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Study finds more mental heath visits decreases risk of suicide among youths

Youths with psychiatric disorders, particularly mood disorders, schizophrenia, and substance use should be routinely assessed for suicide risk and receive high-intensity, evidence-based treatments for suicidality, such as cognitive behavioral therapy.

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A multistate study of Medicaid enrollees led by researchers at The Ohio State University Wexner Medical Center found that suicide risk was highest among youth with epilepsy, depression, schizophrenia, substance use and bipolar disorder. In addition, the odds of suicide decreased among those who had more mental health visits within the 30 days before the date of suicide.

Researchers compared the clinical profiles and mental health service patterns of children and adolescents who had died by suicide to see how they differed from the general population. The findings published today in JAMA Pediatrics.

“To the best of our knowledge, no studies have examined the clinical profiles and health and mental health service utilization patterns prior to suicide for children and adolescents within the Medicaid population,” said lead researcher Cynthia Fontanella, an associate professor in the department of psychiatry and behavioral health at Ohio State Wexner Medical Center. “Understanding how health care utilization patterns of suicidal decedents differ from the general population is critical to target suicide prevention efforts.”

This population-based case-control study merged mortality data with US Medicaid data from 16 states spanning all regions of the country and accounting for 65% of the total child Medicaid population.

The study looked at 910 youth aged 10-18 years who died by suicide between January 1, 2009 and December 31, 2013 compared to a control group of 6,346 youth that was matched based on gender, race, ethnicity, Medicaid eligibility category, state and age.

For both groups, researchers examined health and behavioral health visits in the six-month period prior to date of suicide. Associations between visits, clinical characteristics and suicide were examined.

Clinical characteristics included psychiatric diagnoses (attention deficit hyperactivity disorder, conduct disorders, depression, bipolar disorder and other mood disorders, anxiety disorders, schizophrenia/psychosis, substance use and other mental health disorders) and chronic medical conditions (diabetes, seizure disorders, cerebral palsy, asthma or cancer.)

“Our study found that 41% of youth who died by suicide had at least one mental health diagnosis in the six months prior to death, a finding similar to those of previous studies on adults,” Fontanella said. “Our findings suggest that youths with psychiatric disorders, particularly mood disorders, schizophrenia, and substance use should be routinely assessed for suicide risk and receive high-intensity, evidence-based treatments for suicidality, such as cognitive behavioral therapy.”

In the US, the suicide rate among people aged 10-24 years has increased by 50% since 1999. Suicide is currently the second leading cause of death in this age group, accounting for nearly 6,800 deaths in 2017.

“Suicide among young people is a major public health problem. Based on our findings, we believe that implementing suicide screening protocols for youth enrolled in Medicaid – targeted on the basis of frequency of visits and psychiatric diagnoses – has the potential to decrease suicide rates,” Fontanella said.

Members of the LGBTQIA community encounter more issues related to mental health.

In November 2019, for instance, a study noted that sexual minorities were around five times more likely to experience high depressive symptoms (54% vs 15%) and self-harm (54% vs 14%). They also had lower life satisfaction (34% vs 10%), lower self-esteem and were more likely to experience all forms of bullying (i.e. peer bullying 27% vs 10%) and victimization (i.e. sexual assault/harassment 11% vs 3%) .

In September 2017, another study suggested that experiencing anti-bisexual prejudice, internalized heterosexism, and identity concealment appears to be related to feelings of loneliness and ultimately psychological distress and suicidality among bi individuals.

Health & Wellness

Binge drinkers beware, ‘Drunkorexia’ is calling

Excess alcohol consumption combined with restrictive and disordered eating patterns is extremely dangerous and can dramatically increase the risk of developing serious physical and psychological consequences, including hypoglycaemia, liver cirrhosis, nutritional deficits, brain and heart damage, memory lapses, blackouts, depression and cognitive deficits.

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Mojito, appletini or a simple glass of fizz – they may take the edge off a busy day, but if you find yourself bingeing on more than a few, you could be putting your physical and mental health at risk according new research at the University of South Australia.

Examining the drinking patterns of 479 female Australian university students aged 18-24 years, the world-first empirical study explored the underlying belief patterns than can contribute to “Drunkorexia” – a damaging and dangerous behavior where disordered patterns of eating are used to offset negative effects of consuming excess alcohol, such as gaining weight.

Concerningly, researchers found that a staggering 82.7 per cent of female university students surveyed had engaged in “Drunkorexic” behaviors over the past three months. And, more than 28 per cent were regularly and purposely skipping meals, consuming low-calorie or sugar-free alcoholic beverages, purging or exercising after drinking to help reduce ingested calories from alcohol, at least 25 per cent of the time.

Clinical psychologist and lead UniSA researcher Alycia Powell-Jones says the prevalence of Drunkorexic behaviours among Australian female university students is concerning.

“Due to their age and stage of development, young adults are more likely to engage in risk-taking behaviors, which can include drinking excess alcohol,” Powell-Jones says. “Excess alcohol consumption combined with restrictive and disordered eating patterns is extremely dangerous and can dramatically increase the risk of developing serious physical and psychological consequences, including hypoglycaemia, liver cirrhosis, nutritional deficits, brain and heart damage, memory lapses, blackouts, depression and cognitive deficits.”

She added that “certainly, many of us have drunk too much alcohol at some point in time, and we know just by how we feel the next day, that this is not good for us, but when nearly a third of young female uni students are intentionally cutting back on food purely to offset alcohol calories; it’s a serious health concern.”

The harmful use of alcohol is a global issue, with excess consumption causing millions of deaths, including many thousands of young lives.

In Australia for instance, one in six people consume alcohol at dangerous levels, placing them at lifetime risk of an alcohol-related disease or injury. The combination of excessive alcohol intake with restrictive eating behaviors to offset calories can result in a highly toxic cocktail for this population.

The study was undertaken in two stages. The first measured the prevalence of self-reported, compensative and restrictive activities in relation to their alcohol consumption.

The second stage identified participants’ Early Maladaptive Schemes (EMS) – or thought patterns – finding that that the subset of schemas most predictive of Drunkorexia were ‘insufficient self-control’, ’emotional deprivation’ and ‘social isolation’.

Powell-Jones says identifying the early maladaptive schemas linked to Drunkorexia is key to understanding the harmful condition.

These are deeply held and pervasive themes regarding oneself and one’s relationship with others, that can develop in childhood and then can influence all areas of life, often in dysfunctional ways. Early maladaptive schemas can also be influenced by cultural and social norms.

Drunkorexic behaviour appears to be motivated by two key social norms for young adults – consuming alcohol and thinness.

“This study has provided preliminary insight into better understanding why young female adults make these decisions to engage in ‘Drunkorexic’ behaviors,” Powell-Jones says. “Not only may it be a coping strategy to manage social anxieties through becoming accepted and fitting in with peer group or cultural expectations, but it also shows a reliance on avoidant coping strategies.”

It is recommended for clinicians, educators, parents and friends to be aware of the factors that motivate young women to engage in this harmful and dangerous behavior, including cultural norms, beliefs that drive self-worth, a sense of belonging, and interpersonal connectedness.

“By being connected, researchers and clinicians can develop appropriate clinical interventions and support for vulnerable young people within the youth mental health sector,” Powell-Jones says.

Worth highlighting: Alcoholism is a big issue in the LGBTQIA community.

A 2017 study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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Health & Wellness

Greater availability of non-alcoholic drinks may reduce alcohol consumption

The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

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People are more likely to opt for non-alcoholic drinks if there are more of them available than alcoholic drinks, according to a study published in the open access journal BMC Public Health.

A team of researchers at the NIHR Bristol Biomedical Research Centre, and the Universities of Bristol and Cambridge, UK found that when presented with eight drink options, participants were 48% more likely to choose a non-alcoholic drink when the proportion of non-alcoholic drink options increased from four (50%) to six (75%). When the proportion of non-alcoholic drink options decreased from four to two (25%), participants were 46% less likely to choose a non-alcoholic drink.

Dr Anna Blackwell, the corresponding author said: “Alcohol consumption is among the top five risk factors for disease globally. Previous research has shown that increasing the availability of healthier food options can increase their selection and consumption relative to less healthy food. To our knowledge, this is the first study to demonstrate that increasing the availability of non-alcoholic drinks, relative to alcoholic drinks in an online scenario, can increase their selection.”

Participants in the study completed an online task in which they were presented with a selection of alcoholic beer, non-alcoholic beer and soft-drinks. The drink selections included four alcoholic and four non-alcoholic drinks, six alcoholic and two non-alcoholic drinks or two alcoholic and six non-alcoholic drinks. 808 UK residents with an average age of 38 years who regularly consumed alcohol participated in the study.

When presented with mostly non-alcoholic drinks, 49% of participants selected a non-alcoholic drink, compared to 26% of participants who selected a non-alcoholic drink when presented with mostly alcoholic drinks. These results were consistent regardless of the time participants had to make their decision, indicating that the findings were not dependent on the amount of time and attention participants were able to devote to their drink choice. The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

Anna Blackwell said: “Many licensed venues already offer several non-alcoholic options but these are often stored out of direct sight, for example in low-level fridges behind the bar. Our results indicate that making these non-alcoholic products more visible to customers may influence them to make healthier choices. The market for alcohol-free beer, wine and spirit alternatives is small but growing and improving the selection and promotion of non-alcoholic drinks in this way could provide an opportunity for licensed venues to reduce alcohol consumption without losing revenue.”

The authors caution that as the study measured hypothetical drink selection online, results may differ in real-world settings. Further studies are needed to determine how the relative availability of non-alcoholic and alcoholic drinks impacts the purchasing and consumption of alcohol in real life.

Alcoholism is a big issue in the LGBTQIA community.

In 2017, a study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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Health & Wellness

Study finds more severe eating disorders among LGBT individuals

Delays in accessing treatment are especially widespread for transgender and nonbinary individuals with eating disorders. Some of the causes include delayed diagnosis by providers who fail to assess non-cisgender female patients for disordered eating, as well as limited access to trans-affirming treatment options.

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A study published in the International Journal of Eating Disorders finds that eating disorder patients who identify as LGBT have more severe eating disorder symptoms, higher rates of trauma history, and longer delays between diagnosis and treatment than heterosexual, cisgender patients.

“While we know there is a higher prevalence of eating disorders among LGBTQ folks, particularly trans and non-binary folks (with rates estimated to be anywhere from 40% to 70%), our field is in its infancy with researching this health disparity, so I believe research like ours is especially important” said clinical psychologist Jennifer Henretty PhD, CEDS, one of the study’s co-authors who serves as the Executive Director of Clinical Outcomes for Discovery Behavioral Health, Center For Discovery.

Eating disorders are a serious mental health concern: At least 30 million people—of all ages, sexual orientations, and gender-identities—experience an eating disorder in the US alone, and every 62 minutes at least one person dies as a direct result of an eating disorder. In fact, eating disorders have the highest mortality rate of any mental illness.

The most common eating disorders are binge eating disorder, where people regularly eat a large amount in a short period of time; bulimia nervosa, where people regularly eat a large amount in a short period of time and then try to offset the food using harmful behaviors (like vomiting); and anorexia nervosa, where people regularly eat too little due to a fear of gaining weight and thus are malnourished.

The causes of eating disorders are not clear but both biological and environmental factors are thought to play a role. Eating disorders typically begin in adolescence but it appears that the rate of the disorder may be on the rise in middle-aged and even older adults.

The peer-reviewed academic study analyzed data from 2,818 individuals treated in residential (RTC), partial hospitalization (PHP), and/or intensive outpatient (IOP) levels-of-care at a large eating disorder treatment organization; 471 (17%) of the participants identified as LGBT. The facilities were operated by Center for Discovery, a US healthcare provider specializing in the treatment of eating disorders.

Research shows that individuals who identify as lesbian, gay, bisexual, transgender, or other non-heterosexual/non-cisgender identities have significantly higher rates of mental and physical health conditions compared to their heterosexual, cisgender peers.

“LGBT individuals are more likely to experience housing and employment discrimination, and to struggle with multiple mental health challenges related to minority stress; this perfect storm of barriers means eating behaviors are often overlooked,” said Vaughn Darst, RD, who serves as Operations Advisor for Discovery Behavioral Health, Center For Discovery and who also discussed in a TedX talk the complex issue at the intersection of gender, body image, food and identity.

The study found a full 12-month delay in treatment for LGBT patients compared to non-LGBT patients.

“Delays in accessing treatment are especially widespread for transgender and nonbinary individuals with eating disorders. Some of the causes include delayed diagnosis by providers who fail to assess non-cisgender female patients for disordered eating, as well as limited access to trans-affirming treatment options, particularly at the residential level of care” said Darst.

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Health & Wellness

Most young people with increased suicide risk only display ‘mild to moderate’ mental distress – study

Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.

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The vast majority of young people who self-harm or experience suicidal thoughts appear to have only mild or moderate mental distress, instead of more obvious symptoms associated with a diagnosable disorder, according to a new study.

As such, measures to reduce suicide risk in young people should focus on the whole population, not just those who are most distressed, depressed or anxious, said Cambridge University researchers during Mental Health Awareness week.

They argue that the small increases in stress across the entire population due to the coronavirus lockdown could cause far more young people to be at risk of suicide than can be detected through evidence of psychiatric disorders.

“It appears that self-harm and suicidal thinking among young people dramatically increases well within the normal or non-clinical range of mental distress,” said Professor Peter Jones, senior author of the study from Cambridge’s Department of Psychiatry.

He added: “These findings show that public policy strategies to reduce suicide should support better mental health for all young people, not only those who are most unwell. Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.”

The Cambridge researchers conducted the study with colleagues from University College London. It was supported by the Wellcome Trust and the National Institute for Health Research, and is recently published in the journal BMJ Open.

Recent studies suggest a broad range of mental health problems – e.g. depression, anxiety, impulsive behaviour, low self-esteem, and so on – can be taken as a whole to measure levels of “common mental distress” (CMD).

Researchers analysed levels of CMD in two large groups of young people through a series of questionnaires.

They also separately collected self-reported data on suicidal thinking and non-suicidal self-injury: predictive markers for increased risk of suicide – the second most common cause of death among 10-24 year-olds worldwide.

Both groups consisted of young people aged 14-24 from London and Cambridgeshire. The first contained 2,403 participants. The study’s methods – and findings – were then reproduced with a separate group of 1,074 participants.

“Our findings are noteworthy for being replicated in the two independent samples,” said Jones.

CMD scores increase in three significant increments above the population average: mild mental distress, followed by moderate, and finally severe distress and beyond – which often manifests as a diagnosable mental health disorder.

Those with severe mental distress came out highest for risk of suicide. However, the majority of all participants experiencing suicidal thoughts or self-harming – 78% and 76% respectively in the first sample, 66% and 71% in the second – ranked as having either mild or moderate levels of mental distress.

“Our findings help explain why research focusing on high-risk subjects has yet to translate into useful clinical tools for predicting suicide risk,” said Jones. “Self-harm and suicidal thoughts merit a swift response even if they occur without further evidence of a psychiatric disorder.”

The findings point to a seemingly contradictory situation, in which most of the young people who take their own life may, in fact, be from the considerably larger pool of those deemed as low- or no-risk for suicide.

“It is well known that for many physical conditions, such as diabetes and heart disease, small improvements in the risks of the overall population translate into more lives saved, rather than focusing only on those at extremely high risk,” said Jones. “This is called the ‘prevention paradox’, and we believe our study is the first evidence that mental health could be viewed in the same way. We need both a public health and a clinical approach to suicide risk.”

Jones added that “we are surrounded by technology designed to engage the attention of children and young people, and its effect on wellbeing should be seen by industry as a priority beyond profit. At a government level, policies affecting the economy, employment, education and housing, to health, culture and sport must all take account of young people; supporting their wellbeing is an investment, not a cost. This is particularly important as the widespread effects of the Covid-19 pandemic unfold.”

Mental distress is – obviously – a big issue in the LGBTQIA community.

In 2018, for instance, a study found that 41% of non-binary people said they harmed themselves in the last year compared to 20% of LGBT women and 12% of GBT men. One in six LGBT people (16%) said they drank alcohol almost every day over the last year.

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Health & Wellness

Popular myths about organ transplants

It is estimated that every day in the US, organ transplants save 98 lives. Still, some of the myths about organ transplants make a significant portion of the population less likely to donate their organs.

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It is estimated that every day in the US, organ transplants save 98 lives. In the past, organ transplants were fraught with risk, but since then, the state of our medicine has tremendously improved. Still, some of the myths about organ transplants make a significant portion of the population less likely to donate their organs. 

What are the most common myths?

  • It is true that as years pass by, our bodies become weaker, but there is no age limit when it comes to becoming an organ donor. Sure, most likely, your organs won’t be as healthy when you get older, but it doesn’t mean that you shouldn’t become an organ donor just because you aren’t young anymore. You can save the lives of others no matter what age you are. In the case of organ transplants in the US, the oldest donor was 93 years old.
  • Likewise, even if you are suffering from medical conditions, it shouldn’t stop you from becoming an organ donor. Your organs might be unaffected by the illnesses that you have, or perhaps their state might still be better than those of the person that needs your help. Even if your health isn’t in perfect condition, it’s better to sign up to become an organ donor. After you are gone, the doctors will decide whether your organs are in good enough condition to be transplanted.
  • If you are afraid that, instead of saving someone else’s life, your organs will be sold for money to another person, then you don’t have to worry. Selling organs is illegal in the United States, which means that your worries are unwarranted.
  • Yet another argument that usually appears when people explain why they won’t become organ donors is that they are afraid that their organs will be taken away if they fall into a coma. This is untrue. Organs are not taken from the donors if they fall into a coma, and there is a possibility of recovery. Only when the doctors declare brain death can the organs be transplanted. You shouldn’t worry about it, as there is no chance of recovery from brain death.

The patients who wait for organ transplants often struggle with ways to minimize suffering during the waiting period. Since recently, in many American states, it is legal to buy and sell marijuana, it still doesn’t mean that some of the companies don’t conduct drug tests anymore. Thankfully, thanks to the scientists, it is possible to pass drug tests even if there is still THC in the body, using Quick Fix 6.2.

If you would like to learn more about the organ transplants, then check out this infographic, provided by Quick Fix Synthetic.

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Health & Wellness

Sexual risk behavior is reduced with involvement of parents, healthcare providers

Health care providers and parents have been valuable partners in managing adolescent sexual and reproductive health. But research has been limited concerning the efficacy of “triadic” interventions, or those implemented with parents and providers with the goal of reducing adolescent sexual risk behavior.

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Health care providers and parents have been valuable partners in managing adolescent sexual and reproductive health. But research has been limited concerning the efficacy of “triadic” interventions, or those implemented with parents and providers with the goal of reducing adolescent sexual risk behavior.

Now, a randomized clinical trial carried out under a grant by the National Institutes of Health shows the efficacy of a triadic intervention to postpone adolescent sexual debut and to promote condom use among adolescents aged 11 to 14 years.

Published in Pediatrics, the study – “A Triadic Intervention for Sexual Health: A Randomized Clinical Trial” – was conducted by Vincent Guilamo-Ramos, director of the Center for Latino Adolescent and Family Health (CLAFH) at the Silver School of Social Work at New York University and a nurse practitioner specializing in adolescent sexual and reproductive health care at the Adolescent AIDS Program at Children’s Hospital at Montefiore.

The study’s coauthors include Adam Benzekri (CLAFH); Marco Thimm-Kaiser (CLAFH and the CUNY School of Public Health and Health Policy); Patricia Dittus (Centers for Disease Control and Prevention, Division of STD Prevention); Yumary Ruiz (Purdue University and CLAFH); Charles M. Cleland (NYU Langone), and Dr. Wanda McCoy (Morris Heights Health Center, Bronx, NY).

The researchers evaluated Families Talking Together (FTT), a triadic intervention developed by Dr. Guilamo-Ramos and colleagues designed to reduce adolescent sexual risk behavior and address persistent disparities in unplanned teen pregnancies as well as sexually transmitted infections such as HIV/AIDS.

Adolescents aged 11-14 and their female caregivers were recruited from a Bronx, N.Y., pediatric clinic, and 900 families enrolled in the study. The Families Talking Together intervention consists of a 45-minute face-to-face session for mothers, health care provider endorsement of the intervention content, FTT family communication workbook for families, and a booster phone call for mothers.

To evaluate the FTT intervention, assessments were conducted initially (baseline), three months later, and a year later, asking whether adolescents engaged in vaginal intercourse, made their sexual debut within the past 12 months, and used a condom in their last sexual encounter.

  • At 12-month follow-up, 5.2% of adolescents in the experimental group (those participating in the Families Talking Together intervention program) reported having had sexual intercourse, compared to 18.0% of adolescents in the control groups, who did not receive the FTT intervention.
  • In the experimental group, 4.7% of adolescents reported sexual debut within the past 12 months, compared to 14.7% of adolescents in the control group.
  • In the experimental group, 74.2% of sexually active adolescents indicated using a condom at last sex, compared to 49.1% of sexually active adolescents in the control group.

“The research suggests that the FTT triadic intervention is efficacious in delaying sexual debut and reducing sexual risk behavior among adolescents,” according to the study.

The findings are particularly important since FTT addresses the important role of parents in shaping adolescent sexual and reproductive health while respecting adolescent autonomy and confidentiality in healthcare, making FTT an innovative solution to respond to calls from parents and national health organizations for more parental involvement in adolescent SRH care.

It is worth noting that parenting involving LGBTQIA youth is reported to be harder.

For instance, a 2018 study – which included 44 parents of LGBT teens between the ages of 13 and 17 – noted how parents faced many challenges in trying to educate their teens about sex, including their general discomfort in talking about it, and feeling unable to offer accurate advice about safe LGBT sex.

Meanwhile a 2019 study noted that as it is, parent-child discussions about sexual health and sexual identity are complicated, but this is even more particular with a male teen who identifies as gay, bisexual, or queer (GBQ). The research from the University of Pennsylvania shows that even as parents become savvier in these conversations, departing from gender stereotypes and embracing more accepting attitudes, factors beyond the home will still affect the message parents convey and their child hears.

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