Danish Suicide Prevention Clinics prevent more than deaths by suicide

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This post was written by Johannes Birkbak and Annette Erlangsen.

A new Danish study finds that psychosocial therapy for suicide prevention does more than preventing deaths by suicide. The treatment also reduces risk of death by other causes.

Mental and physical well-being are interrelated. People at risk of suicide have a considerably increased risk of dying, not only by suicide, but also by other causes of death.

A group of Danish researchers examined causes of death among nearly 6,000 persons who, following an episode of deliberate self-harm, received psychosocial therapy at one of the Danish Suicide Prevention Clinics. The group who received the intervention was compared to people receiving standard care following an episode of deliberate self-harm. Psychosocial therapy was associated with a 37% decrease in alcohol-related deaths as well as in deaths due to injuries and accidents. The risk of dying by a heterogeneous group of medical causes was reduced by 39%, while the risk of dying by suicide was reduced by 28%.

“This is the first European study to show improvements in mortality among persons who have received psychosocial therapy after deliberate self-harm. While we knew that the treatment in the Suicide Prevention Clinics does more than prevent suicidal behavior, we found it important to uncover what additional causes of death were prevented by the intervention,” says Johannes Birkbak, M.D., from the Danish Research Institute of Suicide Prevention, Mental Health Centre Copenhagen.

In conjunction with other research in this area, the results indicate that psychosocial therapy might enable patients to revise their coping strategies and, as a possible result, improve their general lifestyle, which might explain the mortality reductions.


About the study:

The study compares 5,678 people who received psychosocial therapy at a Suicide Prevention Clinic after an episode of deliberate self-harm with people who received standard care following an episode of deliberate self-harm. The multi-center study enrolled users from seven of the regional Suicide Prevention Clinics in Denmark during 1992-2011.

Using data from the national Danish registers, the researchers followed the treatment group and the control group for up to 20 years, and all deaths and causes of death were registered.

Given that the study evaluated an already established intervention after self-harm, it was not possible to randomise the patients. To account for this, a comparison group was selected to match the treatment group on 31 different factors using propensity score matching. The treatment group and the control group are comparable on factors such as age, sex, social background and clinical factors.

The study found that psychosocial therapy was associated with reduced risk of death by suicide, injuries and accidents, mental disorders, alcohol-related causes as well as a group of heterogeneous medical causes. Deaths caused by cancer and diseases of the circulatory system were not significantly reduced.

The study was designed and carried out by the Danish Research Institute for Suicide Prevention.

The full paper “Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching” by Johannes Birkbak, Elizabeth A Stuart, Bertel Dam Lind, Ping Qin, Elsebeth Stenager, Kim Juul Larsen, August G Wang, Ann Colleen Nielsen, Christian Møller Pedersen, Jan-Henrik Winsløv, Charlotte Langhoff, Charlotte Mühlmann, Merete Nordentoft, Annette Erlangsen can be read free of charge for a limited time here.

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

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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.

Early screening spots emergency workers at greater risk of mental illness

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Study offers new direction for preventative interventions to increase mental resilience to stress and trauma

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. That’s the conclusion of a Wellcome Trust funded study carried out with trainee paramedics.

Researchers from the University of Oxford and King’s College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services. Their results are published in the journal Psychological Medicine.

Dr Jennifer Wild from the University of Oxford explained: ‘Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.’

The researchers followed a group of around 400 new ambulance staff through the first two years of their three-year training period. During the initial six-week classroom phase of the training, the students were given a number of assessments to establish their thinking styles, coping behaviour, psychiatric history and personality traits.

Follow up sessions were carried out every four months for the next two years to see if any of the participants had had PTSD or depression. After two years, a final assessment looked at quality of life, as well as smoking, alcohol and drug use, days off work, weight change, burnout and insomnia.

Professor Anke Ehlers said: ‘While just under one in five experienced PTSD or depression in the two years, most got better by the next four-month follow-up.

‘However, there were still lasting effects. Those who had reported mental ill health were more likely to have sleep problems at 2 years. They were also more likely to have days off work. Paramedics who developed an episode of PTSD were also more likely to report gaining weight and smoking.’

The team found that even accounting for past psychiatric history, people were more likely to experience PTSD and depression if they had lower perceived resilience to trauma, or if they dwelled on stressful events from the past before they started their training.   Significantly, the number of traumatic incidents they experienced could not be used to predict PTSD but was relevant to predicting MD, suggesting a cumulative risk of different exposures to trauma for depression.

Dr Wild said: ‘This is not about screening out particular people in training. Early assessment means that those who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences. That has the potential to reduce episodes of PTSD and major depression and improve the long term health of a valued and essential workforce.’

The full paper has been published Open Access in Psychological Medicine, ‘A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression’ by  J. Wild et al. can be viewed here free of charge.

Source: Early screening spots emergency workers at greater risk of mental illness- University of Oxford/News

Better Diet Quality may Improve Cognition in Children

Author: Eero Haapala

A recent Finnish study shows that better diet quality is related to better cognitive performance among 6–8 year old children. The results published in the British Journal of Nutrition are part of the Physical Activity and Nutrition in Children (PANIC) Study conducted at the University of Eastern Finland. The study investigated the relationships of the Baltic Sea type and the Dietary Approaches to Stop Hypertension (DASH) dietary patterns to cognition in a population based sample of 428 children aged 6–8 years. Stricter adherence to the Baltic Sea type and the DASH dietary patterns, indicated by a higher consumption of vegetables, fruit and berries, fish, whole grain products, and a lower consumption of red meat, was associated with better cognitive performance. Of the components of these dietary patterns particularly higher consumption of vegetables, fruit and berries and fish and a lower consumption of red meat was related to better cognition. The associations of dietary patterns with cognition were stronger in boys than in girls. In conclusion, a poorer diet quality was associated with worse cognition in children and the relationship was stronger in boys than in girls.

This article is freely available for two weeks via the following link: journals.cambridge.org/bjn/panic

Source: Better Diet Quality may Improve Cognition in Children « Journals in the News « Cambridge Journals Blog

Do Video Games Cause Violent Behavior? More Then 200 Academics Think Not

The APA recently released findings that stated there while there was not a “single” cause for aggression; violent video games can play a role. The APA set up a team to go over studies and papers that were published on the subject between 2005 and 2013.

The paper reports, “The research demonstrates a consistent relation between violent video game use and increases in aggressive behaviour, aggressive cognitions and aggressive affect, and decreases in pro-social behaviour, empathy and sensitivity to aggression.”

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The research for the paper was done primariliy though meta-analysis. It looked at the results of a number, hundreds, of studies and tried to find patterns and parallels. “While there is some variation among the individual studies, a strong and consistent general pattern has emerged from many years of research that provides confidence in our general conclusions,” said task force chairman Mark Appelbaum.

However, the research team’s findings have not been met with open arms. A group of more than 200 academics made up of “media scholars, psychologists and criminologists” have released an open letter to the APA opposing the findings. They suggest that the methodology of the study is inherently unsound. Much of the surveyed papers and studies that the APA used have not been peer reviewed, the open letter criticizes the methodology of the taskforce’s study and findings.

The notion that violent video games may cause aggression is a strongly contested one. It has historically been a scapegoat for violent behavior particularly in adolescents and teens. And while people don’t deny an effect of games, many deny the correlation between violent video games and outright violence:

“I fully acknowledge that exposure to repeated violence may have short-term effects – you would be a fool to deny that – but the long-term consequences of crime and actual violent behaviour, there is just no evidence linking violent video games with that,” says Dr Mark Coulson, one of the signatories of the letter told BBC. “If you play three hours of Call of Duty you might feel a little bit pumped, but you are not going to go out and mug someone.”

The rating system for video games can also be tricky. The US goes by the Entertainment Software Rating Board (ESRB) and begins with “eC” (Early Childhood) and progresses to “AO” (Adults 18+ Only). The rating system however has been controversial from the beginning with critics saying that the ESRB has gotten more lax on their “M” (Mature) rating and the games have gotten progressively more violent without receiving an AO rating.

In the letter to the APA the writers acknowledged that youth violence is currently “at a 40-year low” and that the “statistical data are simply not bearing out this concern and should not be ignored.”

The letter ends with a striking call for better data and research, “Policy statements based on inconsistent and weak evidence are bad policy and over the long run do more harm than good, hurting the credibility of the science of psychology.” With an overwhelming number of signatories, their message should not be ignored.

Turns Out Birth Order Might Not Mean Much

In a curious turn of events, according to a new study by a University of Illinois study birth order actually has no significant effect on personality or intelligence between siblings. The study analyzed 377,000 high school students and its head researcher is calling it the biggest look at the relationship between personality and birth order in history.

Strobist: SB-800 camera right with Honl 5 inch snoot aimed at girl. SB-800 with 8 inch shoot aimed at boy. Both at 1/2 power.

Strobist: SB-800 camera right with Honl 5 inch snoot aimed at girl. SB-800 with 8 inch shoot aimed at boy. Both at 1/2 power.

The study was published in the Journal of Research in Personality and has established that while first-borns statistically have a one-point IQ advantage over their younger siblings the difference is “statistically significant but meaningless.”

The lead researcher, Brent Roberts, stated, “In some cases, if a drug saves 10 out of 10,000 lives, for example, small effects can be profound. But in terms of personality traits and how you rate them, a .02 correlation doesn’t get you anything of note. You are not going to be able to see it with the naked eye. You’re not going to be able to sit two people down next to each other and see the differences between them.”

Birth order has been a fixture of fascination and often is linked closely with fate; firstborns are meant to be controlling and ambitious, middle children are meant to be wayward and rebellious and oft overlooked, and the youngest are coddled, bratty, and babied. The firstborn traditionally has the most weight on his shoulders and inherits the most of the family’s fortune or tribulations. For decades, scientists have been studying the effects of birth order on family dynamics and individual personalities from early 20th Century Austrian psychiatrist Alfred Adler to pop phycology parenting books on how to raise each child based on their place in the family.

The study controlled for a few factors, most notably family size, socio-economic status, and gender and arrived at a .02 correlation between birth order and personality and a .04 correlation between birth order and intelligence.

This shockingly low number goes against almost all previous studies and hypotheses regarding personality and intelligence relative to birth order.

It’s tempting to credit and blame a child’s personality traits, characteristics, and fate on birth order. The reality however is so much more complex; each child’s character and fate are based on biology and environment and encompass hundreds of thousands choices in and out of his control. The study’s co-author, Rodica Damian, sums it up nicely, “Birth order probably should not influence your parenting because it’s not meaningfully related to your kid’s personality or IQ.”

Links:

http://www.chicagotribune.com/lifestyles/ct-birth-order-no-effect-balancing-20150720-column.html

http://www.forbes.com/sites/daviddisalvo/2015/07/20/despite-popular-assumptions-birth-order-isnt-important-says-new-study/

Dodo bird verdict given new life by psychosis therapy study | The University of Manchester

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A study by researchers at The University of Manchester and the University of Liverpool has examined the psychological treatment of more than 300 people suffering from psychosis, showing that, whatever the therapy, it is the relationship between the patient and therapist which either improves or damages wellbeing.

The research relates to one of the more controversial ideas in psychotherapy research – the Dodo bird conjecture.  Named after a bird in Alice’s Adventures in Wonderland which sent several characters on a race and then declared them all winners, this conjecture states that all types of psychotherapy, even though often appearing to be very different from each other, are equally beneficial to patients.

In this case, the research showed that it is the quality of the relationship between the therapist and patient which causes improvement and not the different techniques employed in the two therapies that were compared.

Many studies have looked at types of talking treatment which can help people recover from psychotic episodes.  These include cognitive behavioural therapy (CBT) and family therapy. High quality research uses a comparison group which also receives some kind of less structured treatment, for example supportive counselling or befriending.

Surprisingly, patients in these comparison groups often benefit from the comparison treatment as much as those receiving the specific, targeted therapies (CBT or family therapy). Both groups who receive a psychosocial treatment fare much better than those offered only medication and usual care.

The researchers explored in depth the causative effect of the ‘therapeutic alliance’ or relationship of trust between patient and psychologist when schizophrenia patients were treated during a trial of this kind.

Lucy Goldsmith, a PhD candidate from The University of Manchester’s Institute of Brain, Behaviour and Mental Health, carried out the research in collaboration with the researchers who had carried out the original trial: Manchester professors Shôn Lewis and Graham Dunn, and Liverpool professor Richard Bentall. She said: “The quality of the therapeutic relationship has been linked to outcomes before, but we wanted to see whether the it really causes the changes in wellbeing occurring during therapy.

“Does successful treatment make patients feel well disposed towards their therapist or is the relationship actually at the heart of whether therapy succeeds?”

By using already established rating systems of these relationships and taking data from the earlier study of 308 patients, the researchers found that a good level of therapeutic alliance had a beneficial impact on wellbeing, but where the relationship was poor, the treatment could actually be damaging.

“The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate,” Lucy said.  “More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued.

“The study clearly shows that the two types of therapy are equally beneficial to the patient – as long as the trust, shared goals and mutual respect between client and psychologist are in place.”

The paper, ‘Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis,’ was published in the journal, Psychological Medicine.

via Dodo bird verdict given new life by psychosis therapy study | The University of Manchester.

The paper, “Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis” has been published gold Open Access, and can be found using this link. 

 

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