transitions can make it particularly challenging to get a read on children’s emotional state and whether there is possible depression.”

Still, a third of parents polled said nothing would interfere with their ability to recognize signs of depression in their child.

“Some parents may be overestimating their ability to recognize depression in the mood and behavior of their own child,” Clark says. “An overconfident parent may fail to pick up on the subtle signals that something is amiss.”

The poll also suggests that the topic of depression is all too familiar for middle and high school students. One in four parents say their child knows a peer or classmate with depression, and 1 in 10 say their child knows a peer or classmate who has died by suicide.

Indeed, rates of youth suicide continue to rise. Among people ages 10 to 24 years old, the suicide rate climbed 56% between 2007 and 2017, according to the Centers for Disease Control and Prevention.

“Our report reinforces that depression is not an abstract concept for today’s teens and preteens, or their parents,” Clark says.

“This level of familiarity with depression and suicide is consistent with recent statistics showing a dramatic increase in suicide among… youth over the past decade. Rising rates of suicide highlight the importance of recognizing depression in youth.”

Compared to the ratings of their own ability, parents polled were also less confident that their preteens or teens would recognize depression in themselves.

Clark says parents should stay vigilant on spotting any signs of potential depression in kids, which may vary from sadness and isolation to anger, irritability and acting out. Parents might also talk with their preteen or teen about identifying a “go to” adult who can be a trusted source if they are feeling blue, Clark says.

Most parents also believe schools should play a role in identifying potential depression, with seven in 10 supporting depression screening starting in middle school.

“The good news is that parents view schools as a valuable partner in recognizing youth depression,” Clark says.The bad news is that too few schools have adequate resources to screen students for depression, and to offer counseling to students who need it.”

Clark encourages parents to learn whether depression screening is taking place at their child’s school and whether counseling is available for students who screen positive. Given the limited resources in many school districts, parents can be advocates of such efforts by talking to school administrators and school board members about the importance of offering mental health services in schools.

The Mott Poll report is based on responses from 819 parents with at least one child in middle school, junior high, or high school.

Depression is – of course – an important issue in the LGBTQIA community. One study done in November 2018, for instance, found that half of LGBT people (52%) said they’ve experienced depression in the last year; one in eight LGBT people aged 18-24 (13%) said they’ve attempted to take their own life in the last year; and almost half of trans people (46%) have thought about taking their own life in the last year, 31% of LGB people who aren’t trans said the same.

Health & Wellness

Incarceration, police discrimination may worsen psychological, physical health of sexual minority men – study

43% of study participants reported police discrimination within the previous year, which was most frequent among those with a history of incarceration. Respondents who faced high levels of police discrimination within the previous year also tended to show high levels of psychological distress and HIV risk, and a low willingness to take PrEP compared with their peers.

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Incarceration and police discrimination may contribute to HIV, depression and anxiety among gay, bisexual and other sexual minority men, according to a Rutgers led study.

The study, funded by the National Institute of Health (NIH) and published in the journal Social Science & Medicine, examined associations between incarceration, police and law enforcement discrimination and recent arrest particularly with Black sexual minority mens’ psychological distress, risk for HIV and willingness to take pre-exposure prophylaxis (PrEP) for HIV prevention.

“Evidence suggests Black sexual minority men in the US may face some of the highest rates of policing and incarceration in the world,” said lead author, Devin English, assistant professor at the Rutgers School of Public Health. “Despite this, research examining the health impacts of the US carceral system rarely focuses on their experiences.”

The study particularly examined how incarceration and police discrimination, which have roots in enforcing White supremacy and societal heterosexism, are associated with some of the most pressing health crises among Black sexual minority men like depression, anxiety, and HIV.

The researchers surveyed 1,172 Black, gay, bisexual, and other sexual minority men over the age of 16 from across the US who reported behaviors that increased their risk for HIV over the previous six months. Participants reported on their incarceration history, experiences of police and law enforcement discrimination, anxiety and depression, sexual behavior, and willingness to take PrEP.

They found that 43% of study participants reported police discrimination within the previous year, which was most frequent among those with a history of incarceration. Respondents who faced high levels of police discrimination within the previous year also tended to show high levels of psychological distress and HIV risk, and a low willingness to take PrEP compared with their peers. The study also found that respondents who were previously incarcerated or recently arrested had a heightened HIV risk and lower willingness to take PrEP.

“These findings transcend individual-level only explanations to offer structural-level insights about how we think about Black sexual minority men’s HIV risk,” said co-author Lisa Bowleg, professor of psychology at The George Washington University. “The study rightly directs attention to the structural intersectional discrimination that negatively affects Black sexual minority men’s health.”

The findings support the need for anti-racist and anti-heterosexist advocacy and interventions focused on reducing discrimination in societies, and the carceral system specifically.

“Despite experiencing a disproportionate burden of violence and discrimination at the hands of the police, and extremely high carceral rates, Black queer men are largely invisible in discourse on anti-Black policing and incarceration,” said co-author Joseph Carter, doctoral student of health psychology at the City University of New York’s Graduate Center. “Our study provides empirical support for the intersectional health impacts of police and carceral discrimination that have been systemically perpetrated onto Black queer men.”

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Health & Wellness

Covid-19 affects adolescent and young adults sexual and reproductive health

LGBTQ youth have also been impacted. And for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.

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Social distancing and limited access to contraceptive and abortion care during the COVID-19 pandemic is affecting the sexual and reproductive health of adolescents and young adults, according to a new study by researchers at Columbia University Mailman School of Public Health and Rutgers University. The researchers address how these challenges, as well as peer and romantic relationships, are being navigated.

The finding are published in the journal Perspectives on Sexual and Reproductive Health.

Huge changes for adolescents and young adults, include school closures, potentially much more time with family, the interruption of the normal trajectory toward increased independence and, for many, very limited or no physical proximity to sexual and romantic partners.

Even though the pandemic may lead to less opportunities for sex for some young people, disruptions in access to contraception and abortion can be extremely problematic for adolescents and young adults who are still able to be physically close to their partners during the pandemic, note the authors. “The good news is that some services, including obtaining many forms of contraception and receiving testing and treatment for sexually transmitted diseases can be handled through telemedicine,” said Leslie Kantor, a professor and chair of the Rutgers Department of Urban Global Public Health. “If telemedicine remains as widely available as it has been during the coronavirus pandemic, access to sexual and reproductive health care may actually improve for young people.” However, Kantor and colleagues say that lack of privacy and confidentiality, which many adolescents and young adults are experiencing while living at home with family, can also hinder the ability to get necessary sexual and reproductive healthcare.

In terms of testing for sexually transmitted infections or seeking abortion care, there is not a lot of data specifically on young people. But many states have tried to restrict abortion access by arguing it is not an essential service despite the fact that abortion clearly is essential and needs to be timely. There also have been very concerning declines in vaccinations for all children older than age 2 and the use of the HPV vaccine, which prevents cancer-causing infections and pre-cancers, has plummeted.

Photo by Sharon McCutcheon from Unsplash.com

LGBTQ youth have also been impacted, although fortunately, many LGBTQ centers quickly moved support groups and other services online. And for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.

While social disruption resulting from the pandemic affects young adults’ sense of health and well-being, one positive aspect is that young adults are digital natives familiar with online platforms and social media. “Young people are supposed to be gaining independence at this time in life, so for those who have had to return home after a period of being away, maintaining relationships with friends and romantic partners at a distance may be particularly challenging. Our view that their constant digital connection was negative is now a positive for them at this time,” said David Bell, MD, MPH, Columbia Mailman School of Public Health associate professor of Population and Family Health and Pediatrics.

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Health & Wellness

Study finds gender-affirming health care good on paper; still lacking in practice

Fact: Many trans women, especially those in rural areas, couldn’t find a doctor trained to provide those hormones, and the doctors they could access did not know where to refer them for more specialized care.

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Good in reports; shitty in actual practice.

This is the state of gender-affirming policies and health care for transgender women, with many of pro-LGBTQIA polices actually still not fully realized in practice, according to a study from Oregon State University found.

In the US, the Supreme Court recently barred employment discrimination against LGBTQIA people, which brings national law more in line with laws that have been in place in various states for several years.

Oregon, for instance, has the Oregon Equality Act of 2008 that protects trans people against employment and housing discrimination, while the expansion of Medicaid in 2015 expanded health coverage to include gender-affirming care like hormone-replacement therapy and transition surgery.

However – and this is worth stressing – those legal protections are not enough to address social determinants of health such as financial status and access to housing, or the everyday discrimination still felt by many trans women in Oregon, said Jonathan Garcia, a researcher ins the OSU College of Public Health and Human Sciences said. The cumulative effect of those subtler forms of discrimination takes a significant toll on trans women.

“In spite of ranking so highly in terms of Oregon’s support for gender-affirming care, the impact of social discrimination is so great that it challenges policy implementation and the lived experience of people,” Garcia said. “This is how discrimination sort of gets in between the cracks – it plays out in more complicated and indirect ways so that you can’t really weed it out.”

Garcia’s study, published in the Transgender Health journal, gathered detailed interviews with 25 trans women in Oregon, ages 18 to 39. Of those 25, six had been homeless at some point in the 12 months prior and only 20% had full-time employment, though all had some form of health insurance.

According to the study’s findings, one of the biggest challenges facing trans women is navigating the health care system. At least in Oregon, though the law requires insurance to cover hormone-replacement therapy, many trans women, especially those in rural areas, couldn’t find a doctor trained to provide those hormones, and the doctors they could access did not know where to refer them for more specialized care.

In other cases, trans women had to undergo a psychological evaluation to obtain a diagnosis of gender dysphoria – the distress people feel when the sex they’re assigned at birth doesn’t match the gender with which they identify – before they could begin to access hormone replacement therapy. This route is much more time-consuming and cost-prohibitive than the “informed consent model,” wherein trans patients can attest that they understand the risks and benefits of pursuing gender-affirming medical treatment, without first having to prove psychological distress. For some study participants, the idea of gender dysphoria made them feel like they had a medical problem and invalidated their lived experience.

“All of that is really, really confusing,” Garcia said. “It requires them to become experts in their rights, in the law, in the availability of these services and where they are offered.”

Most trans women who were able to navigate that system credit their success to their social support network of other trans people. In addition to this informal network, Garcia said, the system needs to have trained and properly compensated health workers in place who can act as navigators, and they need to understand not just health care but the intersections with housing and the legal system that affect people’s access to care.

“We need help with navigating these systems and establishing trust, so that people are actually able to claim and enjoy the rights that they have, so that the rights don’t remain on paper,” he said.

The study was limited in that 21 of 25 participants were white women. Despite numerous efforts to recruit Black and Latinx trans women, Garcia said, they were unable to reach them through participant referrals and community center contacts. He attributed this to their extreme marginalization in queer spaces in Oregon.

“But we can tell that whatever this set of women is experiencing, I expect the experience of trans women of color to be far more challenging,” Garcia said. “Specifically because of structural racism and disenfranchisement from queer networks, which were a critical resource for the women who were able to navigate these systems.”

Garcia’s co-author was Richard Crosby at the University of Kentucky.

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Health & Wellness

Suicide rate for people with schizophrenia spectrum disorders 170 times higher

The authors suggest increasing the age limit for admission to first episode psychosis programs (most are closed to people over 30) and increasing the length of clinical follow-up care after a first episode of psychosis.

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The suicide rate for people with schizophrenia spectrum disorders (SSD) is 170 times higher than the general population, according a study just published in the journal Schizophrenia Research, a figure the authors call “tragically high.”

The study of 20-years of population data, believed to be the largest of its kind ever done, examined statistics on over 75,000 patients who received a first diagnosis of SSD. On average, each patient was followed for almost ten years. The study found several key factors that were predictors of suicide including:

  • During the first five years after an individual has been diagnosed with SSD
  • If there was evidence of a mood disorder or hospitalization prior to diagnosis
  • If the individual was diagnosed with SSD at a later age

“What this study teaches is us that although people with SSD are at higher risk for suicide, we can target those at the highest risk with changes in policy and treatment,” said lead author Dr. Juveria Zaheer, Clinician Scientist at the CAMH Institute for Mental Health Policy Research.

“In the past clinicians have focused on treating the psychosis itself when it first appears,” said senior author Dr. Paul Kurdyak, Director, Health Outcomes and Performance Evaluation, CAMH Institute for Mental Health Policy Research and Clinician Scientist at ICES. “This study shows that treatment has to include suicide prevention safety planning as well from the very beginning.”

The authors suggest increasing the age limit for admission to first episode psychosis programs (most are closed to people over 30) and increasing the length of clinical follow-up care after a first episode of psychosis.

“Now that we know what is happening, we need to better understand why,” said Dr. Zaheer. “Our next step will be to study the lived experience of people with SSD who have had suicidal ideation.”

Suicide – by itself – is a big issue in the LGBTQIA community.

In 2018, for instance, a study found that almost 14% of adolescents reported a previous suicide attempt, with disparities by gender identity in suicide attempts. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%).

Still in 2018, another study found that 50.8% of transmasculine adolescents between the ages of 11 and 19 have attempted suicide at least once, while 41.8% of nonbinary adolescents – those who don’t identify as exclusively male or exclusively female – have attempted suicide.

And in June 2020, yet another study noted that death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers.

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Health & Wellness

Physical activity in all of its forms may help maintain muscle mass in midlife

Hormonal changes during menopause decrease muscle mass, but physical activity might slow the decrement.

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A large study of middle-aged women shows that age-related changes in skeletal muscle are part of everyday life for women in their fifties. During this time, women transition from perimenopause to postmenopause and the production of estrogen ceases. Loss of estrogen has an effect on muscles and leads to a decline in muscle mass. Physical activity in all of its forms may help maintain muscle mass in midlife.

“We already knew that estrogen has a role in the regulation of muscle properties,” says doctoral student Hanna-Kaarina Juppi. “By following the hormonal status, measuring many aspects of muscles and by taking into consideration the simultaneous chronological aging of women going through menopausal transition, we were able to show that the decrease of muscle mass takes place already in early postmenopause.”

In the current study, muscle size was measured in the perimenopausal state and right after entering postmenopause, when menstruation had permanently stopped. Women were on average 51-and-a-half years old at the beginning of the study and 53 years old at the final measurements, so the average duration of menopausal transition was one-and-a-half years. The time it takes a woman to go through menopause is unique: in this study it varied from less than six months to more than three years. During this time, the decrease in muscle mass was on average one percent.

Juppi continues: “The observed change does not seem like much, but what is meaningful is that the decline happens in a short period of time and can have an impact on metabolism, as muscles are important regulators of whole-body metabolism.”

Physical activity was found to be positively associated with the maintenance of muscle mass during the menopausal transition. Women who were more active had higher muscle mass before and after menopause compared to the less active women. It seems that even though menopause alone decreases muscle mass, staying physically active throughout middle age can help women to slow the change.

The current study was conducted in the Gerontology Research Center and Faculty of Sport and Health Sciences, and is part of a larger study, Estrogenic Regulation of Muscle Apoptosis (ERMA), led by Academy Research Fellow Eija Laakkonen. More than a thousand women between the ages of 47 and 55 from the Jyväskylä region participated in the ERMA study. At the beginning of the study, 381 of them were perimenopausal, while 234 reached early postmenopause during the study. The research was funded by the Academy of Finland and the European Commission.

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Health & Wellness

Repetitive negative thinking linked to dementia risk

“Looking after your mental health is important, and it should be a major public health priority, as it’s not only important for people’s health and well-being in the short term, but it could also impact your eventual risk of dementia.”

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Persistently engaging in negative thinking patterns may raise the risk of Alzheimer’s disease, finds a new UCL-led study.

In the study of people aged over 55, published in Alzheimer’s & Dementia, researchers found ‘repetitive negative thinking’ (RNT) is linked to subsequent cognitive decline as well as the deposition of harmful brain proteins linked to Alzheimer’s.

The researchers say RNT should now be further investigated as a potential risk factor for dementia, and psychological tools, such as mindfulness or meditation, should be studied to see if these could reduce dementia risk.

Lead author Dr Natalie Marchant (UCL Psychiatry) said: “Depression and anxiety in mid-life and old age are already known to be risk factors for dementia. Here, we found that certain thinking patterns implicated in depression and anxiety could be an underlying reason why people with those disorders are more likely to develop dementia.

“Taken alongside other studies, which link depression and anxiety with dementia risk, we expect that chronic negative thinking patterns over a long period of time could increase the risk of dementia. We do not think the evidence suggests that short-term setbacks would increase one’s risk of dementia.

“We hope that our findings could be used to develop strategies to lower people’s risk of dementia by helping them to reduce their negative thinking patterns.”

For the Alzheimer’s Society-supported study, the research team from UCL, INSERM and McGill University studied 292 people over the age of 55 who were part of the PREVENT-AD cohort study, and a further 68 people from the IMAP+ cohort.

Over a period of two years, the study participants responded to questions about how they typically think about negative experiences, focusing on RNT patterns like rumination about the past and worry about the future. The participants also completed measures of depression and anxiety symptoms.

Their cognitive function was assessed, measuring memory, attention, spatial cognition, and language. Some (113) of the participants also underwent PET brain scans, measuring deposits of tau and amyloid, two proteins which cause the most common type of dementia, Alzheimer’s disease, when they build up in the brain.

The researchers found that people who exhibited higher RNT patterns experienced more cognitive decline over a four-year period, and declines in memory (which is among the earlier signs of Alzheimer’s disease), and they were more likely to have amyloid and tau deposits in their brain.

Depression and anxiety were associated with subsequent cognitive decline but not with either amyloid or tau deposition, suggesting that RNT could be the main reason why depression and anxiety contribute to Alzheimer’s disease risk.

“We propose that repetitive negative thinking may be a new risk factor for dementia as it could contribute to dementia in a unique way,” said Dr Marchant.

The researchers suggest that RNT may contribute to Alzheimer’s risk via its impact on indicators of stress such as high blood pressure, as other studies have found that physiological stress can contribute to amyloid and tau deposition.

Co-author Dr Gael Chételat (INSERM and Université de Caen-Normandie) commented: “Our thoughts can have a biological impact on our physical health, which might be positive or negative. Mental training practices such as meditation might help promoting positive- while down-regulating negative-associated mental schemes.

“Looking after your mental health is important, and it should be a major public health priority, as it’s not only important for people’s health and well-being in the short term, but it could also impact your eventual risk of dementia.”

The researchers hope to find out if reducing RNT, possibly through mindfulness training or targeted talk therapy, could in turn reduce the risk of dementia. Dr Marchant and Dr Chételat and other European researchers are currently working on a large project to see if interventions such as meditation may help reduce dementia risk by supporting mental health in old age.

Fiona Carragher, Director of Research and Influencing at Alzheimer’s Society, said: “Understanding the factors that can increase the risk of dementia is vital in helping us improve our knowledge of this devastating condition and, where possible, developing prevention strategies. The link shown between repeated negative thinking patterns and both cognitive decline and harmful deposits is interesting although we need further investigation to understand this better. Most of the people in the study were already identified as being at higher risk of Alzheimer’s disease, so we would need to see if these results are echoed within the general population and if repeated negative thinking increases the risk of Alzheimer’s disease itself.

“During these unstable times, we are hearing from people every day on our Alzheimer’s Society Dementia Connect line who are feeling scared, confused, or struggling with their mental health. So it’s important to point out that this isn’t saying a short-term period of negative thinking will cause Alzheimer’s disease. Mental health could be a vital cog in the prevention and treatment of dementia; more research will tell us to what extent.”

This is also an issue among members of the LGBTQIA community. In 2019, for instance, a study found that more than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants.

In 2018, meanwhile, SAGE CEO Michael Adams noted: “While the LGBT community faces similar health concerns as the general public, LGBT people who receive a dementia diagnosis and LGBT caregivers face uniquely challenging circumstances. This brief shines a light on these challenges, so we can begin taking steps to address them and improve the care and support LGBT people receive.”

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