Suicide in psychiatric hospitals

There are between 150 and 200 suicides by mental health-inpatients each year in England and Wales, a figure which might be reduceable given the close proximity of mental-health professionals at the time. A study of the 222 patients who killed themselves between the first of April 1999 and the 31 December 2000 looked into the circumstances and risk factors around people's suicides. Nearly a quarter of the suicides took place within the first week of admission with most people dying on the ward or after absconding. After the first week, however, most suicides took place away from the ward, while the patients were on 'leave'. Previous self-harm, recent adverse life events and symptoms of mental illness were all associated with suicide and being off the ward without staff consent was a particularly strong predictor. Other predictors of in-patient suicide were being male, being diagnosed with depression and a history of self-harm.

Hunt, Isabelle M. ... [et al] - Suicide in current psychiatric in-patients : a case-control study Psychological Medicine June 2007, 37(6), 831-837

Suicidal thoughts

A survey of 8,580 people between the ages of 16 and 74 in the UK has found that younger adults are three times more likely to suffer from them than older people. However older people with suicidal thoughts were more likely to be suffering from depression. Tiredness with life and thoughts of death were also more common in the older group. For all ages having a small circle of friends, being divorced or separated and having poor health were all associated with an increased incidence of suicidal thoughts. Being single was an important risk factor for younger age groups while widowhood was an important risk factor for older people.

Dennis, Michael ... [et al] - The spectrum of suicidal ideation in Great Britain : comparisons across a 16-74 years age range Psychological Medicine June 2007, 37(6), 795-805

Korea veterans still suffer fifty years on

The Korean war (1950-1953) which occured when Communist troops from North Korea invaded the South is often overlooked in comparison with other conflicts such as the Second World War, the Vietnam War and the two Gulf Wars despite it being the first collective military action by the United Nations with a total of more than 4 million casualties on both sides. There have been few studies into the psychological problems experienced by Korean War veterans yet a study of 7, 632 people in Australia which compared the mental health of veterans with a control group who did not fight in the conflict found that the veterans experienced significantly more post-traumatic stress. The heavier the combat and the lower the rank of the veterans the more severe their post-traumatic stress was.

Ikin, Jillian F. ... [et al] - Anxiety, post-traumatic stress disorder and depression in Korean War veterans 50 years after the war British Journal of Psychiatry June 2007, 190, 475-483

More time in the womb, less later gloom

Being born prematurely often means that children have lower birth weights than children who are born after a full, nine-month pregnancy. Low birth weight is associated with increased risks of cardiovascular disease and type 2 diabetes later in life and with an increased risk of depression. However, there has been little research into whether being born prematurely can, in itself, lead to an increased risk of depression, regardless of the weight of the baby. A study of 1,371 people in Finland born between 1934 and 1944 asked them about their current levels of depression and compared this with the information about their birth measurements and length of gestation. The researchers found that the less time people spent in the womb the more likely they were to be depressed later regardless of how big they were at birth. The relationship between gestation length and depression still held true even when socioeconomic factors and current weight and height (early babies are more likely to be overweight and obese later in life) were taken into account.

Raikkonen, Katri ... [et al] - Length of gestation and depressive symptoms at age 60 years British Journal of Psychiatry June 2007, 190, 469-474

SARS leaves scars

In 2003 the world was hit by the SARS (severe acute respiratory distress syndrome) epidemic with more than 8,000 people in 29 countries being infected over the course of seven months. In Hong Kong alone 1,755 individuals were infected and 299 died. A study of people in Hong Kong both before and after the epidemic found that people who survived the disease had higher levels of stress at the time of the outbreak and that this elevated level of stress persisted a year later. By 2004 SARS survivors also showed worrying levels of depression, anxiety and post-traumatic symptoms. Those SARS survivors who were health workers at the time of the original outbreak had significantly higher stress levels then other SARS survivors in 2004 and had higher scores for depression, anxiety and post-traumatic symptoms.

Lee, Antoinette M. ... [et al] - Stress and psychological distress among SARS survivors 1 year after the outbreak Canadian Journal of Psychiatry 2007; 52: 233-240

Mindfulness may not be a magic solution for depression and anxiety

Mindfulness has been defined as the 'awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment by moment'. Mindfulness-based stress reduction (MBSR) has been used to treat a wide range of conditions including depression, anxiety, chronic pain, cancer, eating disorders and fibromyalgia. However, a review of fifteen studies into MBSR for depression and anxiety has found the evidence of effects for its benefits to be 'equivocal'. MBSR was better than no treatment at all but this could be due to the attention paid to people by and interaction with researchers. When compared to an 'active' control group MBSR 'did not show any effect on depression and anxiety' and 'the relation between practising mindfulness and changes in depression and anxiety' was 'equivocal'. The researchers did point out, however, that relatively few trials had been done on MBSR and that much more research was needed.

Toneatto, Tony and Nguyen, Linda - Does mindfulness meditation improve anxiety and mood symptoms ? A review of the controlled research Canadian Journal of Psychiatry 2007; 52: 260-266

Borderline personality disorder

Borderline personality disorder (BPD) is characterized by unstable moods, impulsiveness, a fear of abandonment, unstable and intense personal relationships and recurrent suicide attempts. Rates of the disorder range from 0.7% in Norway to 1.8% in the U.S. 10% of people with borderline personality disorder commit suicide ; fifty times the rate of the rest of the population. One of the most promising treatments for the condition is Dialectical Behaviour Therapy (DBT) which was developed by Marsha Linehan in the 1980s and is a mixture of cognitive behaviour therapy and Eastern meditative philosophy. It aims to reduce life-threatening and suicidal behaviour and increase coping skills by improving mindfulness (living 'in the moment'), the ability to tolerate distress, personal relationships and the ability to govern one's emotions. A trial of a six-month programme of DBT on eleven women with BPD in Australia found that it was effective in reducing the number of suicide attempts. The women in the study needed less help from mental health services and their psychological, social and occupational functioning all improved. They also suffered less from depression at the end of the study.

Prendergast, Nicole and McCausland, Jean - Dialectic behaviour therapy : a 12-month collaborative program in a local community setting Behaviour Change 24(1), 2007, 25-35

Coping strategies and gambling

There are many different ways and places for people to gamble these days yet relatively few people go on to develop gambling problems. It has been suggested that individual personality traits or behavioural styles may predispose some people to develop gambling problems. A study of the coping strategies of 65 people by researchers at Monash University, Australia, compared people with gambling problems to those without. Problem gamblers were more likely to be depressed and to use distancing coping strategies ; denying problems, attempting to detach themselves from them and minimising their significance. The gamblers were also more likely to use confrontational coping ; tackling problems head on in a risky or aggressive manner.

Farrelly, Simone ... [et al] - Coping strategies and problem gambling Behaviour Change 24(1), 2007, 14-24

Childhood trauma and depression

A study of 324 people with depression in the U.K. has added further evidence to the already considerable pile linking childhood trauma with adult mental-health problems. 79.9% of the sample reported at least one kind of childhood trauma, most commonly physical neglect, emotional abuse and emotional neglect. Those who had suffered childhood trauma had an earlier age of onset of depression and the more childhood trauma someone had suffered the earlier they became depressed. Physical neglect was particularly linked to adult anxiety.

Moskvina, Valentina ... [et al] - Interrelationship of childhood trauma, neuroticism, and depressive phenotype Depression and Anxiety 24(3) 163-168

Sociotropy, autonomy and depression

Sociotropy is defined as a combination of beliefs, behavioural tendencies and attitudes that lead a person to attend to and depend on others for personal satisfaction. Highly sociotropic individuals are characterized as emphasizing interpersonal interactions involving relatedness, empathy, approval, affection, protection, guidance and help. Autonomy is almost the opposite and is considered to be a combination of beliefs, behavioural tendencies and attitudes that lead people to focus on their own uniqueness, physical functioning and control over their environment. A highly autonomous person is characterized as emphasizing individuality, self-reliance, personal achievements and a sense of power to do what one wants. Both sociotropic and autonomous people are considered to be more at risk of depression the former because of the uncertainty surrounding all human relationships and the latter because we cannot always control our environments or achieve success in the way that we would like. A study of 261 students in Pennsylvania looked at the way sociotropy and autonomy influenced the way people interacted with people close and less-close to them. Sociotropic individuals were overly nurturant to non-close others but vindictive to people who were closer to them whereas autonomous individuals were domineering to people who were less close to them and offhand towards people who were closer to them. As the way in which we get on with other people can make a big contribution to our mental health these findings could prove useful in dealing with depression in sociotropic and autonomous individuals.

Sato, Toru and McCann, Doug - Sociotropy-autonomy and interpersonal problems Depression and Anxiety 24(3), 153-162

Writing autobiographies : better memory, simpler grammar

People's memory often declines as they get older. Strategies to combat this decline include the use of mnemonics (special methods for helping people to remember things) and 'maintenance' activities such as crosswords and Sudoku. A study of 18 people, aged between 62 and 84 in Texas enrolled them on an eight-week writing workshop aimed at teaching them how to write autobiographically. At the end of the eight-week study the participants' scores for verbal memory and attention showed a significant improvement. However, the complexity of the participants' writing, which the researchers had expected to increase as their writing skills improved, actually decreased over the course of the study leading the researchers to hypothesize that as people's writing skills improved they were able to express themselves in simpler, less tortuous sentences.

de Medeiros, Kate ... [et al] - The impact of autobiographic writing on memory performance in older adults : a preliminary investigation The American Journal of Geriatric Psychiatry March 2007, 15(3), 257-261

Social phobia in later life

The hallmark of social phobia is a marked fear of embarrassment in common social situations. This can lead to the avoidance of social activities resulting in impairment at work and in one's personal life and a reduced quality of life. There has been little research done into the prevalence of social phobia among older people but a recent survey of 12,792 people over 55 in Canada found that 4.94% had suffered from social phobia at some point in their lives with 1.32% having suffered during the last year. Current social phobia declined with age and was more common in people with other mental-health problems. There was no correlation between a current diagnosis of social phobia and gender, marital or socioeconomic status.

Cairney, John ... [et al] - Epidemiology of social phobia in later life The American Journal of Geriatric Psychiatry March 2007, 15(3), 224-233

It's official - travel is good for your health !

Previous research on the health effects of travel have concentrated on negative effects such as deep-vein thrombosis, economy-class syndrome and tropical diseases. However, a study of 40 Japanese women on a short package holiday has found more positive results from travel. Nobly agreeing to go on a free holiday with forty women, researchers tested the women's saliva throughout the trip for levels of a substance called chromogranin A (CgA). The higher the levels of the substance the better and, as the trip went on, the women's CgA levels increased. The effect was more pronounced in women who led a healthier lifestyle before the start of the trip.

Toda, Masahiro ... [et al] - Health-related lifestyle and patterns of behavior related to health effects of leisure travel Social Behavior and Personality 2007, 35(3), 287-293

Patches for Alzheimer's

Rivastigmine is widely approved for the treatment of mild to moderate Alzheimer's disease and is currently given in the form of capsules which have to be swallowed. The makers of the drug have now developed a patch - similar to the nicotine replacement patches used by smokers - and a trial on 1,195 Alzheimer's patients has found that this is effective as the capsules. The patches caused less nausea and vomiting than the capsules and only 10% of people suffered from skin irritation.

Winblad, Bengt ... [et al] - A six-month double-blind, randomized, placebo-controlled study of a transdermal patch in Alzheimer's disease - rivastigmine patch versus capsule International Journal of Geriatric Psychiatry May 2007 22(5), 456-467

Drinking up with the Joneses

A number of different studies have shown that American college students tend to overestimate how much their fellow students drink and that the more people overestimate how much others drink the more they are likely to drink themselves. Based on the theory that people modify their behaviour to act in accordance with what they see as normal several campaigns have been developed for use on US campuses aiming to correct this misperception about how much other people drink and therefore to reduce levels of alcohol consumption. However there has been little research into whether the same theory holds true on UK campuses where students are legally allowed to drink and where college authorities hold more liberal views about alcohol consumption. A study of 500 students at Paisley University found the same link between how people thought others drank and how they drank themselves (although the researchers also conceded that the link could be down to heavy drinkers justifying themselves by arguing that 'everybody does it'). The majority of respondents to the survey overestimated how much other students drank although this misperception decreased as they got older. The fact that UK students behaved the same as US ones means that some of the US campaigns telling students about the actual level of drinking of their peers could also be used over here.

McAlaney, John and McMahon, John - Normative beliefs, misperceptions and heavy episodic drinking in a British student sample Journal of Studies on Alcohol and Drugs May 2007, 68(3), 385-392

PTSD and drug abuse

There are well-established links between Post-Traumatic Stress Disorder (PTSD) and drug abuse. Among men who experience PTSD in their lifetime 52% develop alcohol problems and 35% develop drug problems and among women the rates are 28% and 27% respectively. Studies have consistently shown greater impairment on a wide variety of measures in those with PTSD and drug abuse compared to those with either problem alone. A study of 428 out-patients with cocaine addiction in the U.S. found that those people suffering from substance abuse and PTSD were more impaired to begin with and responded less well to treatment compared to those who did not have PTSD.

Najavits, Lisa M. ... [et al] - Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial Journal of Studies on Alcohol and Drugs May 2007, 68(3), 353-361

To sleep, to dream, to tic ...

Sleep disturbances often go hand-in-hand with Attention Deficit Hyperactivity Disorder (ADHD) and tic disorder but there have been relatively few studies of the nature of sleep problems in the two conditions. A study of 32 children in Gottingen, Germany has found that ADHD was primarily characterized by an increse in rapid eye movement (REM) sleep whereas patients with tic disorder had less efficient sleep and were lighter sleepers.

Adolescents, family therapy and anorexia

A number of studies of adolescents with anorexia nervosa have shown positive results for family therapy and several trials comparing family therapy with other treatments have shown that it is more effective than individual psychotherapy and other family interventions. A follow-up study on one of these trials looked at 38 women five years after they had taken part in the original study. The researchers found that 75% of the participants now had no eating disorder symptoms and that only 8% of the patients who had reached a healthy weight by the end of the trial had relapsed. Conjoint family therapy (where the whole family was seen together) was as effective as separated family therapy (where the eating disorder patient was seen seperately from the rest of the family) apart from when the mother of the family was more critical of the child with anorexia. In this group of people separated family therapy was found to be more effective than conjoint family therapy.

Eisler, Ivan ... [et al] - A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa : a five-year follow-up Journal of Child Psychology and Psychiatry June 2007, 48(6), 552-560

Anorexia - the diminishing self

'Selflessness' - the tendency to relinquish one's own interests and ignore one's own needs in order to serve the interests and well-being of others - is a psychological feature first conceptualized, defined and measured in eating disorder patients and many researchers have emphasised the selflessness of patients with anorexia. Eating disorder patients often feel like selfless souls serving others' needs and cannot imagine other people would be willing to give up - even temporarily - their own interests and viewpoints in order to fulfil their (the eating-disorder sufferer's) needs. A study of 443 women in Israel found that as women recovered from eating disorders their scores for selflessness fell. The researchers concluded that assertion of one's own needs and interests could be an integral part of recovery from anorexia and should be emphasized in therapy.

Bachner-Melman, Rachel ... [et al] - The relationship between selflessness levels and the severity of anorexia nervosa symptomatology European Eating Disorders Review May-June 2007, 15(3), 213-220

CD Roms and bingeing

Obese people who binge eat often become obese earlier than other people and start dieting earlier. Their weight goes up and down more and they have lower self esteem. They are also more likely to suffer from depression, anxiety and personality disorders. A comparison of a self-help CD-Rom - based on cognitive behaviour therapy (CBT) - with group CBT sessions found that more people dropped out of the group-therapy sessions than stopped using the CD-Rom. People on a waiting list for treatment were more likely to choose the CD-Rom than group therapy and people who used the CD-Rom carried on using it after the study had finished. Both treatments were found to reduce bingeing and there was little to choose between them in terms of effectiveness.

Shapiro, Jennifer R. ... [et al] - Feasibility and acceptability of CD-Rom-based cognitive-behavioural treatment for binge-eating disorder European Eating Disorders Review May-June 2007, 15(3), 175-184