PTSD in UK soldiers

A study of 5,547 soldiers has found that those who had been deployed for 13 months or more within the last three years were 1.55 times more likely to suffer from post-traumatic stress disorder (PTSD) than soldiers who had had shorter deployments. Those who had seen more active service and more combat were also more likely to have poorer physical health and severe alcohol problems. The number of deployments was less important in causing mental health problems than the length of the deployments and PTSD was also associated with soldiers expecting to be deployed for a certain length of time only to find that they were asked to serve for much longer.

Rona, Roberta J. ... [et al] - Mental health consequences of overstretch in the UK armed forces : first phase of a cohort study British Medical Journal 22nd September 2007, 603-606

Family therapy and bulimia

Bulimia affects between 1 and 2% of adolescents with another 2-3% of teenagers showing some symptoms of bulimia without developing the full-blown condition. Bulimia can cause electrolyte disturbances, swelling of the parotid gland and the loss of dental enamel and is also linked to depression, anxiety and substance abuse. Recently family therapy has been used to combat the condition. Researchers in Chicago compared family therapy with supportive psychotherapy by dividing 80 patients into two groups. After twenty sessions, over a 6-month period 39% of the family-therapy group were free of bulimia symptoms compared to 18% of the supportive-psychotherapy group. After a further six months 29% of the family-therapy group were still symptom free comapared to 10% of the supportive-psychotherapy group.

le Grange, Daniel ... [et al] - A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa Archives of General Psychiatry September 2007, 64(9), 1049-1056

Bipolar nation

There is increasing evidence that there has been a recent increase in the clinical diagnosis of bipolar disorder among young people. A review of doctors visits in the U.S. between 1994-1995 and 2002-2003 found that the number of youth (0-19) visits to the doctor resulting in a diagnosis of bipolar disorder rose from 25 per 100,000 in 1994-1995 to 1003 per 100,000 in 2002-2003 with adult visits resulting in a bipolar diagnosis rising from 905 per 100,000 to 1,679 over the same period. Most youth bipolar visits (66.5%) were by boys whereas most adult bipolar visits (67.6%) were by women. Nearly a third of young people visiting doctors with bipolar disorder also received a diagnosis of attention deficit hyperactivity disorder. 90.6% of young people and 86.4% of the adults were prescribed a psychotropic medication during their visit.

Moreno, Carmen ... [et al] - National trends in the outpatient diagnosis and treatment of bipolar disorder in youth Archives of General Psychiatry September 2007, 64 (9), 1032-1039

Domestic violence and mental health

A study of 177 women in a domestic violence shelter on the East Coast of America looked at the links between how dangerous their partners were and the women's mental-health problems. The researchers found that the more dangerous the women's partners were the more likely the women were to suffer from anxiety, depression, difficulty concentrating, memory loss, suicide attempts, weight gain and illegal drug use.

Sato-DiLorenzo, Aya and Sharps, Phyllis W. - Dangerous intimate partner relationships and women's mental health and health behaviors Issues in Mental Health Nursing 28 (8), 837-848

Loneliness and the immune system

A study of 153 people in the journal Genome Biology found that people who described themselves as 'lonely' had weaker immune systems than people who felt they had a good network of close friends and family. The genes linked to producing antiviral and antibiotic responses worked less well in socially-isolated people and leukocytes (white blood cells) were expressed differently.

Alzheimer's effect on caregivers

New research published in the Journal of Immunology suggests that the strain of looking after someone with Alzheimer's disease could shorten caregiver's lives by between four to eight years. Researchers from Ohio State University looked at telomeres, areas of genetic material at the ends of a cell's chromosome which deteriorate with age. They compared a group of people looking after Alzheimer's sufferers with a control group matched for age, gender, social class etc. The caregivers' telomeres were four to eight years 'older' than the control group and the caregivers also had higher levels of depression and fewer lymphocytes (which play an important part in the immune system) than the control group.

Depression and early retirement

A study of 3,000 people between the ages of 53 and 58 in the U.S., carried out by researchers at the University of Pennsylvania has found that middle-aged men with symptoms of depression are more likely to take early retirement than other people, while middle-aged women with even mild symptoms were more likely to retire early. The study will appear in the journal Health Services Research in the autumn.

Escitalopram for depression and anxiety

A 12-week French study looked at the effects of a drug called Escitalopram on people suffering from depression, and from depression and anxiety. After 12 weeks, on average, the patients showed significant reductions in their depression and anxiety levels although nearly a third of patients (31%) reported some side effects. The most frequent side effects were nausea which was experienced by 8% of the participants and headaches which were experienced by 5% of the patients. 8% of the study's participants dropped out by the end of the study because of the side effects of the drug. However people taking drugs for mental-health problems often experience some side effects and the researchers concluded that 'escitalopram was well tolerated and efficacious in reducing symptoms of depression in patients with or without comorbid anxiety over a 12-week treatment period'

Olie, Jean-Pierre ... [et al] - A prospective study of escitalopram in the treatment of major depressive episodes in the presence or absence of anxiety Depression and Anxiety 24: 318-324

Rumination and PTSD

Rumination is commonly defined as 'repetitive and recurrent, self-focused negative thinking about past negative experiences and/or negative mood'. It is similar to worry with the main difference being that rumination is to do with events or situations in the past while worry deals with events or situations in the future. Recent studies have shown that rumination is a powerful predictor of persistent post-traumatic stress disorder (PTSD) but it is not understood how rumination contributes to the condition. Two studies of assault survivors one cross-sectional (i.e. people's thoughts and problems here and now) and one over six-months looked at the connections between rumination and PTSD. Both studies found that a compulsion to keep ruminating, the occurence of unproductive thoughts, 'why' and 'what if' type questions and negative emotions before and after rumination were significantly associated with PTSD.

Michael, Tanja ... [et al] - Rumination in posttraumatic stress disorder Depression and Anxiety 24: 307-317

CBT and pathological gambling

A study of 290 people in Spain looked at the effectiveness of group cognitive behaviour therapy (CBT) for people with pathological gambling problems. After 16 weekly sessions of group CBT 76.1% of the sample had stopped gambling and this had risen to 81.5% six months after the end of treatment. 'Psychopathological distress' and symptoms of obsessive-compulsive disorder were both associated with patients being more likely to drop out of treatment.

Jimenez-Murcia, Susana ... [et al] - Cognitive-behavioral group treatment for pathological gambling : analysis of effectiveness and predictors of therapy outcome Psychotherapy Research September 2007; 17(5), 544-552

Poverty and therapy in Sheffield

The 'inverse care law' states that 'the availability of good medical care tends to vary inversely with the need for it in the population served' i.e. rich, healthier people, in more affluent areas tend to get better health care than poorer, sicker people in less well-off areas. This applies even in the NHS, perhaps because better-off people tend to be more assertive in demanding and defending better health services. A study of 725 people in Sheffield examined whether people were offered psychotherapy and which kind of therapy they were offered and compared this with their postcodes which were used as a way of measuring how well-off they were. The researchers found that there was no link between how well-off people were and whether they were offered psychotherapy or not or between their financial circumstances and which kind of psychotherapy (psychoanalysis or cognitive behaviour therapy) they were offered suggesting that the inverse care law did not apply in these circumstances.

Saxon, David - Psychotherapy provision, socioeconomic deprivation, and the inverse care law Psychotherapy Research September 2007; 17(5): 515-521

Feeling fat in anorexia

Feeling fat is one of the key features of anorexia nervosa but other women, without eating disorders feel fat too. A study of 48 women in the UK compared those with anorexia, those who were dieting and those who weren't dieting to see what their experience of feeling fat was and to see whether there were any differences between anorexics and other groups of women. All three groups often felt fat an experience which was associated with distress, negative emotions, internal and external bodily sensations, negative self beliefs and a first memory of feeling fat. Those women with anorexia felt fatter than other women and felt more distress about feeling fat. They felt more negative emotions, had an earlier first memory of feeling fat and had stronger negative beliefs about themselves.

Cooper, Myra J. ... [et al] - The experience of 'feeling fat' in women with anorexia nervosa, dieting and non-dieting women : an exploratory study European Eating Disorders Review 15: 366-372

Eating disorder treatment - what patients think is important

Eating disorders are most prevalent in young women between the ages of fourteen and twenty-four. They are often difficult to treat and can take years to recover from. More than half of patients do not recover. However, there has been little research into what eating-disorder patients themselves consider to be the most important elements in their treatment. A survey of 132 eating disorder patients in Belgium and Holland found that 'improving self-esteem', 'improving body experience' and 'learning problem-solving skills' were seen as the most important parts of treatment ; a view shared by the patients' therapists.

Vanderlinden, J. ... [et al] - Which elements in the treatment of eating disorders are necessary 'ingredients' in the recovery process ? - a comparison between the patient's and therapist's view European Eating Disorders Review 15, 357-365

Self-harm and college students

A number of theories have been developed over the years to explain why people harm themselves. Recently research has focused on the negative emotions and coping strategies of people who self-harm, particularly those people in prison or psychiatric hospitals. Researchers now think that people harm themselves to express negative emotions, decrease negative moods and to avoid fully experiencing unpleasant emotions. People who self-harm are more likely to try and avoid, or escape from, their emotions. Studies of college students in the U.S. have found that 17% have self-harmed at some point in their lives with 9.7% harming themselves in the last year. However, there has been little research into the causes of self-harm among this group. A study of 216 college students in the U.S. found that those who were currently self-harming, or who had self-harmed in the past had higher levels of hostility, guilt and sadness than those who had never self-harmed. There was little difference between those who had given up harming themselves and those who were still doing so suggesting that both groups needed careful monitoring and support.

Brown, Seth A., Williams, Kelly and Collins, Amanda - Past and recent deliberate self-harm : emotion and coping strategy differences Journal of Clinical Psychology 63(9), 791-803

Twins, watches and depression in Belgium

The personality trait of neuroticism is related to the tendency to develop negative thoughts in the face of stress. Efforts to research this link have been hampered by the fact that it is difficult to apply information gathered in lab-based questionnaires to 'real' life. A study of 279 pairs of twins in Belgium gave them wristwatches which beeped at random intervals throughout the day. When the watches beeped the twins filled out forms about their current thoughts, what they were doing, how they felt about the situation and their current mood. All the twins were female as it is thought that men and women react differently to stress. Those people with a twin who had suffered from depression at some point in their lives showed a stronger propensity for negative moods at times of stress. The link was stronger in identical than non-identical twins suggesting there may be a genetic component to this.

Wichers, Marieke ... [et al] - Genetic risk of depression and stress-induced negative affect in daily life British Journal of Psychiatry 191: 218-223

Ageing, white matter and depression

Changes to the white matter in the brain are strongly associated with depression in older people but it is unclear whether changes to the brain cause depression, or depression causes changes to the brain or if a third, unknown, factor causes both the depression and the white matter changes. A pan-European study of 639 older adults gave them brain scans and tested them for cognitive function, quality of life, disability and depression. When the tests were repeated after a year severity of white matter changes was shown to 'independently and significantly' predict depressive symptoms.

Teodorczuk, A. ... [et al] - White matter changes and late-life depressive symptoms British Journal of Psychiatry 191: 212-217

Antidepressants in pregnancy

Mood disorders affect twice as many women as men and often emerge during women's childbearing years. Depression is not uncommon during pregnancy and symptoms may occur more frequently during pregnancy than in the postnatal period. Antenatal depression has been associated with low maternal weight gain and increased use of alcohol, cigarettes and drugs. However, a number of studies have shown that using antidepressants during pregnancy can lead to premature births. A study of 90 women in California has found that women taking antidepressants were more likely to have babies at a lower gestational age, had higher rates of pre-term birth and were more likely to have their babies admitted to a special care unit than women who were depressed but not taking medication.

Suri, Rita ... [et al] - Effects of antenatal depressant treatment on gestational age at birth and risk of preterm birth American Journal of Psychiatry 2007 164: 1206-1213

Depression and attrition

In order for the treatment of depression to be most effective people need to keep taking their medication and stay in contact with therapists and clinicians. Unfortunately many people drop out of their treatment ; something researchers call attrition. An American study looked at 4,041 people being treated for depression with a drug called Citalopram. They found there was an overall dropout rate of 26%. Of those people who dropped out of treatment 34% dropped out immediately, 59% dropped out by week 12 and 7% dropped out after 12 weeks. Immediate attrition was linked to younger age, less education and being less severely depressed. Dropping out of treatment later was associated with younger age, less education and being Black. Those people who had experienced more than one episode of depression were less likely to drop out of treatment.

Warden, Diane ... [et al] - Predictors of attrition during inital (Citalopram) treatment for depression : a STAR*D report American Journal of Psychiatry 2007, 164: 1189-1197

Depression, distraction and inhibition

Aaron Beck, the famous psychotherapist and one of the founding fathers of cognitive behaviour therapy, thought that people with depression had automatic negative thoughts about situations, created by pessimistic assumptions and underlying negative thought processes. Research has confirmed these theories but there has been less study of inhibition in depression. It's impossible to pay attention to everything going on in the world around us as this would be overwhelming so inhibition helps us to choose which stimuli to pay attention to and which to ignore ; it's what helps us to listen to a particular conversation in a crowded room. Researchers in Canada thought that people with depression would find it harder to screen out negative stimuli. They studied 111 people, with and without depression, attempting to distract them from completing a task using positive, neutral and negative words. Overall depressed people were more easily distracted and they were particularly distracted by negative words. The more prone people were to negative thoughts and rumination (literally chewing negative thoughts over and over) the more easily distracted they were by negative stimuli.

Lau, Mark A. ... [et al] - Inhibitory deficits for negative information in persons with major depressive disorder Psychological Medicine 2007, 37, 1249-1259

Brain training and depression

In addition to all its other effects depression can cause impairment in people's cognitive functioning, particularly in the areas of decision-making and memory. Cognitive remediation which aims to improve cognitive functioning by using targeted, repetitive exercises has been shown to help schizophrenia patients with similar cognitive problems and a study of 46 people in Canada found that using a computerized cognition retraining package for 10 weeks helped people with depression to improve their attention, verbal learning and memory, co-ordination and decision-making although it did not improve their depression which still needed to be tackled with the appropriate therapy and drugs.

Elgamal, Safa ... [et al] - Successful computer-assisted cognitive remediation therapy in patients with unipolar depression : a proof of principle study Psychological Medicine 2007, 37, 1229-1238