Social Work Today E-Zine

In a national clinical trial, adolescents with moderate to severe depression first given a placebo treatment and then an antidepressant medication alone or in combination with therapy responded just as well over the long term as participants who received active treatment throughout the study, University of Texas Southwestern Medical Center researchers report. The findings were published in The American Journal of Psychiatry.

Researchers found that at the end of nine months, children and teenagers first given placebo treatment for 12 weeks and then given active treatment had a response rate of 82%, compared with an 83% response rate for participants who received active treatment for the entire period.

Betsy Kennard, PhD, an associate professor of psychiatry at Southwestern and lead author of the study, did the research as a secondary analysis in the Treatment for Adolescents with Depression Study, which treated 439 adolescents aged 12 to 17 from 13 sites across the country with moderate to severe major depressive disorder. About 50 patients were treated at Southwestern.

Kennard analyzed what happened to the children in the placebo group. For 12 weeks, placebo participants received education, 30 to 45 minutes with a psychiatrist, supportive care, and clinical management, just like those in the active treatment groups. They also received a pill placebo. About 35% of the participants got better from this approach alone.

“Placebo can be misconstrued as if it’s a bad thing,” Kennard says. “These adolescents received quite a bit of clinical care, and for some of them, that was enough to help them get well. If at any time a child started to do worse, we would change their treatment no matter what group they were in.”

— Source: University of Texas Southwestern Medical Center

Anxiety disorders in children and adolescents should be recognized and treated to prevent educational underachievement and adult substance abuse, anxiety disorders and depression, says a nationally recognized child psychiatrist from the University of Texas Southwestern Medical Center.

In an editorial appearing in The New England Journal of Medicine, Graham Emslie, MD, a psychiatry and pediatrics professor at Southwestern, urges awareness that children need to be treated for anxiety disorders and recommends that related empirical evidence be integrated into treatment guidelines.

“Anxiety disorders may cause children to avoid social situations and age-appropriate developmental milestones,” says Emslie. “Further, the avoidance cycle can lead to less opportunity to develop social skills necessary for success later in life. Treatment would help children learn healthy coping skills.”

Up to 20% of children and adolescents are affected by persistent and excessive worry that can manifest as generalized anxiety disorder, separation anxiety disorder, and social phobia. Research has shown that failure to identify these disorders early leads to educational underachievement and increased rates of anxiety disorders, depression, and substance abuse later in life.

Anxiety disorders in children are frequently unrecognized because they may only report physical aches and may be unable to verbalize “worry” or “fear,” says Emslie.

Emslie says he hopes future studies will build on this work to determine what type to treatment is best for individual patients. “Partial treatment is not adequate,” he says. “If children aren’t treated to the point of complete remission, they are likely to relapse. It’s imperative that we help children overcome their anxiety disorders for their own lifetime good.”

— Source: University of Texas Southwestern Medical Center

Both the developing brain and the aging brain can suffer from lead exposure. For older people, a buildup of lead from earlier exposure may be enough to result in greater cognitive problems after the age of 55, according to a follow-up study of adults exposed to lead at work in Neuropsychology.

The researchers from the Graduate School of Public Health and the School of Medicine at the University of Pittsburgh followed up on the 1982 Lead Occupational Study, which assessed the cognitive abilities of 288 lead-exposed and 181 nonexposed male workers in eastern Pennsylvania. All the workers were given the Pittsburgh Occupational Exposures Test battery, which includes measures of five primary cognitive domains: psychomotor speed, spatial function, executive function, general intelligence, and learning and memory.

In 1982, lead-exposed workers had an average blood lead level of 40 micrograms per deciliter, well above normal; Pennsylvania workers found to have 25 micrograms per deciliter or more must be taken off the job. In 1982, the unexposed workers had an average blood level of 7.2, within normal limits.

In 2004, the current study followed up with 83 of the original lead-exposed workers and 51 of the original nonexposed workers. Researchers measured current lead levels in their blood and cumulative lead levels through special X-rays of the tibia, or lower leg bone (bone is the final repository of circulating blood lead, where it has a half life of about 30 years). Researchers also readministered the test battery to assess cognitive performance relative to both measures of lead.

Among the lead-exposed workers, men with higher cumulative lead had significantly lower cognitive scores. The clearest inverse relationships—when one went up, the other went down—emerged between cumulative lead and spatial ability, learning and memory, and overall cognitive score. This linkage was more significant in the older lead-exposed men, of at least the age of 55. Their cognitive scores were significantly different from those of younger lead-exposed men even when the researchers controlled for current blood levels of lead. In other words, even when men no longer worked at the battery plants, their earlier prolonged exposure was enough to matter.

— Source: American Psychological Association

Veterans with posttraumatic stress disorder (PTSD) are more likely to have metabolic syndrome than veterans without PTSD, according to a study led by Pia Heppner, PhD, a psychologist with the University of California, San Diego School of Medicine and the VA Center of Excellence for Stress and Mental Health (CESAMH). The study was published online in BMC Medicine.

The researchers studied a group of male and female veterans presenting for screening and treatment within the PTSD programs at the Cincinnati Veterans Affairs Medical Center. The sample was primarily male (92%) and Caucasian (76%), with an average age of 52. A majority of the sample had served in the U.S. Army (71%), and close to 70% were Vietnam-era veterans. Clinical data indicate that 55% of these veterans had moderate to severe levels of PTSD and 64% met criteria for major depressive disorder (MDD). About 40% of the veterans met criteria for metabolic syndrome.

Controlling for other factors, the researchers found that those with a higher severity of PTSD were more likely to meet the diagnostic criteria for metabolic syndrome. Additionally, the rate of metabolic syndrome was higher among those with PTSD (34%) than in those with MDD (29%). For those with both PTSD and MDD, 46% met criteria for metabolic syndrome.

“Our research indicates that stress and poststress responses are related to long-term health outcomes,” says Heppner. Studies show that veterans, prisoners of war, and individuals exposed to severe trauma have higher rates of disease and increased use of healthcare, she continued. “Our findings suggest that metabolic syndrome provides a useful framework for assessing and describing the physical burden of PTSD and can be used prospectively to evaluate health risk that may be associated with combat exposure and PTSD.”

— Source: University of California, San Diego Health Sciences

In a pair of related studies released by Seattle Children’s Research Institute and published in the Archives of Pediatric & Adolescent Medicine, researchers found that 54% of adolescents frequently discuss high-risk activities including sexual behavior, substance abuse, or violence using MySpace, the popular social networking Web site. The studies were led by research fellow Megan A. Moreno, MD, MPH, MSEd, and Dimitri Christakis, MD, MPH, of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, and the University of Washington.

In the study Adolescent Display of Health Risk Behaviors on MySpace, the research team collected information directly from readily available public MySpace profiles. A total of 500 randomly chosen Web profiles of self-reported 18-year-old males and females from the United States provided the data. Researchers examined the extent to which high-risk behaviors were reported in the profiles, as well as any correlations that suggested that certain behaviors may be influenced by other items, interests, or activities. They found that 54% of the MySpace profiles contained high-risk behavior information, with 41% referencing substance abuse, 24% referencing sexual behavior, and 14% referencing violence.

The researchers’ pilot study, Reducing At-Risk Adolescents’ Display of Risk Behavior on a Social Networking Web Site, examined whether a physician’s online communication to teens about references to sex and substance abuse found in their MySpace profile would have a positive impact on reducing online display of such behaviors in the social networking site. Looking at 190 self-described 18 to 20 year olds with public MySpace profiles that met study criteria for being at-risk, the profiles received a single intervention e-mail from “Dr. Meg,” the MySpace profile of Moreno. Her profile displayed information about her professional credentials and research interests. The e-mail was sent within the MySpace system; the intervention provided basic information about the risky nature of online personal disclosures and also provided a resource link to a Web site containing information about testing for sexually transmitted infections.

Three months after the MySpace email intervention, the same online profiles were evaluated again for references to sex and substance use, as well as any changes in profile security settings (switching from a “public” to a “private” profile). At the beginning of this study, 54% of subjects referenced sex and 85% referenced substance use. After the email intervention, 13% of the profiles decreased references to sex behaviors, and 26% decreased their substance use references. Ten percent of the profiles changed their security listings from “public” to “private,” and a total of 42% of the profiles implemented any of these three protective measures.

— Source: Seattle Children's Hospital

A new study published in Society and Animals suggests that college students may handle stressful situations better if they have a pet. Research has already shown that pets can improve the quality of life for people who are aging or are chronically ill, but Ohio State University researchers found that many college students may also benefit from owning a cat or a dog.

“We found that a lot of young adults are choosing to have an animal companion for important reasons. Many feel their pets will help get them through these difficult and stressful situations, and many more say that without their pet, they would feel lonely,” says Sara Staats, PhD, lead author of the study and professor emeritus of psychology at Ohio State’s Newark Campus.

The study was based on survey responses from nearly 350 college students at a Midwestern commuter campus and nearby community members. Only those people who currently or previously owned a cat, a dog, or a combination of the two were included in the present study. People who were aged 18 to 87 were all surveyed to study the differences between adults and students.

Nearly one quarter of all college students and adults reported that their pet was useful in keeping them active. This answer was more common for those who owned dogs, but those who had feline friends also reported their cat helped keep them active.

Likewise, 18% of college students and 13% of adults said their pet was important to helping them cope during difficult times. The results showed that avoiding loneliness was the top reason given by both students and adults. Nearly identical percentages of married and single persons gave this response, but students and those aged 50 and older were far more likely to list this as their top reason.

— Source: Ohio State University

In 1988, a massive earthquake in Armenia killed 17,000 people and destroyed nearly one half the town of Gumri. Now, in the first multigenerational study of its kind, UCLA researchers studying survivors of that catastrophe have discovered that vulnerability to posttraumatic stress disorder (PTSD), anxiety, and depression runs in families. The research appears in Psychiatric Genetics.

Armen Goenjian, MD, a research psychiatrist in the UCLA psychiatry and biobehavioral sciences department and the study’s lead author, and colleagues studied 200 participants from 12 multigenerational families exposed to the earthquake. Participants suffered from varying degrees of the disorders. The researchers found that genetics attributed to 41% of the variation of PTSD symptoms, 61% of the variation of depressive symptoms, and 66% of anxiety symptoms.

In addition, Goenjian notes, the study suggests that a large percentage of genes are shared between the disorders. "That tracks with clinical experience," he says. "For example, in clinical practice, the therapist will often discover that patients who come in for treatment of depression have coexisting anxiety. Our findings show that a substantial portion of the coexistence can be explained on the basis of shared genes and not just environmental factors such as upbringing."

The researchers used statistical methods to assess heritabilities. One method was used to determine the genetic component of a disorder such as PTSD. Then, a separate analysis was used to see if different phenotypes shared genes. The results showed that a significant amount of genes are shared between PTSD and depression, PTSD and anxiety, and finally depression and anxiety.

— Source: UCLA Health Sciences

Joyful or sad smiles expressed after a competition are the same for blind and sighted athletes, says a new study, showing that certain facial expressions are innate and managed differently depending on the social situation. These findings are reported in the Journal of Personality and Social Psychology.

The study compared the expressions of 76 blind judo athletes, some of whom were born blind, with the expressions of 84 sighted judo athletes. The blind athletes competed in the 2004 Paralympic Games. The sighted athletes competed in the 2004 Olympic Games. The matches analyzed consisted of gold- and bronze-medal matches.

To track the athletes’ reactions at certain points after the competition in the Paralympic games, the researchers photographed their facial expressions immediately after their match, during the medal ceremonies, and on the podium with other medalists. Each expression was coded according to the displayed emotion. Expressions from the sighted Olympic athletes were taken from another study done the same way by the same authors.

From the photos, the researchers found that the blind athletes produced the same facial expressions involving anger, contempt, disgust, sadness, surprise and multiple types of smiles as the sighted athletes.

The facial expressions differed for the athletes depending on what medal they won and what social situation they were in. Even though many of the blind silver winners and those who placed fifth smiled less after finishing their match, they did manage social and genuine smiles while receiving medals or standing on the podium. This shows how embedded it is to put on a good face even when you lose and can’t see your audience, says study author David Matsumoto, PhD, of San Francisco State University.

— Source: American Psychological Association

Joyful or sad smiles expressed after a competition are the same for blind and sighted athletes, says a new study, showing that certain facial expressions are innate and managed differently depending on the social situation. These findings are reported in the Journal of Personality and Social Psychology.

The study compared the expressions of 76 blind judo athletes, some of whom were born blind, with the expressions of 84 sighted judo athletes. The blind athletes competed in the 2004 Paralympic Games. The sighted athletes competed in the 2004 Olympic Games. The matches analyzed consisted of gold- and bronze-medal matches.

To track the athletes’ reactions at certain points after the competition in the Paralympic games, the researchers photographed their facial expressions immediately after their match, during the medal ceremonies, and on the podium with other medalists. Each expression was coded according to the displayed emotion. Expressions from the sighted Olympic athletes were taken from another study done the same way by the same authors.

From the photos, the researchers found that the blind athletes produced the same facial expressions involving anger, contempt, disgust, sadness, surprise and multiple types of smiles as the sighted athletes.

The facial expressions differed for the athletes depending on what medal they won and what social situation they were in. Even though many of the blind silver winners and those who placed fifth smiled less after finishing their match, they did manage social and genuine smiles while receiving medals or standing on the podium. This shows how embedded it is to put on a good face even when you lose and can’t see your audience, says study author David Matsumoto, PhD, of San Francisco State University.

— Source: American Psychological Association

Joyful or sad smiles expressed after a competition are the same for blind and sighted athletes, says a new study, showing that certain facial expressions are innate and managed differently depending on the social situation. These findings are reported in the Journal of Personality and Social Psychology.

The study compared the expressions of 76 blind judo athletes, some of whom were born blind, with the expressions of 84 sighted judo athletes. The blind athletes competed in the 2004 Paralympic Games. The sighted athletes competed in the 2004 Olympic Games. The matches analyzed consisted of gold- and bronze-medal matches.

To track the athletes’ reactions at certain points after the competition in the Paralympic games, the researchers photographed their facial expressions immediately after their match, during the medal ceremonies, and on the podium with other medalists. Each expression was coded according to the displayed emotion. Expressions from the sighted Olympic athletes were taken from another study done the same way by the same authors.

From the photos, the researchers found that the blind athletes produced the same facial expressions involving anger, contempt, disgust, sadness, surprise and multiple types of smiles as the sighted athletes.

The facial expressions differed for the athletes depending on what medal they won and what social situation they were in. Even though many of the blind silver winners and those who placed fifth smiled less after finishing their match, they did manage social and genuine smiles while receiving medals or standing on the podium. This shows how embedded it is to put on a good face even when you lose and can’t see your audience, says study author David Matsumoto, PhD, of San Francisco State University.

— Source: American Psychological Association

Joyful or sad smiles expressed after a competition are the same for blind and sighted athletes, says a new study, showing that certain facial expressions are innate and managed differently depending on the social situation. These findings are reported in the Journal of Personality and Social Psychology.

The study compared the expressions of 76 blind judo athletes, some of whom were born blind, with the expressions of 84 sighted judo athletes. The blind athletes competed in the 2004 Paralympic Games. The sighted athletes competed in the 2004 Olympic Games. The matches analyzed consisted of gold- and bronze-medal matches.

To track the athletes’ reactions at certain points after the competition in the Paralympic games, the researchers photographed their facial expressions immediately after their match, during the medal ceremonies, and on the podium with other medalists. Each expression was coded according to the displayed emotion. Expressions from the sighted Olympic athletes were taken from another study done the same way by the same authors.

From the photos, the researchers found that the blind athletes produced the same facial expressions involving anger, contempt, disgust, sadness, surprise and multiple types of smiles as the sighted athletes.

The facial expressions differed for the athletes depending on what medal they won and what social situation they were in. Even though many of the blind silver winners and those who placed fifth smiled less after finishing their match, they did manage social and genuine smiles while receiving medals or standing on the podium. This shows how embedded it is to put on a good face even when you lose and can’t see your audience, says study author David Matsumoto, PhD, of San Francisco State University.

— Source: American Psychological Association

A new study finds that the onset of physical disability boosts marital happiness more often than not. The study shows what happens with couples when one of them loses the ability to perform routine daily activities:

• Both men and women, regardless of age, reported being happier in their marriage after they themselves became physically disabled.

• Men whose spouse became physically disabled also experienced greater happiness in their relationship.

• Women whose spouse became physically disabled reported no overall change in the relationship.

“The numbers show that couples seem to come together when one of them experiences physical limitations,” says lead author Jeremy B. Yorgason, PhD, a Brigham Young University assistant professor. “This suggests disability is a two-way street, with some surprising pluses in addition to the minuses people ordinarily expect.”

The results, published in Research on Aging, are based on information provided by 1,217 married people (aged 36 to 75) randomly selected from around the country. Researchers tracked the lives of the study participants for 12 years. By study’s end, about one fourth of participants reported that either they or their spouse had permanent physical conditions that restricted activities like dressing, bathing, eating or working around the house. The researchers zeroed in on this group, comparing their satisfaction in marriage before and after the physical disability occurred.

Exactly why physical limitations boost marital happiness is not fully understood by researchers, Yorgason says. One hint from the new study is that in some cases disability brings more couple interaction. Since the onset of physical disability is often stressful, Yorgason recommends couples allow time to adjust and look within their relationship for the “silver lining.”

— Source: Brigham Young University

Nearly 50 years after one of the most controversial behavioral experiments in history, Jerry M. Burger, PhD, a professor at Santa Clara University, replicated one of the famous obedience experiments of the late Stanley Milgram, PhD, and found that compliance rates in the replication were only slightly lower than those found by Milgram. And, like Milgram, he found no difference in the rates of obedience between men and women. These findings are reported in American Psychologist.

Milgram’s techniques have been debated ever since his research was first published. As a result, there is now an ethics codes for psychologists and other controls have been placed on experimental research that have effectively prevented any precise replications of Milgram’s work.

Burger implemented a number of safeguards that enabled him to win approval for the work from his university’s institutional review board. First, while Milgram allowed his subjects to administer “shocks” up to 450 volts, 150 volts appeared to be the point where participants paused and indicated reluctance to continue. Thus, 150 volts was the top range in Burger’s study.

In addition, Burger screened out any potential subjects who had taken more than two psychology courses in college or who indicated familiarity with Milgram’s research. A clinical psychologist also interviewed potential subjects and eliminated anyone who might have a negative reaction to the study procedure.

In Burger’s study, participants were told at least three times that they could withdraw from the study at any time and still receive the $50 payment. Also, these participants were given a lower-voltage sample shock to show the generator was real—15 volts, as compared with 45 volts administered by Milgram.

Several of the psychologists writing in the same issue of American Psychologist questioned whether Burger’s study is truly comparable to Milgram’s, although they acknowledge its usefulness.

— Source: American Psychological Association

Following a psychiatric discharge, Medicare patients in insurance plans that provide equal cost sharing for mental health services have higher use of those services compared with patients in plans that require greater cost sharing, according to a study in The Journal of the American Medical Association.

The researchers examined the relation between parity in outpatient cost sharing and whether enrollees had an outpatient mental health visit within 7 and 30 days following a hospitalization for mental illness. Among 43,892 enrollees in 173 health plans who were hospitalized for a mental illness, the relation of parity in cost sharing and receipt of timely outpatient mental health care after discharge was determined analyzing 10 plans that discontinued parity compared with 10 matched control plans that maintained parity.

The researchers found that individuals in full-parity plans were more likely to visit a mental health practitioner within 7 and 30 days after a hospitalization compared with enrollees in plans with intermediate or no parity. For example, copayments that were $14 greater in plans without parity compared with full-parity plans were associated with an 11 percentage point lower rate of follow-up after a psychiatric hospitalization. Rates of follow-up visits within 30 days decreased by 7.7 percentage points in plans that discontinued parity and increased by 7.5 percentage points among control plans that maintained parity.

“Most Medicare health plans, like most commercial health plans, have unequal coverage for mental health services compared with other medical services. Enrollees in plans without parity in cost sharing are less likely to receive timely outpatient care following a hospitalization for mental illness. While prior studies have shown that adoption of mental health parity does not increase mental health spending, parity legislation that equalizes cost sharing for mental health and primary care may increase the use of clinically appropriate mental health services,” the authors concluded.

— Source: American Medical Association

The use of antidepressant medications by patients with fibromyalgia is associated with a reduction in pain, sleep disturbances, and depressed mood and improvement of health-related quality of life, according to an analysis of previous studies, which is published in The Journal of the American Medical Association.

Fibromyalgia, which consists of chronic widespread pain and tenderness, with other symptoms including fatigue and sleep difficulties, has an estimated prevalence of 0.5% to 5.8% in North America and Europe. “Patients with [fibromyalgia] experience disability and reduced health-related quality of life. Fibromyalgia is also associated with high direct and indirect disease-related costs. Effective treatment of [fibromyalgia] is therefore necessary for medical and economic reasons,” the authors wrote.

Winfried Häuser, MD, of Klinikum Saarbrücken in Germany, and colleagues conducted a meta-analysis to evaluate the effects of treatment with antidepressants on fibromyalgia-related symptoms. The researchers identified 18 randomized controlled trials, involving 1,427 participants, for inclusion in the study.

Overall, there was strong evidence for a reduction of pain, fatigue, and depressed mood and improved sleep and health-related quality of life with the use of antidepressants by patients with fibromyalgia.

The researchers found large effect sizes of tricyclic and tetracyclic antidepressants for reducing pain, fatigue, and sleep disturbances; small effect sizes of selective serotonin reuptake inhibitors for reducing pain; small effect sizes of serotonin and noradrenaline reuptake inhibitors for reducing pain, sleep disturbances, and depressed mood; and small effect sizes of monoamine oxidase inhibitors for reducing pain.

— Source: American Medical Association

Nearly one third of veterans who are treated at VA healthcare centers have significant depressive symptoms, and about 13% have clinically diagnosed depression, says Marcia Valenstein, MD, a clinical psychiatrist with the VA Ann Arbor Healthcare System and an associate professor of psychiatry with the University of Michigan Health System.

Depression is a “very potent” risk factor for suicide among people receiving treatment for depression at the VA, she notes, with a suicide rate that is three times higher than that of the overall VA patient population. Such high rates led Valenstein and her colleagues to study the best time to provide intensive interventions to veterans with depression to prevent suicide. In a study published by the Journal of Affective Disorders, the researchers found that veterans with depression were at highest risk for suicide in the 12 weeks after they were hospitalized for psychiatric conditions.

“This finding highlights the need for very close follow-up for patients who are discharged from our inpatient services because this is a particularly vulnerable time for them,” says Valenstein.

Current government recommendations have focused on providing intensive follow up for patients following all new antidepressant starts. More attention needs to be paid to the highest-risk periods that follow psychiatric hospitalization, Valenstein says. “Health systems with limited resources should focus their efforts on this time period to have the greatest impact on suicide prevention.”

The Department of Veterans Affairs has made mental health issues a priority, Valenstein notes. VA health centers have received more than $300 million for expansion of suicide prevention and other mental health services from the Veterans Health Administration.

— Source: University of Michigan Health System

At least one in 25 older adults (about 2.2 million people in the United States) take multiple drugs in combinations that can produce a harmful drug-drug interaction, and one half of these interactions involve a nonprescription medication, researchers from the University of Chicago Medical Center report in The Journal of the American Medical Association.

"Older adults are the largest consumer of prescription drugs," says study author Stacy Tessler Lindau, MD, an assistant professor of obstetrics and gynecology and of medicine at the University of Chicago Medical Center. "We find that they commonly combine these prescription medications with over-the-counter medications and dietary supplements, which can increase their vulnerability to medication side-effects and drug-drug interactions."

The study used data collected for the National Social Life, Health and Aging Project, a nationally representative multipurpose survey of adults aged 57 to 85 administered between July 2005 and March 2006. The survey team interviewed 3,005 participants in their homes about the medications they used every day or every week. About 2,970 respondents completed the interview and medication log.

Of those that responded, 91% regularly used at least one medication and 29% took more than five prescription medications; 68% of those who took prescription drugs also used over-the-counter medications or dietary supplements; men were more likely to take over-the-counter medicines, while women were more likely to use supplements in addition to their prescription; and nearly one half of the drug-drug interactions identified could cause bleeding problems.

"Physicians and pharmacists need to ask their patients about the use of nonprescription medications," said Lindau. "Patients need to inform their providers about all medications they use--prescription and nonprescription--and should ask their physician or pharmacist about interactions any time they start a new drug, on their own or following the doctor's recommendation."

— Source: University of Chicago Medical Center

For parents with concerns about their child’s mental health, they may look to their child's primary care physician (PCP) for guidance and assistance with getting treatment if needed. But according to the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health, PCPs aren't asking most parents if they have concerns about their child's mental health. “We found that more than one half of parents (56%) report that their primary care physician never asks about whether they have mental health concerns for their child,” says Matthew M. Davis, MD, MAPP, director of the National Poll on Children's Health.

The poll asked parents of children aged 5 to 17 the degree to which they interacted with their children's PCPs about mental health issues and how often their child received specialty mental health services. Though many parents said their child's PCP never asks about mental health concerns for their kids, 22% of parents reported that their child's PCP regularly asks and 22% report being asked sometimes.

For parents who have discussed mental health concerns with their child's PCP, 62% report having used specialty mental health services for their children. Of parents whose children have mental health diagnoses, 25% say they've had difficulty finding the specialty mental health services they want for their child.

For parents who say they've had difficulty getting specialty mental health services for their child, 46% of parents cite difficulty finding a provider as the reason, 43% of parents say services cost too much, 35% say they could not get a timely appointment, and 33% say they did not know where to go.

— Source: University of Michigan Health System

Menthol cigarettes are harder to quit, particularly among African American and Latino smokers, according to researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ) in a study that examined the effects of menthol on quit rates among a diverse group of nearly 1,700 smokers attending a Tobacco Dependence Clinic at the UMDNJ-School of Public Health, which is published in The International Journal of Clinical Practice.

“We previously found that menthol cigarette smokers take in more nicotine and carbon monoxide per cigarette. This study shows that menthol smokers also find it harder to quit, despite smoking fewer cigarettes per day,” says study author Kunal Gandhi, MBBS, MPH, a researcher in the division of addiction psychiatry.

Jonathan Foulds, PhD, director of the Tobacco Dependence Program, adds: “More than 80% of the African American smokers attending our clinic smoke menthols, and they have half the quit rate of African Americans who smoke nonmenthol cigarettes.”

The researchers believe the cooling effect of the menthol makes it easier to inhale more nicotine from each cigarette and, therefore, to obtain a stronger and more addictive nicotine dose. “That may be part of the reason why African Americans have much higher rates of lung cancer,” Foulds says.

The researchers also are concerned that the tobacco industry may target its marketing of menthol cigarettes to groups with less cash to spend, such as youths, with the aim of getting them hooked even on fewer cigarettes per day, they say. Their study findings may have implications for future regulation of cigarettes. Recent legislation in New Jersey and pending federal legislation bans fruit- and candy-flavored cigarettes but allows menthol to be added.

— Source: University of Medicine and Dentistry of New Jersey

According to a new study published by a University of Illinois professor, adolescents are increasingly experiencing both individual and vicarious discrimination online, which in turn triggers stress, depression, and anxiety.

Brendesha Tynes, PhD, a professor of educational psychology and of African American studies at the university, believes that with teenagers increasingly tethered to the Internet, more consideration should to be given to race-related online victimization not only as an Internet safety issue, but also as a public health concern for parents. Tynes and coauthors published their findings in the Journal of Adolescent Health.

For the study, Tynes created a measure for race-related online victimization. She discovered that 71% of African American adolescents, along with 71% of white and 67% of multiracial/other adolescents, experienced vicarious racial discrimination online at least once. Twenty-nine percent of African American adolescents, and 20% of white and 42% of multiracial/other adolescents also reported experiencing individual discrimination directed at them while online, according to the findings.

Tynes’s research indicates that, regardless of a victim’s racial background, increased exposure to online racial discrimination was significantly related to increased depression; females were found to experience significantly more depression and anxiety than males.

Tynes’s findings depart from previous research in the field, which had shown discrimination to disproportionately impact the emotional and physical health primarily of people of color. The variance in her findings could be attributed to the sample or the measures used in her study, she said, since the discrimination gap between whites and blacks is profoundly different, both online and offline.

“More research is needed to determine the impact of those differences,” Tynes says.

— Source: University of Illinois at Urbana-Champaign

The landmark "Sexual Behavior in the Human Male" report revealed major insights into bisexual behavior and orientation—without even using the word bisexual—when it was published 60 years ago by Alfred Kinsey and his research team at Indiana University (IU). While the Kinsey Scale has become a fixture in sexuality textbooks and even popular culture, the rating system and Kinsey's findings regarding male bisexuality have largely been overlooked by today's sex researchers, according to an article in the Journal of Bisexuality.

For this article, Brian Dodge, PhD, associate director of the Center for Sexual Health Promotion in the School of Health, Physical Education and Recreation, collaborated with Paul H. Gebhard, PhD, an original member of Kinsey's research team, to reflect on research involving male bisexuality since the Kinsey Report and potential directions for future research.

Kinsey believed that culture plays a key role in a person's sexual behavior. Gebhard said Kinsey and his research team avoided looking for causes for sexual orientation out of concern that the findings could be used against people. Since Kinsey's day, Gebhard noted that many researchers have moved to a medical model of sex research—looking for genetic causes of homosexuality or in an attempt to define what is normal, usually using heterosexuality as the reference point.

"It's not necessarily a bad thing that research is evolving," Dodge said. "Biology and genetics, of course, are part of the picture. But we seem to be swinging in the direction where some scientists are using these as universal explanatory constructs and trying to minimize, or even negate, the role of an individual's culture and environment, aspects that Kinsey thought were most important."

Gebhard and his coauthors offered the following suggestions for future research focusing on male bisexuality:

• Move away from a disease-focused lens. Dodge said the medical model of sexuality research has established heterosexuality as the norm even though Kinsey's findings indicated it was natural for people to move across the Kinsey Scale throughout their lives.

• Improve sampling methods for bisexuality research. Dodge acknowledged that finding bisexual participants for studies is often challenging but important, requiring innovative techniques.

• Revive the concept of the Kinsey continuum. Dodge suggested the need for a revival of the discussion surrounding this concept in research circles, as well as popular culture. "People should not be pigeon-holed into social categories, such as homosexual, heterosexual, or even bisexual," Dodge said.

— Source: Indiana University

In rural America, 70% of married mothers with children under six work for pay, finds a major new report spanning nearly 40 years of women’s employment trends. As men’s employment rates have dropped over the past four decades, more rural women are working to keep the lights on at home, according to the report from the Carsey Institute at the University of New Hampshire.

“The rural America of our collective imagination is changing. Mom is no longer home in the kitchen, and dad is no longer on the tractor or in the mines,” says Carsey Institute family demographer Kristin Smith, PhD, author of “Working Hard for the Money: Trends in Women’s Employment 1970 – 2007.” Rural women are just as likely as their urban counterparts to work for pay, says Smith, but they earn less, have fewer occupational choices, and have seen their family income decline as men’s wages have not kept pace with inflation.

Using employment estimates from the U.S. Census Bureau’s Current Population Survey’s March Supplements, the report is unique in its look at women’s work trends, both nationally and in rural and urban America.

In rural areas, college-educated women reap less of an “education dividend” than their urban peers, earning on average 81 cents to every dollar urban college graduates earned. Types of jobs available in rural vs. urban areas explains some of this disparity: while the top eight occupations held by highly educated women in urban areas include well-paying doctor and lawyer positions, two low-paying jobs, preschool and kindergarten teachers, are among the top eight for those in rural areas.

— Source: University of New Hampshire

Parents of a child with attention-deficit/hyperactivity disorder (ADHD) are nearly twice as likely to divorce by the time the child is 8 years old than parents of children without ADHD, the first study to look at this issue in depth has shown. Moreover, among couples in the study who were divorced, marriages involving children with ADHD ended sooner than marriages with no ADHD-diagnosed children. Results of the study appear in the Journal of Consulting and Clinical Psychology.

Additional findings from a subset of divorced couples with children with ADHD showed that several characteristics within the family contribute individually to the risk of divorce: age of the child when diagnosed, race and ethnicity of the parents, severity of coexisting disorders in children with ADHD such as oppositional-defiant disorder and conduct disorder, education levels of the parents, and a father’s antisocial behavior (trouble with the law).

Data for the study was gathered from a subset of participants in a larger investigation called the Pittsburgh ADHD Longitudinal Study (PALS), which is funded by grants from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.

Some 282 adolescents and young adults, who had been diagnosed with the disorder in childhood, and their parents completed a series of questionnaires and diagnostic instruments, along with individual interviews. The child’s birth date was used as the starting point of the time to divorce. These results were compared with those from 206 demographically similar PALS participants without ADHD and their parents.

Results showed that 22.7% of parents of children with ADHD had divorced by the time the child was 8 years old, compared with 12.6% of parents in the control group. Divorce rates of parents with and without children with ADHD were not significantly different after children passed the 8-year mark.

— Source: University at Buffalo

Standardized testing is an inescapable part of modern education; however, these tests often fail to meet the needs of students with learning disabilities. Vanderbilt University Learning Sciences Institute researchers Stephen N. Elliott, PhD; Peter A. Beddow, PhD; and Ryan J. Kettler, PhD, have developed a decision-making instrument called the Test Accessibility and Modification Inventory (TAMI) to address the issue of accessibility for students with special needs.

“The TAMI should help all test developers systematically apply principles of universal design to advance the accessibility of tests for all students, not just students identified with disabilities. TAMI is helping test developers achieve their dual goals of better tests and better testing practices,” says Elliott, director of the Learning Sciences Institute and director of the Interdisciplinary Program in Educational Psychology. “Teachers and test developers alike have told us that the TAMI advances their goals of better and more inclusive assessment for students with disabilities. These educators eagerly tell us that these students have learned significantly more than they had previously been able to show on less accessible tests.”

“We define accessibility as ‘the extent to which an environment, product, or service eliminates barriers and permits equal access to all components and services for all individuals,’” says Beddow, a research assistant in special education and a member of the Learning Sciences Institute. “In the case of standardized testing, this means developing assessment tools that do not place students at a disadvantage because of difficulties with reading, comprehension, or other problems when it comes to being able to understand the question posed and its corresponding answer set.”

The researchers emphasize that they are not using TAMI to water down standardized tests, but instead to make the tests more appropriate to the students taking them, while ensuring that the knowledge being assessed and demonstrated is of the same depth. “We anticipated that there would be a need for a tool that could be used to analyze and modify test items for this purpose because of our involvement with a similar project, the Consortium for Alternate Assessment Validity and Experimental Studies,” Beddow says.

— Source: Vanderbilt University

Researchers at the Babraham Institute near Cambridge, supported by the Alzheimer's Research Trust and the Biotechnology and Biological Sciences Research Council (BBSRC), have discovered that the brain's circuitry survives longer than previously thought in diseases of aging such as Alzheimer's. The findings were published in the journal Brain.

"We've all experienced how useless a computer is without broadband. The same is true for a nerve cell [neuron] in the brain whose wiring [axons and dendrites] has been lost or damaged," explains Michael Coleman, PhD, the project's lead researcher. "Once the routes of communication are permanently down, the neuron will never again contribute to learning and memory, because these 'wires' do not regrow in the human brain."

During healthy aging this miniature transport system undergoes a steady decline, but the challenges are immense. Axons up a meter long have to survive and function for at least eight or nine decades, surviving from childhood. In Alzheimer's disease, axons swell dramatically, ballooning to 10 or 20 times their normal diameter. These swellings disrupt transport but not, it seems, completely. Enough material gets through the swellings to keep more distant parts of the axon alive for at least several months, and probably for a year or more. This is important because it suggests a successful therapy applied during this early period may not only halt the symptoms, but allow a degree of functional recovery.

"We've been able to look at whole nerve cells affected by Alzheimer's," says Coleman. "For the first time we have shown that supporting parts of nerve cells are alive, and we can now learn how to intervene to recover connections. This is very important for treatment because in normal adult life, nerve cell connections constantly disappear and reform, but can only do so if the supporting parts of the cell remain. Our results suggest a time window in which damaged connections between brain cells could recover under the right conditions."

— Source: Babraham Institute

Rush University Medical Center and 10 other healthcare facilities in the United States and Canada have been awarded a $4.3 million grant from the National Institutes of Health to identify which rehabilitation therapies, or combination of therapies, can best help victims of traumatic brain injuries (TBIs).

“Our aim in this study is to isolate individual components of the range of therapies we use to treat our patients and determine how, and to what degree, each is associated with improved function,” says James A. Young, MD, chairman of the department of physical medicine and rehabilitation at Rush and an internationally recognized expert in the treatment of brain injuries.

The five-year study will collect the records of more than 2,300 patients who have suffered moderate to severe TBIs, including detailed demographic, diagnostic, and clinical profiles of each patient. Daily logs will be kept of the individually tailored treatment programs the patients undergo in physical therapy, occupational therapy, speech/language therapy, physiatry, psychology/psychiatry, and social support. Outcomes will be catalogued and correlated with both the patients’ characteristics and therapeutic interventions.

The researchers will then analyze the data to determine which therapies were the most successful in improving outcomes for patients with different types and severities of TBIs. Patients will also be followed for a full year after being discharged to assess their quality of life, including whether they were able to live independently, drive a vehicle, and participate in daily activities.

“From the extraordinary wealth of data we’ll collect in this five-year analysis, we will be able to offer clinicians the information that can help them evaluate their current treatment practices and select therapies that are most likely to help their patients,” Young says. “This is medicine at its best: treatment based on the results of years of clinical practice.”

— Source: Rush University Medical Center

New research has traced elevated levels of a specific compound, kynurenic acid, in the brain to problem-solving deficits in patients with schizophrenia. The finding suggests that drugs used to suppress kynurenic acid may be an important supplement to antipsychotic medicines, as these adjuncts could be used to treat the disorder’s most resistant symptoms—cognitive impairments.

Though schizophrenia is commonly characterized by hallucinations and delusions, patients also have problems with what is known as cognitive flexibility or executive decision-making. Many patients can set a goal and plan one way to achieve it, but cannot adjust their thinking if circumstances force them to consider alternative strategies.

“We’ve got this core cluster of symptoms that is the Achilles’ heel for these individuals, and we’re not really doing a good job of treating them,” says John P. Bruno, PhD, a professor of psychology, psychiatry, and neuroscience at The Ohio State University and principal investigator of the research.

Bruno and colleagues have combined advanced animal modeling of schizophrenia-related chemical changes in the brain with the observation that the production of too much kynurenic acid is linked to troubled thinking that affects the research animals’ behavior. The compound is present in all human brains and has some useful functions. But in excessive amounts, the researchers found, kynurenic acid interferes with other chemical processes that govern the ability to pay attention and think strategically under changing conditions.

“If we try to make predictions about how disabled patients with schizophrenia will be and how likely are they to be integrated into the social fabric, it’s the severity of the cognitive deficits that are most predictive,” Bruno says. “Antipsychotics are particularly good at what we call positive symptoms, but these same drugs are very poor at treating the cognitive deficits.

— Source: The Ohio State University

Though effective treatments are available for individuals suffering from chronic depression and anxiety, very little is known about how often these treatments are used or how prevalent these conditions are among the nation's general population. But UCLA researchers have developed estimates for both the prevalence of chronic psychiatric illness in the general population and how often individuals suffering from such illnesses receive appropriate treatment.

In the study, published in Psychiatric Services, researchers found that approximately 4.7% of the nation's population suffers from persistent depression or anxiety disorders, with a minority of those afflicted receiving adequate medication or counseling.

The study was based on data from Healthcare for Communities, a nationally representative household survey of adults in the United States. The researchers analyzed responses from 1,642 adults with major depression or anxiety disorders. These surveys, conducted in 1997 and 1998, with follow-ups approximately two-and-a-half years later, assessed diagnosis, quality of life, treatment satisfaction, medical conditions, suicidal thoughts, insurance, and the use of medications and counseling.

At follow-up, the researchers found that 59% of the individuals no longer met the criteria for having a psychiatric disorder. But to their surprise, they found that among those who remained ill, there were only modest increases in medication use and no statistically significant increase in the use of counseling for their disorders—measures that are known to significantly improve outcomes, especially when used in combination.

Among this subgroup: 87% had a chronic, comorbid medical disorder; in the prior year, 88% had seen a primary care practitioner, but only 22% had consulted a mental health specialist; in the two-and-a-half years between baseline and follow-up, use of medication rose from 21% to 29%, and use of counseling fell from 23% to 19%; only 12% with persistent illness were getting both medication and counseling; 51% had suicidal thoughts at follow-up; and men and those with less education received less treatment.

— Source: UCLA Health Sciences