Social Work Today E-Zine

Mothers of multiples have 43% increased odds of having moderate to severe depressive symptoms nine months after giving birth compared with mothers of single-born children, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers examined the relationship between multiple births and maternal depressive symptoms and found that multiple births increased the odds of maternal depression. The results are published in Pediatrics.

“Our findings suggest that 19% of mothers of multiples had moderate to severe depressive symptoms nine months after delivery, compared to 16% among mothers of singletons,” says Yoonjoung Choi, DrPH, lead author of the study and a research associate with the Bloomberg School’s department of international health.

Choi and colleagues used data from the Early Childhood Longitudinal Study—Birth Cohort, a nationally representative sample of children born in 2001. They measured depressive symptoms in mothers using an abbreviated version of the Center for Epidemiologic Studies Depression (CES-D) scale. Researchers examined the association between multiple births and maternal mental health. They also found that, among the mothers of both singleton and multiples, only 27% reported talking to a mental health specialist or a general medical provider when experiencing depressive symptoms.

“The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms,” says Cynthia Minkovitz, MD, MPP, senior author of the study and an associate professor with the Bloomberg School’s department of population, family and reproductive health. “Pediatric practices should make an additional effort to educate new and expecting parents of multiples regarding their increased risk for maternal postpartum depression. Furthermore, well-child visits are potentially valuable opportunities to provide education, screening and referrals for postpartum depression among mothers of multiples.”

— Source: Johns Hopkins Bloomberg School of Public Health

The American College of Emergency Physicians (ACEP) said a study from Austin, TX, was incorrectly being used to perpetuate the myth that emergency departments (ED) are overcrowded because of patients with nonurgent medical conditions. Nick Jouriles, MD, president of ACEP, issued the following statement:

“Patients with nonurgent problems represent only 12% of all emergency visits nationally, and they cost the least to treat in both time and resources. It is frankly absurd to blame overcrowding in any emergency department on such a small number of people. Blaming patients deflects attention from the real reasons emergency departments are crowded.

“America’s emergency departments are crowded because we have increasing numbers of patients with serious problems seeking care in a shrinking number of emergency departments. Research clearly shows that most frequent users of the emergency department need emergency care. Every year, the country’s population gets older and sicker; these are the patients who need the most care and take up the most resources. On top of that, many hospitals engage in a practice known as ‘boarding,’ by holding patients in the emergency department even after they have been admitted to the hospital. This prevents doctors and nurses from treating new patients coming for treatment and that is the true source of overcrowding.

“The notion that emergency departments could free up significant treatment space and resources by directing the most vulnerable patients to outside resources is illogical and impractical. In fact, we believe many measures being suggested to provide care elsewhere for nonurgent patients actually increase costs.

“The myth that poor, uninsured, or underinsured patients could just as easily make appointments with a doctor is contradicted by the reality that most care providers will not treat patients without health insurance. Many providers are now also refusing to take patients with Medicare and Medicaid. These patients typically have to wait until their illnesses get severe before seeking emergency care. By that point, they often need to be admitted to the hospital. These are the people society has turned its back on, which is why they turn to emergency departments: They are the only places these people can get help.”

— Source: American College of Emergency Physicians

The West Virginia Legislature has passed one of its first major healthcare bills of the session: Senate Bill 672, the Mental Health Stabilization Act of 2009. The bill is intended to rebuild West Virginia’s community-based mental health system.

“As the bill says, the Legislature has determined that the community mental health system is in a state of crisis,” lead bill sponsor and Senate Judiciary Chairman Jeff Kessler, D-Marshall, said. “The bill clearly states: ‘There are not sufficient community resources to meet the needs of the state’s population.’”

The bill notes that the state has been “the subject of various court orders as a result of the manner in which it dealt with people with mental health needs and the Legislature desires to be proactive and resolve issues surrounding mental illness without the intervention of the courts.”

Last summer, the court-appointed Ombudsman for Behavioral Health David Sudbeck found Bateman Hospital in Huntington, one of two state psychiatric hospitals, to be overcrowded and understaffed. In January, the West Virginia Supreme Court agreed with Kanawha County Circuit Judge Duke Bloom that he should be allowed to conduct evidentiary hearings into conditions at Bateman Hospital and also into whether the state is providing sufficient services for individuals with traumatic brain injuries.

“It’s important to get Senate Bill 672 signed into law, because without legislative action to fix the mental health system, the courts could very well impose a more costly solution,” John Russell, executive director of the West Virginia Behavioral Healthcare Providers Association, said.

The bill recognizes that the current rates of involuntary mental health commitments and the incarceration of people with mental health needs are using significant state resources. Its premise is that those resources could be used more effectively and efficiently in community-based mental health services, which should reduce the number of people needing involuntary commitments or incarceration.

“More than 37,000 people each year in our regional jails have needed treatment for mental illness,” Delegate Scott Varner, D-Marshall, said. “That places a burden on our counties that would be unnecessary if more people could receive help from mental health providers in their communities.”

— Source: West Virginia Behavioral Healthcare Providers Association

Older African Americans with HIV/AIDS frequently draw upon their spiritual beliefs to cope with the disease but rarely disclose it to friends inside or outside the church, according to a study conducted by University of Alabama (UA) researchers.

The study, presented at the International AIDS Conference in Mexico City, is one of the first to look at the stigma of AIDS in older, rural African Americans in the South. It is authored by Pamela Payne Foster, MD, MPH, a physician and deputy director of UA’s Rural Health Institute for Clinical and Translational Science, and Susan Gaskins, DSN, ACRN, a professor of nursing in UA’s Capstone College of Nursing.

Seventy-five percent of those in The University of Alabama study indicated they didn’t feel they could be open with others about their illness. “Nondisclosure is a way that people manage the stigma they experience,” Gaskins said. “It’s how they protect themselves.”

Because the disease is primarily spread by unprotected sex with an infected partner, women who contract the virus often fear others will think they are promiscuous, the researchers said.

Although 31% of all new HIV infections in the United States in 2006, according to statistics from the Centers for Disease Control and Prevention, occurred via heterosexual contact, the incorrect stereotype that HIV only affects homosexual men adds much to the stigma men feel, the researchers said.

Study participants who did disclose their disease most often told their moms and/or their sisters, the researchers found. Since disclosure was so limited, participants reported experiencing little to no direct stigma from others, but experienced the most stigma related to their internalized shame, the researchers said.

The 24 men and women in the four focus groups the UA researchers studied were all 50 and older and had a confirmed diagnosis of HIV. Most of them never considered themselves at risk of contracting the disease, the researchers said.

“They saw it as a young person’s disease,” said Foster. “They think they are immune … being over 50.”

— Source: University of Alabama

Individuals with autism spectrum disorders (ASD) tend to stare at people's mouths rather than their eyes. Now, a study, reported online in Nature, in 2 year olds with the social deficit disorder suggests why they may find mouths so attractive: lip-sync—the exact match of lip motion and speech sound. Such audiovisual synchrony preoccupied toddlers who have autism, while their unaffected peers focused on socially meaningful movements of the human body, such as gestures and facial expressions.

"Typically developing children pay special attention to human movement from very early in life, within days of being born. But in children with autism, even as old as two years, we saw no evidence of this," explains Ami Klin, PhD, of the Yale Child Study Center, who led the research.

While it was known that people with autism do not spontaneously orient to social signals, it was unclear what early-emerging mechanism may contribute to that. Nor was it clear exactly what they were attending to instead. To find out, the researchers tracked the eye movements of two year olds with and without the disorder while they looked at cartoon animations on split-screen displays.

Eye-tracking data initially showed that 21 toddlers with ASD had no preference for either screen’s animation, looking back and forth between the two. By contrast, 39 typically developing toddlers and 16 developmentally delayed but nonautistic toddlers clearly preferred the one screen’s animation.

However, responses to one animation didn't fit the pattern. In this animation, unlike the others, the movements of the points of light actually cause the clapping sound. This physical synchrony—dots colliding to produce a clapping sound—only existed on the one side of the screen. The children with ASD chose this figure 66% of the time, a strong preference.

The researchers then reanalyzed the data, factoring in more subtle synchronous changes in motion and sound. "Audio-visual synchronies accounted for about 90% of the preferred viewing patterns of toddlers with ASD and none of unaffected toddlers," says Warren Jones, a researcher.

A follow-up experiment using new animations optimized for audiovisual synchrony confirmed these results.

The researchers also reported that children with autism look more at peoples' mouths than eyes as early as the age of 2. Since the mouth is the facial feature with most audiovisual synchrony—lip motion with speech sound—the researchers propose that their new findings offer a likely explanation for this phenomenon.

— Source: National Institute of Mental Health

Flavored alcoholic beverages—or alcopops—are becoming more popular, especially among young people, and it’s raising people’s concerns about underage drinking. According to a recent report, 52% of adults believe definitely or probably that alcopops encourage underage drinking. The report also finds that because these often fruity, fizzy, pop-like drinks can be easily confused with nonalcoholic beverages, 92% of adults strongly support the use of warning labels on alcopops. Most adults also support greater restrictions on advertising that focuses on youth.

“Alcopops are sweet drinks made to taste like cola or soda pop or punch or lemonade,” says Matthew Davis, MD, director of the C.S. Mott Children’s Hospital National Poll on Children’s Health. “Typically, alcopops have between 5% and 8% alcohol content, which is a little bit more than most beers, and they’re marketed to look like familiar drinks to kids.”

What many people may not know is that most alcopops contain distilled alcohol but are classified in most states as “malt beverages” similar to beer. This designation allows alcopops to be marketed more widely, including online and in magazines, and sold in a greater number of retail locations.
“We also found in this poll that about 75% of adults in the United States are concerned underage drinking is a problem,” Davis says. “Underage drinking in the U.S. is pretty common. About 20% of 8th graders and 40% of 12th graders drink.”

The National Poll on Children’s Health also found that among adults 84% support banning alcopops ads from youth Web sites; 80% from youth magazines; 75% from billboards within 500 feet of a school or park; 59% from ads during primetime television; 58% support prohibiting alcopops sponsoring college sporting events; and 57% support limiting alcopops ads during televised sporting events.

“There is a lot of action in state legislatures regarding alcopops or flavored alcoholic beverages,” Davis says. “Many states are considering legislation and some have enacted legislation to limit advertising and otherwise change how alcopops are presented to the public.”

— Source: University of Michigan Health System