Occupation and suicide - back to the drawing board

A study 67,095 people in Denmark between 1991 and 1997 looked at the links between people's occupation and their propensity to commit suicide. Motor mechanics and fitters, and primary school teachers had an average risk of suicide and were given a risk score of 1. In general lower socio-economic groups were - perhaps unsurprisingly - more likely to kill themselves but doctors (2.73 times as likely as primary-school teachers) and nurses (2.04) also scored highly perhaps because these professions have ready access to lethal drugs. The professions least likely to commit suicide were architects and engineers who both had a mere 0.44 times the risk of infant teachers. So for a happy career choice it's throw away the stethoscope and get back to the drawing board !

Work stress, anxiety and depression

A long term study of 972 people in Dunedin, New Zealand has shed further light on the links between workplace stress and depression and anxiety. Those people who had high psychological job demands (an excessive workload and/or extreme time pressures) had double the risk of major depression or anxiety of other people, regardless of their socio-economic status, personality of mental-health history prior to being exposed to workplace stress. Analysis of the results showed that high demand jobs were associated with the onset of new depression and anxiety even in people without any history of mental-health problems.

Melchior, Maria ... [et al] - Work stress precipitates depression and anxiety in young, working women and men Psychological Medicine August 2007, 37 (8), 1119-1129

Feeling the heat

For over a century seasonal fluctuations in suicide have been observed with studies usually showing an increase in people killing themselves in spring and early summer. However, within this seasonal variation it is hard to disentangle the effects of temperature, humidity, hours of sunshine and the length of daylight. A study of daily temperature and suicide rate in the UK between 1993 and 2003 has found that there was no spring or early summer peak in the suicide rate but that above 18C each 1C rise in mean temperature was associated with a 3.8% rise in suicides. Suicides increased by 46.9% during the 1995 heatwave but did not rise at all during the heatwave of 2003.

Page, Lisa A., Hajat, Shakoor and Kovats, R. Sari - Relationship between daily suicide counts and temperature in England and Wales British Journal of Psychiatry August 2007, 191, 106-112

Race and sectioning

Over the last twenty years several studies have shown that a disproportionate number of people from Black and other ethnic minority groups are compulsorily detained under the Mental Health Act. A review of 19 studies on this topic has found that Black people are 3.83 times as likely to be sectioned as White people while Asian people are 2.06 times as likely to be sectioned. The most common explanations the authors of the study found for this discrepancy were : misdiagnosis of and discrimination against ethnic minority patients, a higher incidence of psychosis among ethnic minority groups and the different ways that mental illness can manifest itself among different groups.

Singh, Swaran P. ... [et al] - Ethnicity and the Mental Health Act 1983 British Journal of Psychiatry August 2007, 191, 99-105

Antidepressants, ageing and death

A long-term study of 470,000 elderly people in Denmark has found that over a period of twelve years antidepressant use increased substantially among this age group. Among people aged over 65 the use of antidepressants increased with age. Over a quarter of women aged between 85-89 were taking antidepressants with 17.5% of men in this age group also taking them. However old people were their use of antidepressants increased in the last three years of life with a third of women and a quarter of men taking antidepressants in the six months before they died.

Hansen, Dorte Gilsa ... [et al] - Increased use of antidepressants at the end of life : population-based study among people aged 65 years and above Age and ageing July 2007, 36(4), 449-454

Depressed people and depressed carers

A study of 97 people and their carers in Canada has shown that compared to caregivers looking after people without depression those who looked after depressed people had much worse mental health and were more likely to become depressed themselves. This was despite the fact that those people looking after non-depressed people had worse physical health than those caring for depressed people.

McCusker, Jane ... [et al] - Major depression among medically ill elders contributes to sustained poor mental health in their informal caregivers Age and ageing July 2007, 36(4), 400-406

Pills and therapy the best combination for depressed adolescents

A study of 439 adolescents with depression in the U.S. compared the effectiveness of treating them with fluoxetine (Prozac), fluoxetine and cognitive behaviour therapy (CBT), CBT alone and a placebo. The most effective treatment was fluoxetine and CBT, followed by fluoxetine alone. CBT alone was no more effective than a placebo.

March, J., Silva, S. and Vitiello, B. - The Treatment for Adolescents with Depression Study (TADS) Journal of the Academy of Child and Adolescent Psychiatry 2006, 45: 1393-1403

A comparison of antipsychotics

A study of 182 people in Spain compared the effectiveness and side effects of three anti-psychotic drugs : haloperidol, risperidone and olanzapine. The researchers concluded that all three drugs were equally effective. Haloperidol increased tremors and restlessness while olanzapine lead to weight gain. Both olanzapine and haloperidol caused increased sleepiness.

Crespo-Facorro, B. ... [et al] - A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis Journal of Clinical Psychiatry 2006, 67: 1511-1521

Nurses' survey points the way to improvements

A survey of mental health nurses asked them 'How can mental health nurses best improve service users' experiences, and outcomes, in inpatient care settings?'. The survey received 326 written responses with the most common suggestions being that service users should have an influence over services and that they should be involved more in their own care. The other most popular suggestion was that nurses should have 'protected time' with patients, free from interruptions and administrative chores. The results of the survey went into making up the Chief Nursing Officer's review of mental health nursing 'From values to action'.

Brimblecombe, N., Tingle, A. and Murrells, T. - How mental health nursing can best improve service users' experiences and outcomes in inpatient settings : responses to a national consultation Journal of Psychiatric and Mental Health Nursing August 2007, 14(5), 503-509

CBT for depressed adolescents - keep taking the tablets

Adolescent depression is a serious disorder with a high risk of suicide. Selective serotonin reuptake inhibitors (SSRIs) are used in treatment although there are concerns about how effective they are and fears that they could actually raise the risk of suicide. The National Institute for Clinical Excellence (NICE) has proposed that Cognitive Behaviour Therapy (CBT) be also used for this age group, however, a study of 208 teenagers in Manchester and Cambridge has found that CBT made little difference compared to taking SSRIs and routine clinical care. The study divided the children into two groups giving one group SSRIs and CBT and the other group just SSRIs. The trial lasted twelve weeks and by the end of the study there was no difference in effectiveness of treatment between the two groups.

Goodyer, Ian ... [et al] - Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression : randomised controlled trial British Medical Journal July 21, 2007, 142-146

Asthma, anxiety and depression in old people

Studies of children, teenagers and young adults have found higher rates of anxiety among people with asthma than in the rest of the population and in comparison to people with other chronic illnesses but the links between asthma and depression are much more tenuous. However, there has been very little research into the links between asthma and mental health problems among elderly people. A study of 1,092 elderly people in Singapore found that people with asthma were nearly two-and-a-half times more likely to suffer from depression than people without the condition and those with other chronic illnesses. However although there was a raised incidence of anxiety and depression among people with asthma this was not statistically significant i.e. it could just have been down to the particular characteristics of this sample of people.

Ng, Tze-Pin, Chiam, Peak-Chiang and Kua, Ee-Heok - Mental disorders and asthma in the elderly : a population-based study International Journal of Geriatric Psychiatry July 2007 22(7), 668-674

Alzheimer's drugs still not reaching those in need

Studies in the late 1990s found that drugs called cholinesterase inhibitors (CHEIs) could be helpful for people in the early stages of Alzheimer's disease and in 2001 the National Institute for Clinical Excellence (NICE) recommended that these drugs could be prescribed to individuals with mild-to-moderate Alzheimer's disease. However data from a long-term study of 13,004 elderly people has found that people with the condition are still not being prescribed the drugs. Of the 219 people in the study who were diagnosed with dementia between 2001-2003 only 12 were prescribed CHEIs and of the 28 people diagnosed with dementia in 2004 none were given the drugs. People with better education and higher incomes were more likely to be prescribed CHEIs.

Matthews, Fiona E. ... [et al] - Reaching the population with dementia drugs : what are the challenges International Journal of Geriatric Psychiatry July 2007, 22(7), 627-631

Personal construct psychotherapy - how well does it work ?

Personal construct psychotherapy was established in 1955 by George Kelly. He thought that we could not approach reality directly but that we interpret it according to our own models or personal constructs of how the world works. Problems arise when we fail to change our personal constructs, even when it turns out that they could be harmful or that they have little basis in reality. Personal construct therapy aims to move people to a more viable construction of reality although - unlike other cognitive therapies - the individual is not guided towards a particular point of view. A review of studies into the effectiveness of personal construct psychotherapy has found that there is strong evidence of the beneficial effects of the technique. However studies which compared it to other methods of treatment found that it was neither more nor less effective than other talking therapies.

Metcalfe, Chris, Winter, David and Viney, Linda - The effectiveness of personal construct psychotherapy in clinical practice : a systematic review and meta-analysis Psychotherapy Researcy July 2007, 17(4), 431-442

Eating disorders and the figure of the therapist

'Therapist variables' have been extensively studied in psychotherapy research with particular attention being paid to the match between therapist and patient characteristics and the impact of therapist characteristics on treatment outcome. However there has been far less attention paid to patients' preferences for particular therapist characteristics. A study of 64 people in Germany compared the preferences of people with an eating disorder to those of people suffering with anxiety as far as the figure of their therapist was concerned. Those people with eating disorders attached more importance to the figure of their therapist but both groups expressed a preference for a therapist with an average figure. Within both groups participants preferred their therapist to have a shape similar to their own.

Vocks, Silja, Legenbauer, Tanja and Peters, Inga - Does shape matter? Preference for a female therapist's figure among patients with eating disorders Psychotherapy Research July 2007 17(4), 416-422

Old people's smell

Mild cognitive impairment (MCI) is increasingly recognised as a precursor to Alzheimer's disease but there has been little research into how this transition occurs and therefore little knowledge about the symptoms to look out for. A declining ability to distinguish between different smells has been linked to MCI and a study of 589 elderly people in the U.S. has now found that impaired odour identification was associated with a lower level of cognitive function at the start of the study and a more rapid decline in cognition as the study (which lasted five years) went on.

Wilson, Robert S. ... [et al] - Olfactory identification and incidence of mild cognitive impairment in older age Archives of General Psychiatry , July 2007, 64(7), 802-808

Grey matter, schizophrenia and recovery

There are distinct differences in the brains of people who suffer from schizophrenia which have less grey matter in the cortex, hippocampus and amygdala regions. However, there is some debate as to whether these are inherent differences or whether the changes in brain structure are cause by the effects of the schizophrenia. Scientists often study the close relatives of people with schizophrenia in an attempt to see whether there is any familial link to the condition. A study on 104 people in Canada compared the siblings of schizophrenia sufferers with a control group. The researchers found the siblings had grey matter deficits in their cortexes compared to the control group. However, if the siblings stayed healthy and did not develop schizophrenia their brains recovered by the time they reached twenty and their psychological health was as good as the control group. This led the researchers to conclude that there was a familial link to schizophrenia but that if people stayed healthy the brain could recover any defecits over time.

Gogtay, Nitin ... [et al] - Cortical brain development in nonpsychotic siblings of patients with childhood-onset schizophrenia Archives of General Psychiatry July 2007, 64(7), 772-780

Sex, drink and forward rolls

A study of 2,123 students in America compared the attitudes to, and experience of, sex and drink of those students who were involved in sport and those who were not. Sporty students drank more over the course of a week, were more likely to mix sex and alcohol and had a greater number of sexual partners than other students. Sporty students were more likely to see sex as an enhancement of their self esteem rather than as part and parcel of an intimate relationship. Those who adopted the 'notch-on-the-bedpost' approach to sex were more likely to have a higher number of sexual partners and to mix sex and drink while those who saw sex as part of a relationship were more likely to have fewer sexual partners and to drink less before sex.

Grossbard, Joel R. ... [et al] - Alcohol and risky sex in athletes and nonathletes : what role do sex motives play? Journal of Studies on Alcohol and Drugs July 2007, 68(4), 566-574

Substance abuse treatment helps cut suicide risk

A history of suicide attempts is common in patients entering treatment for substance-abuse problems. A study of 3,733 people beginning treatment for substance abuse in the U.S. found that 9% of them had tried to kill themselves in the year before they started their treatment. In the year after their treatment had finished 'only' 4% of them tried to kill themselves. Suicide attempts made during the course of their treatment were less likely in patients treated in residential as opposed to outpatient settings and a longer course of treatment was associated with a lower likelihood of a post-treatment suicide attempt.

Ilgen, Mark A. ... [et al] - Substance Use-Disorder treatment and a decline in attempted suicide during and after treatment Journal of Studies on Alcohol and Drugs July 2007 68(4), 503-509

Eating disorders and self esteem

A study of 3,972 women in Canada looked at the links between disturbed eating patterns and a range of socio-demographic, psychological and health factors. The study found that underweight women were more likely to be preoccupied with food and their body image and feel external pressures to eat. Being young was not associated with disturbed eating attitudes but the lower people's self esteem the more likely they were to have disturbed eating patterns. However there was also a link between high self esteem and dieting.

Park, Jungwee and Beaudet, Marie P. - Eating attitudes and their correlates among Canadian women concerned about their weight European Eating Disorders Review July-August 2007, 15(4), 311-320

Eating disorders and anxiety - a review of the research

A review of studies into the links between eating disorders and anxiety has found that anxiety disorders are significantly more frequent in people with eating disorders than in the general community. Studies also show that anxiety disorders pre-date eating disorders leading to a suggestion that childhood anxiety might predispose people to developing eating disorders. The authors of the study say that the research to date presents 'strikingly inconsistent' findings complicating the understanding of the links between the conditions. While there has been a fair amount of research into the anxiety problems of people with eating disorders there has been little research into the early identification of potential eating disorders in people seeing professionals for anxiety problems.

Swinbourne, Jessica M. and Touyz, Stephen W. - The co-morbidity of eating disorders and anxiety disorders : a review European Eating Disorders Review July-August 2007, 15(3), 253-274