Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds « Swansea University

shutterstock_165510029
Antidepressant prescribing amongst children and young people has shown a significant increase of 28% in the past decade, even though recorded diagnoses of depression have gone down, according to new research published today.

One in ten children and young people suffer from some kind of mental health problem, including depression and anxiety. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.

The research, published in Psychological Medicine, and carried out by a team which included several Swansea University experts, was led by Ann John, associate professor at Swansea University Medical School, who is also a qualified GP. The team looked at data from 358,000 registered patients between 6 and 18 years old, living in Wales, UK, between 2003 and 2013. The data was drawn from GPs and other NHS primary care services.

The research found that:
• Antidepressant prescribing rose significantly, by 28%, mainly in older adolescents
• Depression diagnoses showed a steady decline by just over a quarter, while symptoms of depression more than doubled
• Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose
• Just over half of new antidepressant prescriptions were associated with depression. The rest were associated with diagnoses such as anxiety and pain

The findings led the researchers to call for new strategies to implement current guidance for managing depression in children and young people.

Dr Ann John, associate professor at Swansea University Medical School, said: “These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.

The main issue is whether they being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.

Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”

Dr John underlined the importance of responding appropriately to the needs of young people:

“The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses- stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated.

Teenagers may be moving into adulthood without many of the skills necessary to deal with these issues if we don’t manage them well at an early age.

It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.

We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given. If an antidepressant is required, fluoxetine should be the first option.”

via Swansea University – Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds

The full paper, published in Psychological Medicine, “Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study” by A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan and K. Lloyd has been published Open Access and can be viewed here free of charge.

Do higher vitamin E levels have a protective effect on pulmonary condition in Cystic Fibrosis?

The  July Nutrition  Paper of the Month is entitled ‘Vitamin E intake, The affect of  levels and pulmonary function in children and adolescents with cystic fibrosis’

Cystic fibrosis (CF) is a life-threating genetic disorder, characterised by chronic pulmonary inflammation that causes a gradual, progressive decline in pulmonary function, partly due to oxidative stress. Most patients have pancreatic insufficiency, leading to intestinal malabsorption of fat and fat-soluble vitamins. Therefore, lifelong treatment with fat-soluble vitamins such as vitamin E has become standard care.

It has been suggested that higher vitamin E levels, expressed as serum α-tocopherol levels, have a protective effect on pulmonary condition in CF. However, serum α-tocopherol levels are compromised during a pulmonary exacerbation and recover with resolution of the inflammation. Likewise, chronic pulmonary inflammation may reduce levels, and the suggested association between vitamin E levels and pulmonary function might be secondary.

Whether current recommendations for vitamin E supplementation are optimal for preventing deficiency and whether higher serum α-tocopherol levels have beneficial effects on pulmonary function are subjects of debate. The present paper studied the association between vitamin E intake (dietary intake plus prescribed supplementation), the coefficient of fat absorption and chronic inflammation on serum α-tocopherol levels, and the long-term effect of both serum α-tocopherol levels and chronic inflammation on pulmonary function in paediatric patients with CF.

Results

In our study sample, we found no clear effect of vitamin E intake, the coefficient of fat absorption or chronic inflammation on serum α-tocopherol levels. Moreover, patients with CF received vitamin E supplementation at half the CF-specific recommended dosage; nevertheless, serum α-tocopherol levels were normal.

Furthermore, we found that chronic inflammation was inversely associated with pulmonary function and we found no association between serum α-tocopherol levels and pulmonary function. Paradoxically, we even found an overall trend towards a lower pulmonary function in those with higher serum α-tocopherol levels.

Conclusions

Our results suggest that the CF-specific vitamin E recommendations are higher than necessary to prevent deficiencies. Therefore, vitamin E dosages of 50% of the recommendations could be used, at least initially. We found no evidence that higher serum α-tocopherol levels had protective effects on pulmonary function in paediatric patients with CF. Moreover, the finding of higher serum α-tocopherol levels in patients with lower pulmonary function casts doubt on the hypothesis that vitamin E has therapeutic benefits.

This paper is freely acvailablke via the following link for one month: journals.cambridge.org/ns/jul15

Authors: Janna W. Woestenenk, Nancy Broos, Rebecca K. Stellato, Hubertus G. M. Arets, Cornelis K. van der Ent and Roderick H. J. Houwen

Nutrition Society Paper of the Month

Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science). This paper is freely available for one month.

Pregnant women lack guidance on iodine intake levels


Pregnant women are not getting enough information about the need to include iodine in their diets, despite high awareness of general advice for pregnancy nutrition.

While 96% of pregnant women surveyed by researchers were aware of general nutritional recommendations for pregnant women, only 12% were aware of iodine-specific advice.

The study, published in the British Journal of Nutrition, estimated the median intake of iodine during pregnancy was 190 micrograms (ug) per day, with 74% consuming less than the World Health Organisation (WHO) recommended intake of 250ug daily.

Iodine is required for the production of thyroid hormones, which are crucial for fetal development with links between iodine deficiency and developmental impairments.

Dr Emilie Combet, who led the reserch at the University of Glasgow, said: “Women aren’t receiving the message about the importance of iodine in pregnancy, meaning they cannot make informed choices to ensure they get the amount they require.”

Iodine deficiency affects 1.9 billion people globally and is the most preventable cause of intellectual disability. The UK is ranked 8th in a list of iodine-deficient countries in the world.

The main sources of iodine-rich foods are seafood and dairy products, and in some countries iodine-fortified salt or bread. In the UK, the Reference Nutrient Intake (RNI) for adults is 140ug per day, with no proposed increment for pregnant and lactating women.

Unborn children and young infants are entirely reliant on their mother for iodine supply, making babies and pregnant or lactating mothers the most vulnerable groups of the population.

At present there is no recommendation for routine iodine supplementation in the UK unlike folic acid and Vitamin D, or routine testing in pregnancy that would reflect iodine levels, as there is with iron.

The study surveyed 1,026 women across the UK who were pregnant or mothers of children aged up to 36 months. Participants were asked about their awareness of nutritional guidelines and completed a food frequency questionnaire.

Knowledge of iodine-rich foods was low, with 56% unable to identify any iodine-rich food and the majority wrongfully believing dark green vegetables and table salt had high levels. Most, 84% were unaware that iodine from diet is important for the healthy development of the unborn baby, and only 11% had heard about iodine from a healthcare professional.

Dr Combet said: “Iodine is crucial during pregnancy and the first months of life, to ensure adequate brain development, but achieving over 200ug a day of iodine through diet requires regular consumption of iodine-rich foods such as milk and sea fish. Not everyone will have the knowledge, means or opportunity to achieve this.

“There is an ongoing debate as to whether there should be some form of fortification of food with iodine. Iodine-fortified salt is common in other countries, but using salt as the delivery method has raised concerns since it is perceived to clash with public health messaging around reducing salt intake to combat high blood pressure. However, other countries have demonstrated that both measures could be held simultaneously. We need to work toward a solution.

“The most important issue to come from this study, however, was the lack of awareness of the important role iodine plays in fetal development and how to consume adequate levels of this essential mineral. This is something that needs to be addressed. Our current Yorkhill Children Charity – funded project us developing tools and resources for health care professionals and women either pregnant or planning a pregnancy.”

This paper is freely available for 2 weeks

Related links

Dr Emilie Combet: researcher profile

Media enquiries: stuart.forsyth@glasgow.ac.uk / 0141 330 4831

The importance of Youth Mental Health

young children jumping_2

Find out the Guest Editors’ (Mary Cannon and John Lyne) response to questions about youth mental health following a recent special issue in Irish Journal of Psychological Medicine.

What is Youth Mental Health?

Youth Mental Health refers to mental health among adolescents and young adults. The time period covered by the term “youth mental health” typically ranges between 15-25 years of age though some would advocate that this should extend from 12-30 years. Youth mental health focuses on the well-being of young people, and aims to ensure that young people transition between childhood and adulthood with positive mental health. With this in mind a recently published issue of the Irish Journal of Psychological Medicine provided a focus on mental health during this youth phase of people’s lives.

Why highlight the Youth Mental Health agenda?

It is now recognised that many so-called “adult” mental health difficulties have their origins during adolescence and young adulthood. An illness prevention focus has been very effective in reducing the prevalence of some illnesses, such as heart attacks and cancers, however similar strategies have lagged behind in the field of mental health. Appropriate help for young people early in their lives has the potential to reduce later mental health morbidity. However, despite the high levels of mental health issues among young people, services for this age-group remain fragmented and difficult to access.  The delivery of tailored youth-friendly services could help address this need and is a particular focus of youth mental health advocates.

Why publish this special issue now?

This Special Issue follows on from the adoption of Youth Mental Health as the official annual theme by the College of Psychiatry of Ireland in 2013. Several annual Youth Mental Health Research conferences have been held in Ireland since 2011, establishing Ireland as one of the leading international countries in the field of youth mental health. This special issue aims to harness the large amount of research activity in this area in Ireland and internationally.

What does the issue include?

Scientific papers were contributed by several high profile national and international researchers. New data papers are included which report the prevalence of mental disorders among young Irish adults. Risk and protective factors for mental illness in young people and the importance of early intervention in psychosis and bipolar disorder are also addressed.  Editorials and perspective pieces by experts in the field address the challenges in providing seamless care during transition from childhood to adulthood, and give examples of youth services developed in United Kingdom, Canada and Ireland. Overall this special issue brings together high quality research which highlights that youth mental health should be prioritised on health policy agendas.

 

Read the full contents of the special issue free of charge here for a limited time period

If you are using a mobile device please click here to view the issue

 

A looming danger…

shutterstock_222042955 - loom bands
This paper reports on four paediatric patients who presented with a loom band associated foreign body in the nose over a 7-day period at a district general hospital in Scotland. The patients were two three-year old and two four-year old children with either loom bands or the S-shaped hooks in their noses.

There has been a surge in the popularity of loom bands amongst children in recent months. These small rubber bands, which can be woven together to make colourful bracelets and necklaces, have become the world’s most popular toy. Foreign bodies in paediatric nasal and aural cavities are a common presentation to ENT units across the country. Whilst most are removed without incident, foreign bodies in nasal passages represent a potential risk for inhalation, leading to airway obstruction.

Two of the cases resulted in the item being removed with local anaesthetic and forceps, and in one case, forceps without anaesthetic. In the fourth case, the hook was originally visible deep within the nasal passage, but partial inhalation into the posterior nasal passage meant that the hook was no longer visible. Whilst waiting for a senior medical review, the patient was observed to choke.  After examination, it was assumed that the patient had ingested the foreign body and after a short period of observation, the patient was released.

Although the four cases presented were resolved without the need for general anaesthetic, the ever-soaring prevalence and popularity of loom bands necessitates a degree of caution and vigilance from parents, retailers and manufacturers alike.

The authors said, “Foreign body airway obstructions in children are potentially avoidable, life-threatening events. The case series presented reflects a poor public understanding of the complications of inhaled foreign bodies in children and limited hazard advertising by the manufacturers of loom bands. There is a great urgency to rectify this in light of the ever-increasing popularity and availability of loom bands.”

 

 The full paper, published in The Journal of Laryngology & Otology, “Loom bands and young children – a tragedy waiting to happen?” by I R M Bohler, C Douglas and S Ansari, can be viewed free of charge here for a limited period.

Explore the online archive of AGMG

AGMG cover-1
Cambridge University Press and Twin Research and Human Genetics (TRHG) are proud to announce the release of the online archive of AGMG, the predecessor journal to TRHG. AGMG was the official journal of the International Society for Twin Studies (ISTS) from 1952-1998 when TRHG took over this role. However, both journals have always had a wider interest in the field of human genetics.

Twins can provide unique and powerful opportunities to study genetic and environmental factors that make people differ in how they look, behave and how healthy they are. Monozygotic [identical] twins share all their genetic variation and dizygotic [non-identical] twin pairs, on average, share about 50% of their genetic variation. Both types of twin pairs often but not always share similar pre- and post-natal environments as well. Having twins participate in these studies helps to continue important research for common human conditions such as diseases, health, and behaviors, leading to advances in science, medicine and future potential therapies.

Much effort has gone into creating this digitised archive and making it available online to the research community because we believe that many of the classic papers published in AGMG reveal the academic foundations of the subject and still have relevance today. Below is a link to the 20 most cited papers from the AGMG archive to demonstrate the wide scope of interest. We encourage you to explore and enjoy this fascinating resource.

View the 20 most-cited papers from the AGMG archive here .

The papers cover a wide spectrum of topics and include the following articles:

  • Population-Based Twin Registries: Illustrative Applications in Genetic Epidemiology and Behavioral Genetics from the Finnish Twin Cohort Study (1990)
  • Resting Metabolic Rate in Monozygotic and Dizygotic Twins (1985)
  • Causes of Variation in Drinking Habits in a Large Twin Sample (1984)
  • The Vanishing Twin (1982)

 

Autism rates steady for two decades

shutterstock_197545553

A University of Queensland study has found no evidence of an increase in autism in the past 20 years, countering reports that the rates of autism spectrum disorders (ASDs) are on the rise.

The study was led by Dr Amanda Baxter from UQ’s Queensland Centre for Mental Health Research at the School of Population Health, and was a first-of-its-kind analysis of research data from 1990 to 2010. Dr Baxter and her colleagues found that rates had remained steady, despite reports that the prevalence of ASDs was increasing.

“We found that the prevalence of ASDs in 2010 was one in 132 people, which represents no change from 1990,” Dr Baxter said.

“We also found that better recognition of the disorders and improved diagnostic criteria explain much of the difference in study findings over time.”

Part of the Global Burden of Disease project, this is the largest study to systematically assess rates and disability caused by ASDs in the community, using data collected from global research findings in the past 20 years.

ASDs are chronic, disabling disorders that stem from problems with brain development. They affect people from a young age and are among the world’s 20 most disabling childhood conditions.

The study shows that about 52 million children and adults around the globe meet diagnostic criteria for an ASD.

Dr Baxter said researchers hoped the study would help guide health policy and improve support for those with ASD and their families.

“As ASDs cause substantial lifelong health issues, an accurate understanding of the burden of these disorders can inform public health policy as well as help allocate necessary resources for education, housing and employment.”

The study was a collaboration with the University of Leicester and the University of Washington’s Institute for Health Metrics and Evaluation, and is published in the journal Psychological Medicine.

 

The full paper “The epidemiology and global burden of autism spectrum disorders” can be viewed free of charge for a limited time here.

 

%d bloggers like this: