Category: Mental Health

Workplace Injury: Musculoskeletal Conditions & Mental Illness

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Research Paper Title

Prevalence of serious mental illness and mental health service use after a workplace injury: a longitudinal study of workers’ compensation claimants in Victoria, Australia.

Background

Serious mental illness is common among those who have experienced a physical workplace injury, yet little is known about mental health service use in this population.

This study aims to estimate the proportion of the workplace musculoskeletal injury population experiencing a mental illness, the proportion who access mental health services through the workers’ compensation system and the factors associated with likelihood of accessing services.

Methods

A longitudinal cohort study was conducted with a random sample of 615 workers’ compensation claimants followed over three survey waves between June 2014 and July 2015.

The primary outcome was receiving any type of mental health service use during this period, as determined by linking survey responses to administrative compensation system records for the 18 months after initial interview.

Results

Of 181 (29.4%) participants who met the case definition for a serious mental illness at one or more of the three interviews, 75 (41.4%) accessed a mental health service during the 18-month observation period.

Older age (OR=0.96, 95% CI 0.93 to 0.99) and achieving sustained return to work (OR=0.27, 95% CI 0.11 to 0.69) were associated with reduced odds of mental health service use.

Although not significant, being born in Australia was associated with an increased odds of service use (OR=2.23, 95% CI 0.97 to 5.10).

Conclusions

The proportion of injured workers with musculoskeletal conditions experiencing mental illness is high, yet the proportion receiving mental health services is low.

More work is needed to explore factors associated with mental health service use in this population, including the effect of returning to work.

Reference

Orchard, C., Carnide, N., Mustard, C. & Smith, P.M. (2020) Prevalence of serious mental illness and mental health service use after a workplace injury: a longitudinal study of workers’ compensation claimants in Victoria, Australia. Occupational and Environmental Medicine. pii: oemed-2019-105995. doi: 10.1136/oemed-2019-105995. [Epub ahead of print].

CNS Endothelium: Respiratory & Affective Disorders associated with Vascular Diseases

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Research Paper Title

Impaired endothelium-mediated cerebrovascular reactivity promotes anxiety and respiration disorders in mice.

Background

Carbon dioxide (CO2), the major product of metabolism, has a strong impact on cerebral blood vessels, a phenomenon known as cerebrovascular reactivity.

Several vascular risk factors such as hypertension or diabetes dampen this response, making cerebrovascular reactivity a useful diagnostic marker for incipient vascular pathology, but its functional relevance, if any, is still unclear.

Here, the researchers found that GPR4, an endothelial H+ receptor, and endothelial Gαq/11 proteins mediate the CO2/H+ effect on cerebrovascular reactivity in mice. CO2/H+ leads to constriction of vessels in the brainstem area that controls respiration.

The consequential washout of CO2, if cerebrovascular reactivity is impaired, reduces respiration.

In contrast, CO2 dilates vessels in other brain areas such as the amygdala. Hence, an impaired cerebrovascular reactivity amplifies the CO2 effect on anxiety.

Even at atmospheric CO2 concentrations, impaired cerebrovascular reactivity caused longer apneic episodes and more anxiety, indicating that cerebrovascular reactivity is essential for normal brain function.

The site-specific reactivity of vessels to CO2 is reflected by regional differences in their gene expression and the release of vasoactive factors from endothelial cells.

This data suggests the central nervous system (CNS) endothelium as a target to treat respiratory and affective disorders associated with vascular diseases.

Reference

Wenzel, J., Hansen, C.E., Bettoni, C., Vogt, M.A., Lembrich, B., Natsagdorj, R., Huber, G., Brands, J., Schmidt, K., Assmann, J.C., Stölting, I., Saar, K., Sedlacik, J., Fiehler, J., Ludewig, P., Wegmann, M., Feller, N., Richter, M., Müller-Fielitz, H., Walther, T., König, G.M., Kostenis, E., Raasch, W., Hübner, N., Gass, P., Offermanns, S., de Wit, C., Wagner, C.A. & Schwaninger, M. (2020) Impaired endothelium-mediated cerebrovascular reactivity promotes anxiety and respiration disorders in mice. Proceedings of the National Academy of Sciences of the United States of America. 117(3), pp.1753-1761. doi: 10.1073/pnas.1907467117. Epub 2020 Jan 2.

Do Individuals who are Suicidal have Unusual Patterns of Brain Activity?

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Individuals who are suicidal seem to have unusual patterns of brain activity.

The differences are not big enough to identify those who may try to kill themselves, however, the researchers hope it will provide them with more information about what may be happening in terms of brain mechanisms (Schmaal et al., 2019).

The finding comes from a review of 131 brain-scan studies, comprising more than 12,000 people. The study looked to see whether there are distinctive patterns of brain activity in those who had made suicide attempts or had been thinking about suicide.

Most of these studies compared individuals with a certain mental health condition, such as depression, who had a history of suicidal behaviour, with a similar group with that condition who had not become suicidal, or with individuals without mental health problems.

The researchers found that two brain networks appear to function differently:

  • The first of these involves areas at the front of the head known as the medial and lateral ventral prefrontal cortex and their connections to regions involved in emotion. This may lead to difficulties regulating emotions.
  • A second involves regions known as the dorsal prefrontal cortex and inferior frontal gyrus system, which play a role in decision making.

However, the differences in these networks may just reflect that individuals who are suicidal are in more distress, rather than indicating specific thoughts of suicide.

Reference

Wilson, C. (2019) Suicidal Behaviour Linked to Two Brain Networks. New Scientist. 07 December 2019, pp.16.

Schmaal, L>, van Harmelen, A-L., Chatzi, V., Lippard, E.T.C., Toenders, Y.J., Averill, L.A., Mazure, C.M. & Plumberg, H.P. (2019) Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Molecular Psychiatry. 25, pp.408-427. https://www.nature.com/articles/s41380-019-0587-x

Did you know that Mental Health Sites Share User Data with Ad Firms?

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Mental health websites are sharing user data with advertisers, including the results of tests for depression.

This means that individuals seeking information or help for mental health conditions can be targeted with adverts while they may be vulnerable.

Researchers, from Privacy International based in London, looked at 136 of the most popular websites in the UK, France and Germany that provide resources and information about mental health conditions.

The researchers found that 76% of the websites contained third party marketing trackers. These collect information about a user and can track them as they browse other sites.

This can be combined into a detailed profile.

Many of the pages had trackers from Google, Facebook and Amazon and shared information with data brokers – firms that aggregate information and sell individual profiles to other organisations – and advertising companies.

Commentators state that it is currently (almost) impossible to seek information and help about depression without advertisers knowing.

Knowing who is depressed and when allows advertisers to target people when they are at their most vulnerable.

Advertisers target users based on their personal data, such as their IP address and location, and the site they visit. Some sites also have real-time bidding, where information, including a page’s content and URL, is used to instantaneously show a relevant ad on the page.

Several websites with questionnaires about depression stored users’ answers and shared them with third parties.

When the researchers first analysed the UK’s National Health Service (NHS) website in September 2019, they found that a mood self-assessment quiz shared individual answers, test scores and the test URL with Adobe for analysis purposes. However, the NHS website has since updated its privacy policy so users now need to manually opt in to be tracked.

The researchers also found that doctissimo.fr, one of France’s most popular health websites, sent unique user identifiers and answers to a data collection firm. They basically send all of an individuals answers to the test to a third party that is named nowhere on their website, and nowhere in their privacy policy. A perfect example of abusing someone’s confidence.”

Under the European Union’s General Data Protection Regulation (GDPR), websites and apps are required to obtain consent before tracking users.

Data relating to physical or mental health is considered a “special category” and can only be processed with explicit consent or for relevant other reasons.

Reference

Lu, D. (2019) Mental Health Sites Share User Data with Ad Firms. New Scientist. 07 December 2019, pp.9.

Analysing Voluntary Admission Rates for Patients with Schizophrenia

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Research Paper Title

Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis.

Background

Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia.

Methods

PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model.

Results

Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %).

Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily.

Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate.

Conclusions

Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia.

With the continuing liberalisation of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.

Reference

Yang, Y., Li, W., Lok, K.I., Zhang, Q., Hong, L., Ungvari, G.S., Bressington, D.T., Cheung, T. & Xiang, Y.T. (2019) Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian Journal of Psychiatry. 48:101902. doi: 10.1016/j.ajp.2019.101902. [Epub ahead of print].

Are Mental Health Apps Worthwhile?

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Among the hundreds of thousands of apps available for health and fitness, among many others, millions of us have downloaded mental health apps for everything from breathing exercises to guided meditation.

However, a recent analysis now suggests that almost everyone gives up on such apps in just two weeks.

Amit Baumel (2019), at the University of Haifa in Israel and his colleagues, analysed the use of 93 popular mental health apps.

The data suggests that, after 15 days, more than 94% of users had stopped opening their apps.

Baumel and colleagues only studied apps that are available in English and that have been installed at least 10,000 times via the Google Play store.

App use differed depending on the kind of support provided.

On any given day, just over 4% of individuals who have downloaded mindfulness or meditation apps will use them. However this figure is 17% among those who have installed peer-support apps, which enable individuals to talk to someone who may be experiencing similar issues.

The team did not reveal which apps were included in the analysis, but the findings raise questions over how useful mental health apps are.

It is currently unknown how often an individual needs to use such apps for them to be effective.

Baumel and colleagues study confirms what the clinical community has known for a long time: a lot of individuals abandon these apps.

However, it should be noted that a low engagement rate does not necessarily mean mental health apps do not work – it could be an indication of how curious we are about these apps, and how easy it is to download them.

References

Baumel, A., Muench, F., Edan, S. & Kane, J.M. (2019) Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis. Journal of Medical Internet Research. 21(9), e14567. https://www.jmir.org/2019/9/e14567/.

New Scientist. (2019) People Quickly Abandon Mental Health Apps. New Scientist. 16 November 2019, pp.14.

Does Depression Alter Brain Structure?

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Research suggests our brain looks different if we have depression.

These differences seem to be caused by depression, rather than precede it.

When neuroscientists compare the brains of individuals with and without depression, there are common dissimilarities.

For example, individuals with depression tend to have a smaller hippocampus, a brain region important in forming memories.

However, it has been difficult to work out whether such differences cause the symptoms of depression or result from the disorder.

To try and find out which, Heather Whalley and her colleagues at the University of Edinburgh made use of two huge genetic databases.

  • Consumer genetic testing company 23andMe holds information on the DNA and depressive symptoms of tens of thousands of individuals; and
  • The UK Biobank collects DNA, lifestyle and behaviour questionnaires and brain scans from thousands more.

Whalley and colleagues used this, as well as earlier research, to create a polygenic risk score (PRS) for depression (A PRS assigns weight to various genetic factors thought to contribute to the risk of a condition).

They made sure the PRS worked by testing it in a separate group of 11,214 people. They then assessed the brain scans and behaviour records of individuals with a PRS that put them at risk of depression. Individuals with higher genetic risk tended to have less white matter in their brains, and it did not seem to function as well. White matter is the tissue that makes up most of our brains.

Whalley and her colleagues then analysed how closely both brain structure and symptoms of depression were related to genetic factors.

Genes are present from birth, so if genetic factors are more closely linked to symptoms, for example, that suggests the symptoms were present before the brain structure differences.

They found that many brain differences appear to be caused by depression. There was one exception: differences in a brain structure called the anterior thalamic radiation appear to come before depression (Shen, Howard & Adams, 2019).

This suggests the genes that puts an individual at risk of depression do so via this structure.

Whalley’s team also found that a combination of childhood trauma and poverty leaves individuals at greatest risk of depression.

Behaviours linked to depression could end up impacting the brain’s white matter connections more generally. It might be that patients with depression do not use some of the brain connections that others would use.

Being socially withdrawn, or focusing more on the negative than the positive, could have an effect. For example, it is known that if we do not use a pathway in the brain, that pathway starts to shrink.

References

Hamzelou, J. (2019) Depression Alters Brain Structure. New Scientist. 19 October 2019, pp.16.

Shen, X., Howard, D.M. & Adams, M.J. (2019) A phenome-wide association and Mendelian Randomisation study of polygenic risk for depression in UK Biobank. Available from World Wide Web: https://www.biorxiv.org/content/10.1101/617969v1. [Accessed: 31 January, 2020].

Are Community-Based Psychiatric Services Essential to Mental Health?

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Research Paper Title

The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes?

Background

Community-based psychiatric services are essential to mental health.

For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care.

Cross-national data from the World Health Organisation call this presumption into question.

Community and hospital psychiatry appear to be complements, not substitutes.

Reference

Perera, I.M. (2020) The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes? Psychiatric Services (Washington, D.C.). doi: 10.1176/appi.ps.201900086. [Epub ahead of print].

Feeling the Pain: Substance Misuse & Generalised Anxiety Disorder

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Research Paper Title

An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey.

Background

Chronic pain and generalized anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse.

However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse.

The aim of this article was to examine the associations between comorbid GAD and chronic pain conditions compared to GAD only with non-medical opioid use, drug abuse/dependence, and alcohol abuse/dependence in a Canadian, population-based sample.

Methods

Data came from the 2012 Canadian Community Health Survey-Mental Health (N = 25,113). Multiple logistic regressions assessed the associations between comorbid GAD and chronic pain conditions (migraine, back pain, and arthritis) on substance misuse.

Results

Comorbid GAD + back pain and GAD + migraine were associated with increased odds of non-medical opioid use compared to GAD only.

However, the relationship was no longer significant after controlling for additional chronic pain conditions.

No significant relationship was found between GAD + chronic pain conditions with drug or alcohol abuse/dependence.

Conclusions

Comorbid GAD + back pain and GAD + migraine have a unique association with non-medical opioid use in Canadians compared to GAD only, and chronic pain multi-morbidity may be driving this relationship.

Results emphasise the need for screening for substance misuse and prescription access in the context of GAD and comorbid chronic pain.

Reference

Bilevicius, E., Sommer, J.L., Keough, M.T. & El-Gabalawy, R. (2020) An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey. Canadian Journal of Psychiatry. doi: 10.1177/0706743719895340. [Epub ahead of print].

Meditation & Mindfulness

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“Explain your work in one easy paragraph.

I am a Buddhist monk who teaches meditation and mindfulness. I’m interested in the application of Buddhist philosophy to the problems of modern life. Meditation is training for the mind, helping us become less controlled by stressful thoughts and emotions. Mindfulness brings the benefits of meditation into daily life. I am also interested in the interface between Buddhism and science, and I frequently collaborate with neuroscientists and medics.

How did you become a monk?

I had an extreme burnout 26 years ago due to high levels of stress, and I went to a Buddhist monastery to find answers. I loved it so much, I decided to remain a monk.

Did you have to overcome any particular challenges to get where you are today?

I used to have bouts of depression and anxiety, so my journey has involved quite a few rocky patches. I do, however, feel that these struggles have helped me to grow and discover valuable knowledge that I can share with others.” (Thubten, 2019, p.56).

Reference

Thubten, G. (2019) The Back Pages: The Q&A. New Scientist. 05 October 2019.