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Association found between mental disorders diagnosed at the time of military conscription and premature death in a cohort of men over a 22-year period.

TUESDAY, Aug. 7, 2012 (MedPage Today) — Patients with conditions ranging from neurotic disorders to schizophrenia faced an increased risk of premature death, even when their disease wasn’t severe enough to warrant hospitalization, Swedish researchers determined.

Among young men diagnosed with a mental disorder at the time of military conscription, the mortality risk was almost doubled for those with depression and more than five times higher for those with bipolar disorders, according to Finn Rasmussen, PhD, of the Karolinska Institute in Stockholm, and colleagues.

And among those who were diagnosed later, at the time of hospital admission, hazard ratios for mortality ranged from 5.46 for those with adjustment or neurotic disorders to 11.2 for those with substance abuse disorders other than alcohol, the researchers reported in the August issue of Archives of General Psychiatry.

Patients with severe mental illness are known to have an increased risk for death, for various reasons including cardiovascular disease, psychosocial disadvantage, and suicide.

Most information about these concerns has derived from studies of patients with severe disorders such as schizophrenia who were hospitalized, and less has been known about risks among community-dwelling individuals with less serious illnesses.

To consider this, Rasmussen and colleagues examined the records of 1.09 million men who underwent physical and psychiatric examinations at the time of conscription for military service between 1969 and 1994. Most were about 18 years of age.

A total of 5.6 percent at that time were diagnosed with a variety of conditions including schizophrenia, bipolar disorder, depression, personality and neurotic disorders, and alcohol or other substance abuse disorders.

During a mean of 22.6 years of follow-up, 15,110 of the men died.

After adjustment for age, socioeconomic status, blood pressure and body mass index, intelligence, and education achievement, the mortality risks were elevated for all diagnoses.

“Our finding that a clinical diagnosis of a neurotic and adjustment disorder or a personality disorder during a screening examination in early adulthood was associated with an approximately two-fold risk of death, even in those with no evidence of comorbid mental illness, suggests that the mortality risk associated with mental disorder is not limited to those whose disease is severe enough to require inpatient care,” Rasmussen and colleagues observed.

Among the men diagnosed later, during hospitalizations post-conscription, 4,879 had died.

The researchers stratified this group of men according to year of conscription, and found that among men born between 1951 and 1958, there was a five to 11 times greater mortality risk for those hospitalized with mental illness compared with those without mental illness hospitalizations.

In addition, for those born between 1968 and 1976, mortality risks were seven to 29 times greater.

Even after excluding the 20 percent to 32 percent of men whose deaths were considered suicides, the mortality risk remained notably elevated, with hazard ratios of 3 to 9 in the earlier birth cohort and 4 to 17 in the later group.

A total of 60,333 men had admissions for psychiatric reasons after their conscription, 10,665 of whom had already been diagnosed at the time of conscription.

The odds ratio for early death among these men was 12.4, whereas those who were later hospitalized, but had no mental disorders at conscription, had an odds ratio of 8.45.

The greater risk for men with earlier diagnoses might reflect more severe, longstanding disease, according to the researchers.

The factors that appeared to most strongly attenuate the link between mental illness and early death were intelligence, education, and socioeconomic status in later life, the researchers noted.

Limitations of the study included the male-only population and the possibility of an underestimation of psychiatric diagnoses at conscription, since not all conscripts were referred for psychiatric evaluation.

In addition, they acknowledged that there were unmeasured factors that might have contributed to mortality risk in these analyses, including concomitant physical illnesses, diet, physical activity, adverse effects of medications, and lack of access to healthcare.

“If this huge burden of premature mortality is to be reduced, the physical healthcare of people with mental illness needs to be a greater priority for medical care professionals,” they concluded.

Mental disorders like depression, anxiety, OCD, and bipolar disorder all have warning signs. Find out what they are and when to get help.

Everyone has good days and bad days — even good years and bad years — but you should be concerned when the signs of depression, anxiety, obsessive-compulsive disorder (OCD), or bipolar disorder make it difficult to carry out the tasks of everyday life. Challenging emotions can arise in any situation, from work to relationships, and you want to act before they seriously interfere with your ability to function.

Mental Health: 5 Signs of Clinical Depression

“You determine clinical depression by two measures. One is by time and one is by severity — impact on function. When you have severe symptoms that last at least two weeks and are interfering with fundamental basic functions, it falls into the realm of clinical depression,” explains psychiatrist Jill RachBeisel, MD, associate professor of psychiatry of the University of Maryland School of Medicine in Baltimore.

There are many symptoms of depression, but most common among people with clinical depression are changes in:

1. Appetite. “In clinical depression you lose your appetite completely, and you stop eating, or you eat very little,” says Dr. RachBeisel.
2. Sleep. When clinical depression sets in, you may have consistent, severeinsomnia and be unable to sleep well almost every night.
3. Concentration. “Someone might find themselves unable to maintain focus on simple activities like watching a TV program or reading a newspaper article,” says RachBeisel. You may not be able to focus on a recipe for dinner or tasks at work.
4. Energy level. “With severe clinical depression your energy is so low you have trouble getting out of bed in the morning or carrying through your basic activities of daily living. People find themselves lying in bed and staying in pajamas all day long,” RachBeisel explains.
5. Interest in activities that one would normally enjoy. This may mean that you no longer care about shaving or styling your hair, for example, or about bigger issues, like caring for your children.

At its most severe, clinical depression can lead to suicide. Having thoughts like “My family would be better off without me” is a warning sign.

Mental Health: 5 Signs of Anxiety

“We all should have a little anxiety on board because when you think about it, what makes you really perform well is you get a little anxious,” says RachBeisel. These, however, are signs that you may need help with your anxiety level:

1. You can’t follow a conversation or complete a basic task.
2. You can’t do what other people do; for example, a fear of crossing bridges prevents you from seeing the other side of town.
3. You find yourself avoiding family gatherings or office parties due to social anxiety.
4. You worry that in a crowded room people are looking at you or talking about you.
5. You may avoid projects that require public speaking or presenting your work.

Mental Health: 5 Signs of Obsessive Compulsive Disorder

Obsessive-compulsive disorder is on the extreme end of the anxiety spectrum.

“People with OCD are so anxious, they have intrusive thoughts that are irrational, and they can’t get the thoughts out of their head. So what they do is develop behaviors to cope with the anxiety,” says RachBeisel. These behaviors or rituals may be so time-consuming that you can’t get to work (or anywhere) on time, and may even prevent you from working. For example, you may:

1. Wash your hands 20 to 30 times a day.
2. Count 15 cars before you can park.
3. Spend hours checking the door and window locks before going to bed.
4. Spend hours bathing.
5. Repeat work tasks multiple times to make sure they are perfect.

Mental Health: 5 Signs of Bipolar Disorder

“A person with bipolar disorder is someone who has severe mood swings,” says RachBeisel. During the depressed phase, the signs of clinical depression appear, but people with bipolar disorder also experience a manic phase during which they may have a lot of energy and positive feelings about themselves. Signs of mania are:

1. Mood swings. Examples are elevated mood or extreme irritability.
2. Fast speech. “You can’t get a word in edgewise and you have to ask them to slow down,” says RachBeisel.
3. No need for sleep. People with pipolar disorder may stay up all night for many days cleaning, painting walls, or doing laundry.
4. Overextended. An overly high estimation of themselves leads to commitments they can’t possibly keep, such as taking on jobs they don’t have the skills to do.
5. Excessive behaviors. Charging tens of thousands of dollars or having sex with casual acquaintances are just two examples.

Mental Health: How to Get Help

If you suspect that you have signs of one of these mental health conditions, RachBeisel advises that you:

1. Call your primary care doctor and ask for a referral so you can get evaluated by a specialist.
2. Call a local suicide hotline if you are experiencing severe symptoms.
3. Contact your local health department for a list of mental health services.

By knowing the signs of these common mental health conditions, you’ll be better equipped to recognize when you, or someone you love, may need professional help.

States may be trimming their mental health budgets, but you can still find psychological care that’s affordable and effective.

From the maxed-out mom who finds comfort in a community support group to the recent retiree who needs help pinpointing the source of his blues, access to adequate, affordable treatment is essential for millions of Americans with mental health concerns. But with state budget cuts threatening local services and programs across the country, the people who need these services most could see their support systems disappear.

A recent report from the National Alliance on Mental Illness (NAMI) found that more than half of Americans with mental and emotional issues don’t get help — and that number is only expected to grow as states slash their mental health care budgets in response to growing deficits. The 10 states with the biggest cuts over the last two years are:

• Alaska (35 percent)
• South Carolina and Arizona (23 percent)
• Washington, D.C. (19 percent)
• Nevada (17 percent)
• Kansas and California (16 percent)
• Illinois and Mississippi (15 percent)
• Hawaii (12 percent)

Worse, mental health care shortages are expected to deepen in 2011 and 2012.

“When policy makers are forced to make difficult decisions on spending cuts, mental health funding seems to be an easy target,” says Ruth Wolever, PhD, a clinical health psychologist and the research director of Duke Integrative Medicine.

What such changes translate to: Services and programs vital to Americans with mental health issues are getting downsized or eliminated, including community mental health centers, alcohol and drug abuse treatment centers, crisis centers, beds in psychiatric hospitals, and psychiatrists and social workers on staff at these facilities.

Unfortunately, as mental health care budgets shrink, the need for such services is greater than ever, according to NAMI. Ongoing economic distress has lead to moredepression, anxiety, and other mental health issues while reducing people’s ability to pay for treatment. Troops returning home from war also require services to treat such issues as PTSD.

Related: 8 Secrets of Really Happy People

But if you need mental health attention and you can’t afford it, the last thing you should do is nothing.

Even though budget cuts abound, there are still plenty of inexpensive ways to get the help you need. First, decode your health insurance. It’s important to understand your insurance policy — copayments, costs of coverage, and the doctors covered vary from plan to plan. The Mental Health Parity and Addiction Equity Act of 2008 mandates that all group health plans provide mental health benefits, but most of them still require patients to foot a portion of the bill for therapy.

If you are having trouble affording therapy sessions or don’t have health insurance, then consider these affordable alternatives.

1. Start with your community health center. While it’s true that community mental health centers are feeling the brunt of budget cuts, they’re still a good place to start, says Dr. Wolever. Most of these state agencies offer low-cost consultations and inpatient/outpatient services. To find one near you, try theSubstance Abuse and Mental Health Service Administration’s (SAMHSA) Mental Health Locator.
2. Go grassroots. Mental health organizations, such as NAMI and Mental Health America (MHA) have made it their mission to help every American find a mental health care solution. These grassroots advocacy organizations have local affiliates spanning all states — they’re generally small groups that can assist you in identifying local, low-cost treatment. They can answer questions about insurance policies, provide doctor referrals, and more. Find a local NAMI branch or a local MHA affiliate.
3. Check out a nearby college. If your alma mater or a local university offers graduate training programs in psychology, psychiatry, social work, or counseling, they also probably provide mental health services to the community for reduced fees. Here, you’d meet with a student in training under the direct supervision of a licensed faculty member.
4. Give group therapy a try. Some providers offer group therapy as a more affordable alternative to one-on-one sessions. If you currently have a therapist, ask him if he offers group sessions, or find a certified group therapist in your area by using American Group Psychotherapy Association’s locator.
5. Ask about sliding fees. Wolever suggests contacting your state’s licensing boards for referrals for providers who offer sliding fee structures — payments that are determined by your level of income. If you already have a therapist, let him know about your financial concerns and see if he can work out a payment plan.
6. Consider disability. If your health concern is significantly impairing your work, you may be eligible for disability benefits — income support payments throughSocial Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To qualify, you’ll need to prove that your mental illness has hindered your ability to keep a job, says Wolever.

Related: Your Relaxation Toolkit

Find out how support from friends, family, and other sources can help prevent recurrences of mental health issues and give you the positive reinforcement you need.

A strong support network can help ground you emotionally, and provide you with ideas for problem-solving. But people with mental health problems often have a hard time reaching out, in no small part because they may be part of families with poor communication skills. Fortunately, there are many resources for creating a support network to provide the assistance you need.

Your Support Network: Friends and Family

“Mental illness is very isolating. There is a lot of stigma. You can be isolated from your family, from your friends, from your employer,” says Eileen Ryan, co-director of the Depression and Bipolar Support Alliance chapter in New Orleans. Ryan has been coordinating bi-monthly support groups in the New Orleans area since 2001.

“If you don’t have people close to you, you might go off the deep end, but if people close to you can ask if you have been sleeping, if you have been taking your meds, if they can talk to you in that window of rationality, it can be lifesaving. That’s the Catch-22 of mental illness — you might not know when it’s going bad,” says Ryan.

A formal support network can serve this purpose as well. A study of 120 people withbipolar disorder compared structured support groups to informal support groups and found that those in the structured groups with trained leaders were less likely to have a return of severe symptoms. This is probably because the group leader was able to identify early signs of recurrence and provide help. People in the structured groups were also more likely to keep taking their prescribed medications.

This study also found that when caregivers and family members learn about helping patients and coping with mental health concerns in a support group setting, they are better able to prevent mental health crises. Patients whose spouse or other primary caregiver joined a support group were less likely to have a recurrence of severe manic symptoms.

Reaching out to loved ones may be difficult for you. You may feel that people will think less of you if they know you have a mental illness; you may be embarrassed by something you did or said to them before you were diagnosed; or, you may anticipate a negative, critical, or overly emotional response. Start by asking for just two things they can do to help you:

• To let you know if they see signs that your mental illness is returning.
• To join a support group to learn about living with mental illness.

Your Support Network: Seeking Support Online

For some people, online support is very helpful. There are a number of reasons for going online to get support, such as having a mental health concern that you don’t want to discuss with family and friends. A survey of 85 people who were members of online support groups for trichotillomania (chronic hair-pulling) revealed that close to one-third had never told their family about their disorder, but that they found information about symptoms and treatments, as well as the friendships they formed through the trichotillomania support groups, very helpful.

Your Support Network: Learning to Communicate

People with mental illness and their families may need to learn new communication habits. Studies show that people who live in families where communication is often hostile, critical, or overly emotional are at higher risk of experiencing a relapse of their mental illness. Finding ways to break the “attack-counter attack” mode of communication is essential before you can reasonably ask for help.

You and your family may need to practice:

• Diplomatically making requests for change
• Rationally evaluating the pros and cons of a suggestion
• Giving both praise and constructive criticism
• Active listening

If your family needs help learning these skills, or is unwilling to practice healthier communication, speak with a mental health professional about how to deal with the situation.

Your Support Network: How Much Information Is Too Much?

Ryan notes that the guidelines for sharing in a group focus on confidentiality, openness, and the use of “I-statements,” which means talking about what you are going through solely from your own perspective. These rules should guide conversation with anyone about your mental health status.

It may take some time to learn the boundaries of sharing information with others and asking for help. Participation in support groups can help you identify when your requests to family and friends are excessive, notes Ryan, who says group members often have practical tips to offer about how to handle these situations as they arise.

If you’re feeling down most of the time and find yourself withdrawing from social activities, you may be facing mental health issues. It may be hard to reach out for help, but you may need emotional support to get better.

It’s normal to feel stressed or anxious every now and then. But if you’re sad and depressed for extended periods of time and don’t feel that you’re getting better, you may be experiencing a mental health issue and need emotional support from a professional.

Some of the first signs to look for include constant fatigue and lack of motivation to get things done, says Vivien Wolsk, PhD, a clinical psychologist and dean emeritus of the Gestalt Center for Psychotherapy and Training in New York City.

Though mental health issues, such as depression, bipolar disorders, and anxiety disorders, have different symptoms and treatments, some signs may overlap. Telltale changes in your behavior and outlook to be aware of include:

• Overeating or eating too little
• Sleeping too much or sleeping too little
• Withdrawing socially — avoiding friends and family
• Having trouble concentrating
• Experiencing mood swings — feeling very energetic and sharp one day and crashing the next
• Experiencing an addiction — doing something to escape, whether it’s sex, drugs, food, or alcohol
• Having thoughts of suicide
• Denying problems that are obvious

A marked change of behavior, especially in children, can be a sign of mental illness. Parents may notice that their child doesn’t want to go to school anymore or that grades aren’t as good as they used to be, Wolsk says. Persistent nightmares in children may be another sign.

On the other hand, Wolsk cautions, some of these symptoms could be signs of a physical problem. If you’re experiencing tiredness or anxiety, the first thing you should do is get a medical checkup. “Sometimes psychiatric symptoms can be part of a thyroid or other physical condition,” she says.

Overcoming Reluctance to Seek Treatment

If your doctor gives you a clean bill of health and symptoms persist, you should consider getting mental health treatment. However, many people are reluctant to do so for a variety of reasons.

One is the fear of what other people will think. “There’s a stigma for some,” says Marion Jacobs, PhD, a licensed clinical psychologist in Laguna Beach, Calif., and author of Take-Charge Living. People are afraid that if they seek mental health treatment others will see them as “crazy.” But mental health issues are nothing to be ashamed of — as many as 54 million Americans live with emotional disorders each year.

If you’re avoiding mental health treatment, learning the truth behind common excuses may help change your mind:

• You don’t think you need it. You might believe that you can deal with your problems on your own by buying books, or going on the Internet and participating in interactive therapy sites. “There are things that you can do — exercises and programs — but for someone who really needs the help, they’re not a substitute,” Jacobs says.
• You’re afraid of what you might learn. “People say, ‘I feel miserable, but I don’t want to go poking around because I don’t know what I’m going to find,'” Jacobs explains. However, uncovering your issues should make them easier to deal with.
• You’re worried about the cost. If you don’t have insurance or if you have a deductible and out-of-pocket costs, you may worry about the expense of therapy sessions or medications. Depending on where you live, your county may offer low-cost clinics or other mental health programs that can help you. Also, check with your insurance provider about your coverage. Often going to in-network health professionals is less costly than seeing a therapist who is out-of-network.
• You’re worried counseling will go on indefinitely. “Much therapy is geared for short-term help and won’t necessarily be a long-term deal,” Jacobs says.

Finding the Right Match

Once you make the decision to seek mental health treatment, the next step is to find a therapist who can provide the emotional support you need and who is experienced with the condition you have. For instance, some mental illnesses, such as bipolar disorder, may require medication. In that case, Jacobs says, you may need to seek a psychiatrist.

These guidelines will help you find a therapist you’ll feel comfortable working with:

• Be patient. The first therapist you speak to may not be the right one for you. Take your time and you are more likely to find a good match.
• Ask questions. “I would encourage people to do a short interview with the therapist on the telephone or via e-mail and see if you like the attitude you get,” Jacobs says. “If the therapist isn’t willing to be interviewed over the telephone, what does that tell you?”
• Review the therapist’s Web site. “The way people describe themselves on their site tells you a lot,” Jacobs says. “It will give you a flavor of how they talk about themselves and their work.”
• Get trusted referrals. Your family physician, especially if he knows you well, is likely a good resource. Others who may be able to make referrals are your school counselor, your clergy, and local chapters of mental health organizations.

By seeking help and emotional support, you will be able to address mental health issues more successfully. A professional will help you understand your illness and offer better ways to cope with it and conquer it.

People in debt are three times more likely to have a mental health problem than those not in debt, according to new research led by the University of Southamptom. With levels of debt increasing in the recent years, in light of the economic recession and fiscal instability. Researchers from theUniversity of Southampton, along with a researcher from Kingston University, carried out a review on all previous research, which looked at the relationship between health problems and unsecured debt.

The results, published online in Clinical Psychology Review, showed that those in debt were more than three times more likely to have a mental health problem as those who were not in debt. 

Less than nine percent of participants with no mental health problems were in debt, compared to more than a quarter of participants being in debt and with a mental health problem.

The team found that those in debt were also more likely to suffer from depression, drug dependence and psychosis and the results also suggest that those who die by suicide are more likely to be in debt.

Dr Thomas Richardson, Clinical Psychologist from the University of Southampton who led the research, comments: “This research shows a strong relationship between debt and mental health; however it is hard to say which causes which at this stage. It might be that debt leads to worse mental health due to the stress it causes. It may also be that those with mental health problems are more prone to debt because of other factors, such as erratic employment. Equally it might be that the relationship works both ways. For example people who are depressed may struggle to cope financially and get into debt, which then sends them deeper into depression.

“Debt advisors should consider asking about mental health when speaking to members of the public. Similarly mental health professionals should ensure they ask about whether their patients are in debt. Further research is now needed to show exactly how debt leads to poor mental health, so that interventions can be designed to try and prevent those in financial trouble developing mental health problems and vice versa.”