Social Work Today E-Zine

Research is shedding new light on what happens in the brains of children and adults affected by clinical depression and schizophrenia, according to Washington University in St. Louis studies.

Joan L. Luby, MD, an associate professor of child psychiatry and founder and director of Washington University School of Medicine's early emotional development program, is currently investigating the efficacy of a new treatment program for clinically depressed children as young as age 3—a time of significant neurobiological change when there is the potential to alter the course of depression later in life.

Starting with a large-scale study funded by NARSAD and the National Institute of Mental Health, Luby and her team identified anhedonia—the inability to experience pleasure from activities and play—as a key symptom of depression in very young children. Another common symptom is that depressed children often use play to explore themes about death and sometimes even suicide.

"We learned that depressed children don't derive pleasure from the same things as a typical 3- to 5-year-old child," said Luby. "They're less joyful when they encounter the pleasures of daily life."

"The normal developmental curve for any child is very steep at this point in life and being depressed and dysfunctional for a long period of time could actually impair normal development," Luby explained. "It's very important that we find a safe way to help them get better and to prevent future episodes."

Living with schizophrenia: overcoming emotional and motivational challenges

New research findings may also pave the way for new therapies to regulate the memories and emotions of people with schizophrenia, one of the most debilitating psychiatric disorders, suggests Deanna M. Barch, Ph.D., director of the Silvio Conte Center for Neuroscience Research at Washington University.

Barch, an associate professor of psychology in Arts & Sciences and of psychiatry and radiology in the School of Medicine, is now focusing on the emotional and motivational problems that affect how people with schizophrenia function on a daily basis. Her studies complement other NARSAD-funded research, which showed people with schizophrenia can be assisted in remembering things if they are given proper cues and memory aids.

— Source: Washington University in St. Louis

People with psychiatric illnesses, including children, who are admitted to the hospital from the emergency department (ED) can wait 24 hours or longer for an inpatient bed, principally because of a lack of psychiatric beds, according to findings reported by the American College of Emergency Physicians (ACEP).

“’Boarding’ [the practice of holding admitted patients in the emergency department instead of moving them to an inpatient bed] is an appalling fact of life in our nation’s emergency departments, and too often our most vulnerable patients—psychiatric patients in this instance—bear the biggest burden,” says Linda L. Lawrence, MD, ACEP’s president.

Of the 328 ED directors who responded to the survey, almost 80% said their hospital “boards” psychiatric patients in the ED. Thirty percent said their hospitals board psychiatric patients between eight and 24 hours, and more than one quarter said that their hospitals board children with psychiatric illnesses for that long.

The main reasons given for boarding of psychiatric patients in the ED are the lack of in-house inpatient psychiatric beds, and either absence or inability of any facility to accept transfers of these patients. Sixty percent of respondents said their ED does not have a dedicated area in the ED for psychiatric patients.

“People with psychiatric emergencies have nowhere else to turn, and they are suffering,” says Lawrence. “The harmful delays that they experience in the emergency department compound the delays that everyone else experiences as well. About three quarters of survey respondents agreed that psychiatric patients in the emergency department require more nursing and other resources than nonpsychiatric patients. This problem affects every emergency patient.”

— Source: American College of Emergency Physicians

Children and teens with attention-deficit/hyperactivity disorder (ADHD) who were treated with the herb St. John’s wort did not have any greater improvement in ADHD symptoms compared with those who received placebo, according to a study in a recent issue of The Journal of the American Medical Association.

Wendy Weber, ND, PhD, MPH, of Bastyr University in Kenmore, WA, and colleagues conducted a clinical trial of St. John’s wort (Hypericum perforatum) with 54 children and adolescents with ADHD, aged 6 to 17, to determine whether this agent was effective in lessening the severity of ADHD symptoms. Twenty-seven participants were randomly assigned to receive 300 mg of H perforatum standardized to 0.3% hypericin (a compound derived from H perforatum) and 27 participants received a matched placebo, three times daily for eight weeks. Other medications for ADHD were not allowed during the trial.

The researchers found that there were no significant differences between the two groups in the change in ADHD rating scale scores from the start of the trial to week 8 and in change in scores rating inattentiveness and hyperactivity. There was also no difference in the proportion of participants who were rated as much or very much improved regarding ADHD symptoms on another measurement scale. No statistically significant difference was found between the two groups in the proportion of participants who experienced 1 or more rash, nausea/vomiting, headache, or sunburn during the trial.

“To our knowledge, this is the first placebo-controlled trial of H perforatum in children and adolescents. The results of this study suggest that administration of H perforatum has no additional benefit beyond that of placebo for treating symptoms of child and adolescent ADHD,” the authors wrote.

— Source: American Medical Association

Contrary to the popular perception of a so-called “opting out revolution,” new sociological research in a recent issue of the American Sociological Review reveals that professional women’s employment rates have continually pushed higher over time, and that the employment gap between mothers and childless women is shrinking.

To determine the truth behind the opting out phenomenon described in mass media reports, sociologist Christine Percheski, PhD, examined trends among college-educated women born between 1906 and 1975 and found that professional women’s employment levels have made steep gains over time, especially for mothers of young children and women in historically male professions.

Despite anecdotal reports of successful working women returning to the home to assume child care responsibilities, less than 8% of professional women born since 1956 leave the workforce for a year or more during their prime childbearing years, according to the study.

Percheski’s research shows that the number of women with young children who work full time year-round has increased steadily, growing from a rate of 5.6% of women born 1926 to 1935 (referred to as the “Baby Boom Parents” by Percheski), to 38.1% of women from Generation X (born 1966 to 1975). More professional Generation X mothers of young children were working full time year-round than their counterparts in any previous generation.

“Contrary to an opt-out revolution, professional women—including mothers of young children—are working more than ever,” said Percheski. “Despite this increase in women’s employment, we can not assume that combining professional work and family life is easy for most women. Indeed, many working women successfully combine these roles by making great personal sacrifices, including curtailing their sleep, civic involvement or leisure time.”

— Source: American Sociological Association

Persons with treated type 2 diabetes are at increased risk for developing depression, while a more modest association was found between persons with depression and the risk of diabetes, according to a study in a recent issue of The Journal of the American Medical Association.

The prevalence of clinical depression and the presence of elevated depressive symptoms are higher among persons with diabetes compared with the general population. These associations may be related to increased risk of depressive symptoms in individuals with diabetes, increased risk of type 2 diabetes in individuals with depressive symptoms, or both. It is unclear whether type 2 diabetes is a risk factor for increased symptoms of depression. “A diagnosis of diabetes or the burden of dealing with its complications might also lead to symptoms of depression,” the authors wrote.

Researchers used measures of fasting blood glucose and depressive symptoms to test whether elevated depressive symptoms predicted incident type 2 diabetes and whether participants with type 2 diabetes at the beginning of the study were more likely to develop increased symptoms of depression than participants without diabetes. The study included men and women age 45 to 84 years who enrolled in 2000 to 2002 and were followed up until 2004 to 2005.

The researchers found that treated type 2 diabetes was associated with a 52% higher risk of developing elevated depressive symptoms. Individuals with untreated type 2 diabetes were not at increased risk.

In examining the development of type 2 diabetes among individuals with and without elevated depressive symptoms, the incidence of type 2 diabetes over 3.2 years was 22.0 per 1,000-person years for those with elevated depressive symptoms and 16.6 for those without elevated depressive symptoms. Thus, there was a significant association between higher levels of symptoms of depression and incident diabetes; however, the association was no longer statistically significant following adjustment for lifestyle factors.

“Our findings of an association in participants with treated but not untreated type 2 diabetes suggests that the psychological stress associated with diabetes management may lead to elevated depressive symptoms,” the authors wrote.

— Source: American Medical Association

New evidence shows that the brains of adults with autism are “wired” differently from people without the disorder, and this abnormal pattern of connectivity may be responsible for the social impairments that are characteristic of autism. Researchers also found that the most severely socially impaired subjects in the study exhibited the most abnormal pattern of connectivity among a network of brain regions involved in face processing.

“This study shows that these brain regions are failing to work together efficiently,” says Natalia Kleinhans, a research assistant professor of radiology and lead author of the paper published in the journal Brain. “Our work seems to indicate that the brain pathways of people with autism are not completely disconnected, but they are not as strong as in people without autism.”

The research team examined connectivity in the limbic system, or the network of brain regions that are involved with processing social and emotional information. Participants in the study included 19 high-functioning adults with autism who had IQs of at least 85. They ranged in age from 18 to 44 and were compared with an age- and intelligence-matched sample of 21 typically developed adults. Each participant had his or her brain scanned while looking at pictures of faces or houses. Participants were shown four series of 12 pictures of faces and a similar number of series showing houses. Each individual picture was seen for three seconds. Occasionally the same face or house picture was repeated, and participants were told to press a button when this occurred.

There was no significant difference on the two groups’ performance, because the task was so basic. However, the two groups exhibited different patterns of brain activity. The researchers focused on the fusiform face area of the brain, a region that is involved in face identification. Compared with the participants with autism, the typically developing adults showed significantly more connectivity between the fusiform face area with the left amygdala and the posterior cingulate. In addition, autistic participants who had the largest social impairment showed the lowest level of connectivity between the right fusiform face area and the left amygdala and increased connectivity between the right fusiform face area and the right inferior frontal gyrus.

“This study shows that the brains of people with autism are not working as cohesively as those of people without autism when they are looking at faces and processing information about them,” says Kleinhans.

— Source: University of Washington

Employees who work overtime are at increased risk of anxiety and depression, suggests a study in a recent issue of Journal of Occupational and Environmental Medicine. Elisabeth Kleppa and colleagues of the University of Bergen, Norway, analyzed data on work hours from a larger study of Norwegian men and women. Symptoms of anxiety and depression were assessed using a standard screening questionnaire. Anxiety and depression scores were compared for 1,350 workers who worked 41 to 100 hours per week; and approximately 9,000 workers who worked normal hours, 40 hours or less.

Working overtime was associated with higher anxiety and depression scores among both men and women. The rate of questionnaire scores indicating "possible" depression increased from about 9% for men with normal work hours to 12.5% for those who worked overtime. For women, the rate of possible depression increased from 7% to 11%. In both sexes, rates of possible anxiety and depression were higher among workers with lower incomes and less-skilled jobs.

The relationship between overtime and anxiety/depression was strongest among men who worked the most overtime—49 to 100 hours per week. Men working such very long hours also had higher rates of heavy manual labor and shift work and lower levels of work skills and education.

— Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

Women can make inroads into male-dominated management ranks as companies that downsize restructure their scaled-back workforces, according to new research by a University of Illinois sociologist.

John Dencker says the findings are surprising because downsizing whittles the pool of jobs available for both men and women, but also show that firms apparently make an effort to balance gender inequities during staff shakeups.

“It might be that they try to make up for past inequalities or they may be aware of other firms that have had legal difficulties and want to make sure they don’t run into the same problems,” says Dencker, a professor in the University of Illinois’ Institute of Labor and Industrial Relations.

But women’s gains during downsizing are short lived, says Dencker. omen entered management ranks at rates up to 25% higher than men in some grade levels after downsizing, which created supervisory openings as older male managers took company-offered buyouts, he says.

But the gap closed within a year or two as management jobs became scarcer in the aftermath of restructuring, according to the study, which appears in a recent issue of the American Sociological Review.

“Everybody’s rates of promotions slowed after downsizing because there simply weren’t as many positions to promote people into,” Dencker said. “With fewer positions available, promoting women more rapidly than men would be more visible and the company may have been concerned about how male managers would react.”

— Source: American Sociological Association

In a recent issue of Nature, Mayo Clinic researchers report that agents known as gamma-secretase modulators (GSM) work to reduce production of long pieces of the amyloid beta protein (Abeta) that readily stick together and form clumps, and increase production of shorter Abeta that can inhibit the longer forms from sticking together. This is critical because only when Abeta aggregates and accumulates is it harmful and can trigger Alzheimer’s disease, the researchers say.

“So, as these compounds lower the amount of the bad, longer, sticky Abeta peptides in the brain, they increase the quantity of shorter Abeta peptides that may protect against development of Alzheimer’s disease,” says senior author Todd Golde, MD, PhD, chair of the department of neuroscience at Mayo Clinic in Jacksonville.

Not only that, GSM agents actually stick to the Abeta already in the brain, keeping it from aggregating. A hallmark of Alzheimer’s is formation of “plaques” and other assemblies of Abeta protein in the brain, which are believed to damage neurons in complex ways that are not yet fully understood, researchers say. “Surprisingly, this means that these compounds may do three things that may be beneficial with respect to Alzheimer’s disease: they inhibit production of long Abeta, block aggregation of Abeta, and increase production of shorter Abeta peptides that may in turn inhibit Abeta aggregation,” says the study’s lead investigator, Thomas Kukar, PhD.

As exciting as these discoveries are, the investigators also found that GSMs work in a way that has not been seen before in other drugs. “Most drugs target enzymes, which act on proteins, or cell surface receptors, which proteins bind to,” Kukar says. “These agents work on the structure, or substrate, of the protein itself, which had not been believed to be druggable.”

“This broadens the notion of what drugs can do, and therefore, has wide reaching implication for future drug discovery for many different disorders,” Golde says.

— Source: Mayo Clinic

A major report by the National Alliance on Mental Illness (NAMI) reveals most Americans are unfamiliar with Schizophrenia. "Americans are not sure what to think about schizophrenia," says NAMI executive director Mike Fitzpatrick, MSW. "They know schizophrenia is a medical illness affecting the brain, but it is largely misunderstood. There are gaps in knowledge and access to treatment. Misinformation, misperceptions, and misunderstanding represent a public health crisis."

Approximately two million Americans live with schizophrenia. Two thirds do not receive treatment, even though the disease can be managed successfully. The survey found the average age at onset was 21, but a nine-year gap exists between symptoms and treatment.

• 85% of Americans recognize schizophrenia as an illness, 79% believe that with treatment, people with the diagnosis can lead independent lives, but only 24% are familiar with it. Many cannot recognize symptoms or mistakenly believe they include "split" or multiple personalities (64%).

• 79% want friends to tell them if they have schizophrenia, but only 46% say they would themselves. Even with treatment, 49% are uncomfortable with the prospect of dating a person with schizophrenia.

• Among people living with schizophrenia, 49% said doctors take their medical problems less seriously, even though the report notes that the death rate from causes like heart disease or diabetes is 2 to 3 times that of the general population.

— Source: National Alliance on Mental Illness

Adults who were placed in a private, enhanced foster care program as teenagers appear to have significantly fewer mental disorders, ulcers, and cardiometabolic problems (diabetes, hypertension, or heart disease) but more respiratory disorders than those who were placed in public programs, according to a report in a recent issue of Archives of General Psychiatry.

Ronald C. Kessler, PhD, of Harvard Medical School, Boston, and colleagues assessed 479 adults (an average age of 23.7 to 25.6) who were placed in foster care between 1989 and 1998, when they were aged 14 to 18. The private program had caseworkers with higher levels of education, lower caseloads, higher salaries, and access to a wider range of services for youth than those in public programs. The private program also offers financial assistance with higher education to alumni.

The adult alumni of the private program, when compared with those of the public program, were less likely to have experienced foster parent neglect, physical abuse, or sexual abuse. In addition, over the previous year, they
had 44.7 fewer mental disorders and 20.1 fewer physical disorders per 100 individuals; were less likely to report major depression (11.3% vs. 24.3%), anxiety disorders (28.8% vs. 43%) and substance abuse disorders (5.1% vs. 11.1%); and were less likely to have had ulcers (7.4% vs. 13%) and cardiometabolic conditions such as diabetes, hypertension or heart disease (14.9% vs. 22.6%) but more likely to have had respiratory conditions (28.8% vs. 17.9%).

The results suggest that similar analyses should be performed on public and private programs nationwide to pinpoint particular core program components that lead to positive effects. “This information could then be used to develop a blended model program for implementation in demonstration sites and subsequent dissemination to public programs throughout the country if state and federal legislatures could be convinced of the importance of this undertaking,” they conclude.

— Source: American Medical Association

A new study of self-assessed job satisfaction, gender and ethnicity in the U.S. military finds that African American and Latino men and women have higher job satisfaction than white men, says Jennifer Hickes Lundquist, PhD, of the University of Massachusetts Amherst.

In civilian society minorities consistently express lower job satisfaction. 
The survey, which covers active-duty personnel, is published in a recent issue of the American Sociological Review.

Overall, African American women have the highest levels of job satisfaction in the military, followed by African American men, Latinas, Latinos, and white women, Lundquist says. She says a key to the findings is that the military has more social and economic equality than the civilian job market, and that is why racial and ethnic minorities and women report higher job satisfaction.

“Military service can be quite demanding, requiring lengthy family separations and allowing the employee far less freedom and autonomy than civilian jobs,” Lundquist says. “It’s not surprising then that white males tend to have lower job satisfaction in the military than in civilian jobs. But what’s striking is that minorities express more satisfaction in military jobs than they do in civilian jobs. This makes a strong case for the continued position of disadvantage for minorities in many civilian jobs.”

Lundquist based her findings on data drawn from the Pentagon’s Survey of Active Duty Personnel (SADP). The data was collected by mail in 1999. The sample size was 30,489 people. She notes that a more recent SADP has just been made available, but she used the earlier one because it was taken prior to the wars in Iraq and Afghanistan and represents the experiences of active duty personnel in the military during peacetime.

— Source: University of Massachusetts Amherst

Research by Cornell University faculty members suggests that aggression and violence that occurs between residents themselves may be a prevalent and serious problem.

Karl Pillemer, PhD, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology has coauthored two articles in Aggression and Violent Behavior and in the Journal of the American Geriatrics Society on "resident-to-resident mistreatment." Both studies report that verbal and physical aggression between residents is common and problematic, and that more research is necessary to identify risk factors and preventative measures.

"Anyone who spends much time in a nursing home will observe arguments, threats and shouting matches among residents, as well as behaviors like pushing, shoving, and hitting," Pillemer says. The studies found 35 different types of physical and verbal abuse between residents at a large urban nursing home. Screaming was the most common form of aggression, followed by such physical violence as pushing and punching or fighting.

In related work, the authors found that 2.4% of residents reported personally experiencing physical aggression from another resident and 7.3% reported experiencing verbal aggression over just a two-week period. Most respondents rated the events as moderately or extremely disruptive to daily activities.

In another study, 12 nurse-observers identified 30 episodes of resident-to-resident aggression on just a single eight-hour shift, 17 of which were physical. Research also indicates that victims are more likely to be male, have behavioral problems like wandering and be cognitively impaired.

— Source: Cornell University

Adolescents attending college six months after completing high school are significantly less likely to engage in risky sexual behavior than those who do not go to college, according to the first study to directly compare the two groups.

The University of Washington (UW) study, published in a recent issue of the Journal of Adolescent Health, also compared risky sexual behavior of teens living at home and those who established their own residences and found no significant differences between the groups, says Jennifer Bailey, a research scientist with the UW’s Social Development Research Group and lead author of the paper.

“No one has compared typical teens before, because we stop being so concerned about their sexual behavior after they leave high school,” says Bailey. “But it is important that we know what they are doing because late adolescence and the early 20s are the peak times for acquiring a sexually transmitted infection.

“HIV is a big risk. Chlamydia can affect fertility. The prevalence of gonorrhea and chlamydia are increasing. And some forms of human papillomavirus are related to cervical and other cancers. So it is important that we know what puts young people at risk for these sexually transmitted infections and what social structures may help protect them.”

The study found that college students were more likely to always use a condom and less likely to engage in casual sex or high-risk sex than teens who did not attend a two- or four-year college.

Overall, the study showed that:
23% of the college students reported inconsistent condom use compared with 35% of the noncollege subjects; 15% of the college students engaged in casual sex vs. 29% of the others; 5% of the college students had high-risk sex vs. 16% of the others; 53% of the college students engaged in sex in the previous month vs. 70% of the others.

— Source: University of Washington

Alcoholism is a devastating disease in part because of the ‘symptom’ of heavy drinking but more so because of the extensive harm it causes physical organs, such as the heart and liver, as well as significant damage to one’s quality of life.

In a landmark study published in a recent issue of the Archives of Internal Medicine, addiction experts led by a University of Virginia (UVa) Health System team have found that topiramate, an effective therapeutic medication, not only decreases heavy drinking, but it also lowers all liver enzymes, plasma cholesterol, body mass index (BMI), and systolic and diastolic blood pressure—all of which tend to increase with heavy drinking and pose such serious health risks as heart disease and cirrhosis.

Researchers also found that topiramate, compared with placebo, decreases certain adverse psychosocial effects caused by alcohol dependence.

“What topiramate offers alcoholic-dependent individuals is a future of improved health and quality of life,” says lead author Professor Bankole Johnson, DSc, MD, PhD, MPhil, FRCPsych, chairman of the UVa department of psychiatry and neurobehavioral sciences. “This medication provides real hope for millions of alcoholics and their families that they can beat their addiction.”


The FDA has approved topiramate for seizures and migraine headaches, but it is not currently approved for treating alcohol dependence. Ortho-McNeil Neurologics, Inc., manufactures topiramate and provided study funding.

— Source: University of Virginia Health System

People who are dependent on alcohol are also likely to smoke cigarettes. Many experts believe that it’s important to counsel alcohol-dependent individuals to give up smoking as well as drinking—not just to improve their health, but also to increase their chances of staying sober, reports a recent issue of the Harvard Mental Health Letter.

It is a common worry that trying to quit smoking and drinking at the same time will undermine treatment for alcohol dependence. However, most studies have reported that efforts to quit smoking either have no impact on maintaining sobriety or actually increase success of alcohol treatment.

There are no smoking cessation guidelines specifically for alcohol-dependent adults. For now, the best option is to follow the federal guidelines for treating tobacco dependence, which recommend a combination of counseling and medication.

A major and still unresolved question is whether it’s better to give up smoking and drinking together, or whether it’s better to tackle one addiction at a time. Researchers have found that when smoking cessation support was delayed by six months, study participants were more likely to remain sober compared with those who received concurrent treatment for both addictions. But a follow-up analysis found that this may have been true only for white people in the study.

Michael C. Miller, MD, editor in chief of the Harvard Mental Health Letter, notes that no single approach is best for every person struggling with both alcohol and nicotine addiction. Whether an individual quits smoking during alcohol treatment or later, it's a net health gain.

— Source: Harvard Health Publications

Women born after 1944 began drinking alcohol at younger ages than their elders, and that appears to have put them at greater risk for alcoholism, according to researchers at Washington University School of Medicine in St. Louis.

The new research, published in a recent issue of Alcoholism: Clinical & Experimental Research, focuses on the ages at which men and women began to drink. 
The researchers compared data from two surveys of alcohol use: the National Longitudinal Alcohol Epidemiologic Survey, gathered in 1991 and 1992, and from the National Epidemiologic Survey on Alcohol and Related Conditions, which was compiled 10 years later.

On average, women born before 1944 began drinking at age 20. Those born after that started drinking alcohol at age 17, and they had a 50% to 80% greater risk for alcohol dependence, the researchers found.

"We had previously noted that women were catching up with men in their rates of drinking and alcohol dependence, and this earlier age at which they began drinking helps explain that finding," says Richard A. Grucza, PhD, an assistant professor of psychiatry and the first author on the study. "An early age at the onset of drinking is a strong predictor of subsequent alcohol dependence. About one in three individuals who start drinking at age 17 or younger become alcohol dependent. For those who wait until age 21 or older, that number is one in ten."

— Source: Washington University in St. Louis

The use of daytime bright lighting to improve the circadian rhythm of older persons was associated with modest improvement in symptoms of dementia, and the addition of the use of melatonin resulted in improved sleep, according to a study in a recent issue of The Journal of the American Medical Association.

“In elderly patients with dementia, cognitive decline is frequently accompanied by disturbances of mood, behavior, sleep, and activities of daily living, which increase caregiver burden and the risk of institutionalization,” the author wrote. These symptoms have been associated with disturbances of the circadian rhythm, which is related influenced by environmental light and the hormone melatonin.
The researchers found that bright light lessened cognitive deterioration by a relative 5%, reduced depressive symptoms by a relative 19% and diminished the gradual increase in functional limitations by a relative 53%.

Melatonin supplementation reduced the time to fall asleep by a relative 19% and increased total sleep duration by 6%, but adversely affected caregiver ratings of withdrawn behavior and mood expressions. The addition of bright light improved the adverse effect on mood. In combination with bright light, melatonin reduced aggressive behavior by a relative 9%.

“In conclusion, the simple measure of increasing the illumination level in group care facilities [improved] symptoms of disturbed cognition, mood, behavior, functional abilities, and sleep. Melatonin improved sleep, but its long-term use by older individuals can only be recommended in combination with light to suppress adverse effects on mood. The long-term application of whole-day bright light did not have adverse effects, on the contrary, and could be considered for use in care facilities for elderly individuals with dementia,” the authors wrote.

— Source: American Medical Association

Contrary to popular notions about what is normal or healthy, new research has found that it is okay not to express one's thoughts and feelings after experiencing a collective trauma, such as a school shooting or terrorist attack.

In fact, people who choose not to express their feelings after such an event may be better off than those who do talk about their feelings, according to Mark Seery, PhD, an assistant professor of psychology at the University at Buffalo and lead author of a study to appear in a recent issue of Journal of Consulting and Clinical Psychology.

The study investigated the mental and physical effects of collective traumas on people who are exposed to a tragedy but who do not experience a direct loss of a friend or family member. It focused on people's responses to the terrorist attacks of September 11, 2001, but the results may generalize to include responses to other collective traumas.

The findings have important implications for expectations of how people should respond in the face of a collective trauma affecting a whole community or even an entire nation, says Seery,

Seery says the results should not be interpreted to mean that expressing one's thoughts and feelings is harmful or that if someone wants to express their emotions they should not do so. "It's important to remember that not everyone copes with events in the same way, and in the immediate aftermath of a collective trauma, it is perfectly healthy to not want to express one's thoughts and feelings," he says.

—Source: University at Buffalo

About 2.1 million teens aged 12 to 17 experienced a major depressive episode in the past year, according to a new nationwide report by the Substance Abuse and Mental Health Services Administration (SAMHSA). For almost one half of the teens, depression drastically reduced their abilities to deal with aspects of their daily lives, the report said.

Overall, 8.5% of adolescents, the equivalent of one in every 12, experienced a major depressive episode, but there were striking differences by gender, with 12.7% of females and 4.6% of males reporting the conditions.

"Fortunately, depression responds very well to early intervention and treatment," says SAMHSA Administrator Terry Cline, PhD. "Parents concerned about their child's mental health should seek help with the same urgency as with any other medical condition. Appropriate mental health care can help their child recover and thrive."

The report is based on combined data from the 2004 to 2006 National Surveys on Drug Use and Health involving responses from 67,706 people aged 12 to 17 throughout the United States. The survey is based on a scientific random sample of households throughout the United States, and professional field representatives personally visit each household to conduct the survey.

— Source: Substance Abuse and Mental Health Services Administration

A study published in Experimental Psychology by a University of South Carolina psychology researcher provides a better understanding of why language—talking and listening, including on a cell phone—interferes with visual tasks, such as driving.

In two different experiments, associate professor of psychology Amit Almor, PhD, found that planning to speak and speaking put far more demands on the brain’s resources than listening.

“We measured their attention level and found that subjects were four times more distracted while preparing to speak or speaking than when they were listening,” says Almor of the 47 people who participated in the experiment. “People can tune in or out as needed when listening.”

“I anticipate the effect to be even stronger and more dynamic because, in conversation, people have the urge to contribute,” says Almor. “In conversation, we compete with the other person. I suspect that the greater the urge to speak, the greater the distraction from the visual task.”

Almor placed the participants in a circular, surround-sound environment in which the speakers were hidden and the voice shifted from the front, rear, or either side. He found that participants could complete the visual task in front of them more easily when the projected voice also was in front.

“Either people are used to face-to-face communication or, when they engage in a language task, they create a mental representation in their mind and place the voice somewhere in space,” Almor says. “In this case, that space is in front of them, which suggests that it may be easier to have all things that require attention occupy the same space.”

— Source: University of South Carolina

Exposure-based therapy, in which recent trauma survivors are instructed to relive the troubling event, may be effective in preventing the progression from acute stress disorder to posttraumatic stress disorder (PTSD), according to a report in a recent issue of Archives of General Psychiatry.

Richard A. Bryant, PhD, of the University of New South Wales, Sydney, Australia, and colleagues conducted a randomized controlled trial involving 90 patients who developed acute stress disorder following a nonsexual assault or motor vehicle crash between March 2002 and June 2006. Thirty participants each were randomly assigned to five weekly 90-minute sessions of exposure therapy or cognitive restructuring, while the remaining 30 were put on a waitlist for treatment. All the patients were assessed at the beginning of the study, after six weeks and six months following treatment.

Sixty-three participants completed the study. After completing treatment, fewer patients in the exposure therapy group (10, or 33%) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63%) or the wait-list group (23, or 77%). At the six-month follow-up, fewer patients in the exposure therapy group (11, or 37%) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63%), and 14 patients (47%) in the exposure group vs. four patients (13%) in the cognitive restructuring group achieved full remission.

Exposure therapy may be more effective than cognitive restructuring because it eases the anxiety associated with the traumatic memory and corrects the belief that the memory must be avoided, in addition to encouraging self-control by managing the exposure exercise, the authors noted. “The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with acute stress disorder,” they concluded. “Exposure should be used in early intervention for people who are at high risk for developing PTSD.”

— Source: American Medical Association

In the year following a stroke, patients who received the medication escitalopram or participated in a problem-solving therapy group had a lower risk of depression compared with patients who received placebo, according to a study in a recent issue of The Journal of the American Medical Association. Depression occurs in more than one half of stroke patients, according to background information in the article

Robert. G. Robinson, MD, of the University of Iowa, Iowa City, and colleagues assessed the efficacy of the antidepressant drug escitalopram or problem-solving therapy compared with placebo pills for the prevention of depression among 176 stroke patients.

The researchers found that participants who received placebo were 4.5 times more likely to develop depression than patients who received escitalopram (22.4% vs. 8.5%), and 2.2 times more likely to develop depression than patients who received problem-solving therapy (11.9%). “Based only on the frequency of depression onset during the one year of treatment, 7.2 acute stroke patients would need to be treated with escitalopram to prevent one case of depression and 9.1 acute stroke patients would need to be treated with problem-solving therapy to prevent one case of depression,” the authors wrote.

“The clinical implications of our findings are that patients who are given escitalopram or problem-solving therapy following acute stroke may be spared depression and perhaps its adverse consequences,” the authors concluded.

— Source: American Medical Association

Community interventions would significantly increase the vaccination rates among hard to reach and at-risk populations such as sex-workers or shut-ins during a flu pandemic or national shortage, new research shows

During such times, immunizing hard-to-reach populations could be challenging but important, says Sandro Galea, a study author and an associate professor at the University of Michigan School of Public Health. Unvaccinated populations may serve as undetected reservoirs of infection and spread the disease to other populations. The paper is highlighted in a recent issue of the American Journal of Public Health.

During the 2004-2005 flu vaccine shortage, the vaccination rate for the general population was double the rate for hard to reach populations, at 42% and 21% respectively. Among the 21%, the people most likely to be vaccinated had ties to a primary care doctor, Galea says.

Low vaccination rates and barriers to healthcare place populations, such as substance abusers, sex workers, undocumented immigrants, the homeless and elderly shut-ins, at high risk for the flu. Additionally, the likelihood that the flu could be fatal is higher among those populations.

Researchers surveyed 6,826 participants from February to October 2005, and 37% were members of hard-to-reach populations. Researchers intervened on three different levels: by contacting individuals, by working in different neighborhoods, and through community organizations.

Methods of intervention included disseminating project information; giving presentations at meetings; and offering street-based and door-to-door vaccinations during two flu seasons.

— Source: The University of Michigan School of Public Health