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Long spells of sunshine – as proven by many scientific studies – can have a positive impact on the human mind and can have a helpful effect for people with depression. Things are very different at the start of a spell of nice weather, however. During the first days of sunshine, the internal unrest and increased activity can act as a driver for some at-risk people to commit suicide.

These are the findings of a recent study led by Matthäus Willeit and Nestor Kapusta from the University Department of Psychiatry and Psychotherapy and the University Department of Psychotherapy and Psychoanalysis at the MedUni Vienna which, to mark World Suicide Prevention Day on 10th September, has now been published in the highly respected journal JAMA Psychiatry.

By analysing suicide data in Austria between January 1970 and May 2010, the scientists were able to use mathematical models to determine that the daily amount of sunshine had a link to the likelihood of suicide, and in fact sunshine acts as a “driver”, especially in the days immediately before the actual suicide. The study correlated data on almost 70,000 suicides and meteorological data gathered from 86 measuring stations in Austria between 1970 and 2010. To exclude the influence of other seasonal rhythms on the results – such as seasonal changes in employment levels – the seasonality factor was removed mathematically from the data so that only the influence of sunlight was measured on the frequency of suicides.

“Between the 14th and 60th day of a fine weather phase, the effect of the sun was clearly positive, there were fewer suicides and the sun almost provides protection against it,” explains Willeit. “Our figures, however, highlight the theory that sunshine should be regarded as a driver on the day of the suicide itself and also in the 10 to 14 days before it.”

The more immediately after a period of little light the sunshine affects the human mind, the more at-risk vulnerable people are. Says Willeit: “During the first few days, a lot of sunshine leads to increased levels of activity in general. For people with depression, this can produce an increase in drive, inner unrest and increased impulsiveness and subsequently lead to suicidal thoughts being put into action.” This is also highlighted by the fact that in Austria, but also in most other countries, most suicides are committed in spring. “Research into the relationship with the seasons provides insight into the biological control mechanisms that we research in great detail in our department,” says Head of the University Department of Psychiatry and Psychotherapy at the MedUni Vienna, Siegfried Kasper. Says Willeit: “And the further north you go, the most marked this effect is.”

Overall, suicide is reassuringly a relatively rare event among the general population. People who have several known risk factors for suicide – such as psychiatric illness, substance abuse, life crises or attempted suicides in the past – will need increased psychiatric and psychotherapeutic support in times of rapidly-increasing daylight, i.e. generally in the spring and early summer.

People who have attempted suicide when young are less likely to have a successful professional career later in life. This was discovered in a joint study by the Swedish Karolinska Institutet and MedUni Vienna. The prospect of long-term unemployment later in life threatens many people who have attempted suicide once or more. However, they make up an even larger proportion of the statistics for long-term sick leave and disability pensions.

Studies prove the connection between suicide attempts in young people and later unemployment. However, the effects on professional development are stronger than previously thought. In this study, long-term unemployment (more than 180 days in a year), as well as long-term sick leave (more than 90 days in a year) and disability pensions, were carefully examined. Scientists from MedUni Vienna and Karolinska Institutet in Stockholm also evaluated data from several Swedish registers. Since the sixties of last century, detailed data concerning the health system has been collected in Sweden. This data gives an overview of the entire population. For the study, the professional development of all 16-30 year olds (cut-off year 1994) who have attempted suicide was examined.

The study, which was published in the top journal International Journal of Epidemiology, shows a clear connection between suicide attempts and later difficulties in establishing oneself on the job market. People who attempted suicide once or more at the age of between 16 and 30 years, later had a 1.6 fold increased risk of long-term unemployment. An even greater tendency, shown for the first time by this study, is that of long-term sick leave (2.2 fold increase) and of disability pension (4.6 fold increase). “These risks apply to the Swedish population, on the basis of those we analysed, however it is to be assumed that the identified risk patterns are essentially also valid for Austria and other countries with highly developed health and welfare systems,” explains the lead author, Thomas Niederkrotenthaler, of the Institute for Social Medicine at MedUni Vienna on the occasion of World Suicide Prevention Day on 10th September.

“The effects of suicide attempts on participation in the job market have until now been considerably underestimated, because generally only the cases of long-term unemployment had been taken into account. What is more, this shows that suicide attempts also have a strong effect on sick leave and disability pensions,” according to Niederkrotenthaler.

“Taking these results into consideration, it is very important to better understand the backgrounds that lead to the marginalisation of the job market,” highlights the Director of Studies Ellenor Mittendorfer-Rutz from the Department of Clinical Neuroscience, Division of Insurance Medicine at Karolinska Institutet. “This knowledge is absolutely essential to develop specially-tailored programmes for job market inclusion.”

Disability pensions have, until now, often represented a permanent withdrawal from the job market. However, that in itself can be damaging to health in the long-term. Lack of prospects, as well as having no social network with colleagues, can have negative psychosocial effects. A subsequent reintegration into the job market appropriate for the individual’s abilities can be preferable, also for socio-economic reasons, says the scientist. As of 2014, there are improved opportunities for a return to professional life in Austria. Whether these opportunities prove successful needs to be examined in future studies.

People taking antipsychotic medications for serious mental illnesses lost significant amounts of weight and improved their glucose levels by participating in a lifestyle-change program, according to a study funded by the National Institutes of Health and published online in the American Journal of Psychiatry.

Studies show that people with serious mental illnesses such as schizophrenia and bipolar disorder are already at higher risk for obesity and obesity-related diseases such as diabetes. The medications that control psychiatric symptoms can make these problems worse by stimulating appetite and thirst and causing metabolic changes that lead to additional weight gain.

This study involved 200 people who were either overweight or obese and were also taking antipsychotics for serious mental illnesses; half of the study participants were enrolled in a year-long lifestyle intervention, the other half served as the control group and did not participate in the intervention.

Intervention participants lost nearly 10 more pounds than those in the control group during the weight loss phase of the study. They regained some of their weight during the weight maintenance phase of the study, but still weighed about 6 pounds less than people in the control group by the end of the intervention.

Intervention participants were also more than twice as likely as those in the control group to have normal fasting glucose levels at the end of the intervention period, and they had fewer medical hospitalizations (6.7 percent compared to 18.8 percent).

“Our study is the first to show that a lifestyle intervention can help people with serious mental illness lose weight, reduce their diabetes risk, and reduce the need for medical hospitalizations,” said lead author Carla Green, PhD, MPH, with the Kaiser Permanente Center for Health Research, in Portland, Oregon.

“Previous studies have shown moderate success with weight loss among this population, but no improvements in blood glucose levels or medical hospitalizations,” added Green.

Dr. Green’s study (called STRIDE) took place between 2009 and 2013 and included members of Kaiser Permanente Northwest and patients served by Cascadia Behavioral Healthcare or LifeWorks Northwest community mental health centers in the Portland Oregon Metropolitan Area.

During the 6-month weight-loss phase, intervention participants attended weekly, two- hour group meetings that included 20 minutes of physical activity. Participants learned how to keep food and exercise diaries, and they set goals for physical activity, eating habits and sleep quality. They also learned about the effects of psychiatric medications on their weight and were given specific advice about how to discuss this topic with their health care providers.

During the 6-month weight-maintenance phase of the trial, intervention participants attended monthly group meetings and received individual monthly telephone sessions with group leaders.

Those in the control group did not participate in the weight loss or weight maintenance group intervention, but were free to pursue alternative weight loss efforts.

All study participants attended a group orientation session and follow-up assessment visits to measure their weight, blood pressure and lab values, and all were referred to primary or urgent care if their values were outside normal ranges.

The STRIDE intervention was adapted from weight management and blood pressure control trials including the PREMIER trial and the DASH diet trial, which were designed for people without mental illness.

STRIDE participants lost between 9-12 pounds, which is comparable to the average weight loss of 10-15 pounds in the PREMIER trial. Study authors say this shows that if people with serious mental illness participate in intensive programs and are given the right tools and support they can lose the same amount of weight as people without serious mental illnesses.

Dr. Green’s study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. (R18DK076775)

In addition to Dr. Green, study authors include Bobbi Jo Yarborough, PsyD; Michael Leo, PhD; Micah Yarborough, MA; Scott Stumbo, MA; Shannon Janoff, MPH; Nancy Perrin, PhD; Greg Nichols, PhD; and Victor Stevens, PhD; all from the Kaiser Permanente Center for Health Research in Portland, Oregon.

ast studies have indicated that rather than being a single disease, schizophrenia is a collection of different disorders. Now, a new study by researchers at Washington University in St. Louis, MO, claims the condition consists of eight distinct genetic disorders, all of which present their own specific symptoms.

DNA magnifying glass
Researchers say they identified specific gene clusters linked to eight different types of schizophrenia, all of which presented recognizable symptoms.

The research team, including senior investigator Dr. C. Robert Cloninger, the Wallace Renard Professor of Psychiatry and Genetics at Washington University, says their findings may pave the way for better diagnosis and treatment strategies for schizophrenia.

Schizophrenia is a mental disorder characterized by hallucinations, delusions, abnormal thoughts, cognitive problems and agitated body movements.

People with a family history of schizophrenia are at much higher risk of developing the condition. Approximately 1% of the general population in the US have schizophrenia, but it occurs in around 10% of individuals who have a first-degree relative with the disorder.

Researchers have worked long and hard to identify specific genes associated with schizophrenia. Earlier this year, Medical News Today reported on a study led by researchers from the Cardiff University School of Medicine in the UK, in which they identified 83 new genes linked to schizophrenia.

But Dr. Cloninger says that rather than trying to pinpoint specific genes to schizophrenia development, he and his colleagues wanted to look at how individual genes work together.

“Genes don’t operate by themselves,” he says. “They function in concert much like an orchestra, and to understand how they’re working, you have to know not just who the members of the orchestra are but how they interact.”

Analyzing genetic variations and identifying clusters

For their study, results of which are published in The American Journal of Psychiatry, the team analyzed the genomes of 4,200 people with schizophrenia and 3,800 people without the disorder.

Fast facts about schizophrenia in the US

•Schizophrenia is one the leading causes of disability in the US
•Approximately 75% of people who develop schizophrenia are between the ages of 16 and 25
•Past research has indicated that 25% of people with schizophrenia recover completely, 25% have symptoms that do not improve over time, while 50% have symptoms than improve over a 10-year period.

Specifically, they looked at almost 700,000 areas of the genome where a variation occurred in a single unit of DNA. This variation is known as a single nucleotide polymorphism (SNP).

By comparing the SNPs of schizophrenic individuals with those of healthy controls, the team was able to identify the genetic variations linked to schizophrenia. Individuals with schizophrenia were divided into groups based on the type and severity of their symptoms. The team looked at how the genetic variations interacted with each other to produce specific symptoms of the disorder.

Dr. Cloninger and colleagues say they identified specific gene clusters associated with eight different types of schizophrenia, all of which present recognizable symptoms. For example, the team discovered a gene cluster that posed a 95% risk of schizophrenia, which they specifically linked to hallucinations or delusions.

The researchers also analyzed two other databases of individuals with schizophrenia and were able to replicate their findings.

“What we’ve done here, after a decade of frustration in the field of psychiatric genetics, is identify the way genes interact with each other, how the ‘orchestra’ is either harmonious and leads to health, or disorganized in ways that lead to distinct classes of schizophrenia,” says Dr. Cloninger.

Genes ‘work in concert’ to disrupt brain structure and function, causing schizophrenia

The team explains that individual genes linked to schizophrenia only have weak and inconsistent associations with the disorder. But when these genes interact and work as clusters, they pose a 70-100% risk of developing schizophrenia, meaning those with such clusters are unlikely to avoid the disorder.

Commenting on their findings, co-investigator Dr. Dragan Svrakic, a professor of psychiatry at the university, says:

“In the past, scientists had been looking for associations between individual genes and schizophrenia. When one study would identify an association, no one else could replicate it. What was missing was the idea that these genes don’t act independently. They work in concert to disrupt the brain’s structure and function, and that results in the illness.”

The researchers believe their findings could lead to better diagnosis and treatments for people with schizophrenia. By identifying genetic variations in people with schizophrenia and linking them to specific symptoms, they say it may be possible to target treatments to specific pathways that contribute to the disorder.

The team says the approach used in this study may also improve understanding of how genes collaborate to cause other common disorders.

“People have been looking at genes to get a better handle on heart disease, hypertension and diabetes, and it’s been a real disappointment,” says Dr. Cloninger. “Most of the variability in the severity of disease has not been explained, but we were able to find that different sets of genetic variations were leading to distinct clinical syndromes. So I think this really could change the way people approach understanding the causes of complex diseases.”

Medical News Today recently reported on a study published in JAMA Psychiatry claiming obsessive-compulsive disorder (OCD) may be a risk factor for schizophrenia.

Written by Honor Whiteman

Mental health services are unable to cope with demand for psychological therapies, according to an investigation by the We Need to Talk coalition. The coalition of mental health charities, professional organisations, Royal Colleges and service providers says that huge variations in referral rates and waiting times around the country are unacceptable and are making people more unwell. It is calling on the next government to make access to talking therapies an immediate priority after the election.

The investigation brings together three separate sets of data from Clinical Commissioning Groups (CCGs), therapists and services users that paint a picture of services struggling to cope. An analysis by the coalition of the latest Health and Social Care Information Centre data from CCGs shows enormous variation in both referrals and waiting times across England. In the last quarter of 2013/14, several CCGs report fewer than 100 new referrals for talking treatments, such as CBT, counselling and group therapy, while others report up to 5,400 in the same period.

While some CCGs, such as NHS Oxfordshire, say the majority of people are assessed for treatment within 28 days of referral, others report that more than 90 per cent have to wait longer. The We Need to Talk coalition surveyed over 2,000 people who have tried to access therapy in the last two years. It reveals that one in ten (9.6 per cent) are waiting over a year between referral and assessment, while four in ten (41 per cent) wait more than three months. Once assessed, most people start therapy within three months, yet a third (32 per cent) wait longer.

While waiting, two thirds (67 per cent) feel they have become more mentally unwell. Four in ten (40 per cent) have harmed themselves, two thirds (67 per cent) have experienced suicidal thoughts and one in six (16 per cent) attempted suicide. The survey also revealed the toll on other services; six per cent of people waiting for therapy have been voluntarily admitted to hospital, three per cent admitted compulsorily under the Mental Health Act and seven per cent have come into contact with the police as a result of their mental health.

Psychological therapies are recognised as effective treatments for a wide range of mental health problems. Since 2007 the Government’s Improving Access to Psychological Therapies (IAPT) programme has enabled more people to access National Institute of Health and Care Excellence-approved talking therapies. The current Government has invested in IAPT but progress has been patchy and the coalition says that there is still much to do before people with mental health problems receive the help and support they need. IAPT services are primarily there to help people with depression and anxiety and there is a need for specialist services for people with more complex mental health problems.

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A joint survey of over 650 NHS therapists by the British Psychoanalytic Council (BPC) and the UK Council for Psychotherapy (UKCP) suggests that despite investment in IAPT, the situation in many areas is getting worse as other psychotherapy services are being cut back. More than half (57 per cent) of therapists report an increase in waiting times over the last year and two thirds (62 per cent) report shorter courses of treatment. Almost four out of five (77 per cent) say they are seeing people with more complex needs coming through their doors.

Meanwhile, more and more people are turning to private providers in a bid to get the help they need. The We Need to Talk survey revealed that a quarter (24 per cent) of people who have recently tried to access therapy have paid to go private, compared with just one in ten (11 per cent) in 2013. The UKCP and BPC also surveyed 600 private therapists, 89 per cent of whom say clients have come to them because the NHS could not give them the help they need.

Paul Farmer, Chair of the We Need to Talk coalition and Chief Executive of mental health charity Mind, said: “Our investigation shows that providers, frontline staff and those who use services are all united in the view that mental health services aren’t currently set up to cope with demand. We know that in some parts of the country investment in IAPT and other models has transformed lives as people have been able to access the help they need when they need it. But far too many are facing unacceptably long waits or are struggling to even get a referral. This simply isn’t good enough.

“At the same time as people are waiting for psychological therapies, prescriptions for antidepressants rise and rise and we have seen mental health services struggle to cope with the demand for beds and other crisis services.

“All three main political parties have been in power in the time we have had IAPT, so we know the commitment is there but we have yet to see the ambitions of the programme made a reality on the ground. Whoever forms our next government must redouble their efforts and make this a priority, ensuring fair access and establishing waiting times targets so that no matter where you live, you can get the help you need when you need it. We are calling on them to ensure the NHS in England offers a full range of evidence-based psychological therapies to everyone who needs them within 28 days of requesting a referral.”

Kerry is 29 and lives in Lambeth. She has had depression and anxiety since she was 15. She received 12 sessions of person-centred counselling about two years ago, which she says really helped. This was provided outside of the NHS by a charity and was something that Kerry had to research and ask for herself. She is currently on the waiting list for a specialised psychological therapy to help her cope with the emotional trauma she has experienced after being raped in 2010. Three weeks ago Kerry tried to take her own life.

She says: “I had to push for three months to see a psychiatrist for a referral and then waited another two months before I got the letter confirming I had been referred. I am now on a four-month waiting list, which feels like a long time. I should have had this therapy a long time ago and it’s only because I have pestered them on a daily basis that I have got this far. And it still feels so far away. In the meantime my depression has got worse and I feel like my life is passing me by. I feel like I am running a marathon every day.

“A friend of mine very kindly offered to pay for me to go private, but it’s not right that it should come to that. Even if my friend can afford it there’s no way I could accept that kind of generosity from a friend.”

When the system works: Case study, TalkingSpace

TalkingSpace is the Oxfordshire Improving Access to Psychological Therapies (IAPT) service, run as a partnership between Oxford Health NHS Trust and Oxfordshire Mind since 2009. The service is offering a high quality but high volume service which copes with 8,000 referrals per year and 6,000 people completing a course of treatment. The recovery rates are at 48 per cent and 92 per cent patient satisfaction. Over 100 people have moved off sick pay and benefits per year and they have trained 56 staff to deliver recommended talking treatments.

The ambition for the service in the coming year is to reach more people, helping more people towards recovery and improving their offer to older adults, BME communities and people with physical health problems.

NHS Oxfordshire CCG reported 1,670 assessments in quarter 4 of 2013/14, which is above the national average. Of these, 91 per cent were assessed within 28 days of referral.

Comments from individual We Need to Talk member organisations

Louise Robinson, Healthcare Development Manager at the British Association for Counselling and Psychotherapy, said: “With increasing demand across the UK and a growing number of trained, qualified and registered workers ready to provide this vital service, effective and timely access is both needed and achievable.”

“BACP has over 40,000 members and the majority meet the Department of Health definition of psychological therapist and yet the majority are also not in full time employment as a therapist. What we need are pragmatic and cost-effective commissioning solutions that mobilize this workforce into services that help address the causes of both psychological distress and physical illness, thus relieving human suffering and saving public money.”

Gary Fereday, Chief Executive of British Psychoanalytic Council, said: “We Need to Talk’s investigation shows that if you happen to be among the millions of people who experience mental illness and need urgent psychological therapy, it is highly likely that you will not receive appropriate or adequate therapy. Moreover, it demonstrates that you have a high chance of waiting for an unacceptably long time for treatment and even that your health may deteriorate further. Although investment in IAPT has changed people’s lives, the state of current provision is unacceptable and would be considered scandalous if we were talking about physical health services. This is why the British Psychoanalytic Council joins with We Need to Talk partners in urgently calling for the NHS to provide the full range of evidence based psychological therapies to anyone who needs them within 28 days of asking for help.”

Professor Jamie Hacker Hughes, President Elect of the British Psychological Society, said: “As a clinical psychologist and psychotherapist, but also as a service user, I know from experience that talking therapies work. However, in order for them to do so, they need to be timely, accessible, evidence-based and tailored to the needs of the client. This is why the British Psychological Society wholeheartedly supports the WNTT campaign, calling on Government to fund and prioritise a range of talking therapy services nationwide ensuring accessibility, equality, equity of access and parity with physical health services.”

Centre for Mental Health deputy chief executive Andy Bell said: “Some 4.6 million people in England have both a long-term health condition and a mental health problem at the same time. This puts them at risk of poorer quality of life and of dying sooner. It also costs the NHS some £10 billion in extra healthcare. Offering evidence-based psychological therapies to people with long-term conditions as part of a better integrated approach to care could help to improve their health and reduce costs. The IAPT programme is finding ways to do this and it is vital that this work is sustained and expanded nationally so that no one misses out on the support they need when they need it.”

Jenny Edwards CBE, Chief Executive of the Mental Health Foundation said: “The effectiveness of evidence based psychological therapies is proven. Despite the clear case for timely access people have to wait far too long, even up to a year before they start to receive help. This is costly to the health of the people waiting and has an impact on many aspects of their lives ”” their work, relationships and ability to cope. People have a right to expect parity in how they are treated whether their ill health is mental or physical.

“Early intervention is common sense and will help people avoid ending up in crisis, with risking harm to themselves and high costs to health services. People from black and minority ethnic communities, people in later life and young people must not be left behind in the drive to provide psychological therapies so we can reduce health inequalities.”

Liz McElligott, Chief Executive, The National Counselling Society, said: “‘We Need to talk’…. but actions speak louder than words and we need Government to act. There are trained professionals waiting to help and there are distressed patients waiting for help but funding is needed to bridge the gap between the two groups.”

Mark Winstanley, CEO of Rethink Mental Illness said: “It’s disgraceful that some people are waiting for over a year to receive talking therapies, and many are missing out altogether. Talking therapies should not be seen as ‘optional extra’, and everyone going through mental illness should be offered this treatment.

“Too often, people are fobbed off with medication alone, when we know that psychological therapies have the potential to transform lives. If you had a serious physical illness like cancer, you’d expect to get the full range of recommended treatments, so why should it be different for people with mental illness?”

Dr Maureen Baker, Chair of Royal College of General Practitioners, said: “We live in a stressful society and GPs are seeing a huge increase in the number of patients presenting with mental health issues.

“Mental health is a clinical priority for the RCGP and we understand how important it is to refer patients to the right place at the right time. It is a travesty that so many people are still falling through the gaps.

“It is crucial that GPs are part of this coalition so that we can take the necessary action to address this.”

David Pink, chief executive of UK Council for Psychotherapy, said: “Demand for therapy is higher than ever but the NHS is not delivering.

“Many NHS psychotherapy posts have been cut, clients are forced into long waits and thousands more are simply turned away. At the same, antidepressant prescriptions continue to rise and rise. This is a national scandal.

“While the NHS flounders, private therapy is the lifeline keeping many afloat. But private therapy is only available to those who can afford to pay.

“The next government must consider how to use this highly trained therapy workforce to ensure the NHS meets its founding commitment: that all can access support based on clinical need and not on the ability to pay.”

on line mental health community @ http://www.bipolar4lifesupport.co

Vulnerable populations in ethnically diverse Toronto reported more discrimination by health care workers based on their housing status, mental health or substance abuse issues than race, a new study has found.

Forty-two per cent of people surveyed reported at least one form of perceived discrimination by health care workers, lead author Dr. Vicky Stergiopoulos wrote in a paper published in the journal BMC Health Services Research.

The most prevalent form of perceived discrimination was due to mental illness or substance abuse (33 per cent) and homelessness or poverty (30 per cent), said Dr. Stergiopoulos, psychiatrist-in-chief at St. Michael’s Hospital.

Only 20 per cent of non-Caucasian and 15 per cent of overall participants reported discrimination due to race, ethnicity or skin colour, said Dr. Stergiopoulos, who is also a scientist in the hospital’s Center for Research on Inner City Health.

Data for this research came from the Toronto site of the At Home/Chez Soi randomized controlled trial of providing safe, quality housing to homeless adults with mental illness to help them better focus on recovery.

All types of discrimination in health care settings were associated with more frequent use of Emergency Departments, a greater severity of lifetime substance abuse and mental health problems, Dr. Stergiopoulos said.

Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination: those who reported discrimination due to homelessness or poverty were 32 times more likely to report discrimination due to mental illness or substance abuse. Those who experienced discrimination due to mental illness or substance abuse were almost nine times more likely to report discrimination due to race, ethnicity or skin color.

“The findings suggest that among ethnically diverse homeless adults with mental illness in a large urban center in Canada, perceived discrimination in health care settings in common,” Dr. Stergiopoulos said.

She said the most common complaint was a lack of respectful treatment by various practitioners.

“Discrimination can have a significant impact on the lives of those affected,” Dr. Stergiopoulos said. “The stress of perceived discrimination negatively affects mental and physical health, poverty and social marginalization, and may increase the likelihood of risky behavior. Discrimination by health care providers can be a key barrier to obtaining needed services, resulting in avoidance or delays in seeking treatment, under diagnosis and mistreatment, non adherence with or discontinuation of treatment and poor treatment outcomes.”

Dr. Stergiopoulos said understanding discrimination in health care is the first step toward designing policies and interventions to address health disparities among disadvantaged populations.

She noted that homeless people with mental illness are already among the most marginalized patient groups, reporting high levels of unmet health needs.

on line mental health community @ http://www.bipolar4lifesupport.co

Yesterday was annual World Suicide Prevention Day, which, given the recent high-profile suicide of the actor Robin Williams – a death that has generated a huge amount of media and professional debate on the subject – has an added layer of poignancy this year.

Although it may be disappointing that it requires the suicide of a much-loved celebrity to engage the media and public in such intense debate on the issue, as this feature investigates, the relationship of the media, celebrity suicide and suicide in the general population is fraught and complex.

First, some statistics. Last week, the World Health Organization (WHO) released some sobering data on suicide prevalence. According to the latest figures, one person commits suicide every 40 seconds.

“Suicides are preventable,” states WHO Chief Margaret Chan, who describes each suicide as an avoidable tragedy, and that suicide as a public health concern fails to grab attention because of taboos and stigma.

She adds:

“Every suicide is a tragedy. It is estimated that over 800,000 people die by suicide and that there are many suicide attempts for each death.

The impact on families, friends and communities is devastating and far-reaching, even long after persons dear to them have taken their own lives.”

The WHO report is the result of a decade of research involving 172 countries. It found that, in 2012, high-income countries had a slightly higher suicide rate than low- and middle-income countries, accounting for a quarter of the global toll.

The global rate was found to be 11.4 suicides among every 100,000 people, with men about twice as likely as women to complete suicide.

tributes to Robin Williams
Examining the outpouring of grief over Robin Williams’ death, we can see how seemingly innocuous statements may still present a violation of the established public health standards.

The report mentions that the most frequently used suicide methods are pesticide poisoning, hanging and firearms, with the exception of urban areas of Asia, where jumping from buildings is a common method.

However, the report castigates the media and users of social networks for providing lurid details of suicides and the methods used in reports of both celebrity suicides – such as Robin Williams – and unusual suicides by non-celebrities.

“Inappropriate media reporting practices can sensationalize and glamorize suicide and increase the risk of ‘copycat’ suicides,” the report states.

“Media practices are inappropriate when they gratuitously cover celebrity suicides, report unusual methods of suicide or suicide clusters, show pictures or information about the method used, or normalize suicide as an acceptable response to crisis or adversity.”

“Coverage of the recent suicide of Robin Williams was problematic,” Prof. Silvia Canetto, from the College of Natural Sciences-Psychology at Colorado State University, told Medical News Today.

“The reason,” she elaborates, “is that many journalists are not aware of the guidelines, and that training of journalists needs to be consistent, across generations of journalists, and with booster training opportunities.”

Media guidelines on suicide reporting

The “guidelines” she speaks of are perhaps not well known to the general public. In 1989, the Centers for Disease Control and Prevention (CDC) for the first time published recommended guidelines for news organizations on how to report on suicide.

newspaper printing press
In 1989, the CDC for the first time published recommended guidelines for news organizations on how to report suicide.

These recommendations were followed by similar guidelines from the National Institute for Mental Health (NIMH) and WHO.

What the guidelines are striving to prevent, is what experts term “suicide contagion.” Suicide contagion is a measurable phenomenon whereby sensationalized reporting of high-profile suicides is directly followed by a spike – on either a regional or national basis – in suicide attempts and/or completed suicides.

In the CDC’s own words, suicide contagion is “a process by which exposure to the suicide or suicide behavior of one or more persons influences others to commit or attempt suicide.”

The CDC’s position is that while suicide is often newsworthy and therefore likely to be reported, it is incumbent upon reporters to “understand that a scientific basis exists for concern that news coverage of suicide may contribute to the causation of suicide.”

For the CDC, this involves avoiding presenting simplistic explanations for suicide, sensationalizing or excessively repeating coverage, or reporting “how-to” details of suicide. Their guidelines also warn against glorifying people who commit suicide or “presenting suicide as a tool for accomplishing certain ends.”

The NIMH guidelines recommend that in media reporting on suicide, reporters should offer hope to readers, adding statements on the many treatment options and resources available for the psychiatric or substance abuse problems that they claim are present in 90% of people who have died by suicide.

Suicide contagion has been a public health concern since at least the 18th century, when the novel The Sorrows of Young Werther by Johann Wolfgang von Goethe was banned in much of Europe. Goethe’s titular lead character commits suicide following a failed love affair. The powers that be in these countries were worried that young romantics would take the character’s dilemma to heart, potentially sparking a wave of what are now known to the media as “copycat suicides.”

Despite this, there have been relatively few studies to comprehensively investigate suicide contagion. Some studies had found that – overall – suicide rates rise following an increase in media reporting on suicide, and that the greater the amount of coverage is, the greater the rise will be.

Corroborating the stance of the CDC and NIMH, these studies also suggest that media reports portraying suicide negatively are less likely to be followed by a rise in suicides. Goethe may be vindicated here, as studies have not yet reported a link between a rise in suicide and fictional accounts of suicide in the media.

However, the same studies have shown that reporting of the suicides of political or entertainment celebrities is followed by a rise in suicides.

‘Cluster suicides’ and suicide contagion

When a spike in suicide incidence follows a high-profile suicide, it is known as “a suicide cluster.” Teenagers are considered to be particularly at risk for cluster suicides.

depressed teenager hugging his knees
Teenagers are considered to be particularly at risk for cluster suicides.

Earlier this year, Medical News Today reported on a study in The Lancet Psychiatry that set about addressing the paucity of evidence on cluster suicides with an analysis of 469 American newspapers published between 1988 and 1996 and their relationship to 48 identified suicide clusters.

In each of these clusters, between 3 and 11 victims aged 13-20 killed themselves within 6 months of the first suicide.

The study – conducted by researchers from New York State Psychiatric Institute – reported that significantly more newspaper stories were published in the aftermath of a suicide that was closely followed by another suicide than those with no additional suicides within 6 months.

Also, the association was strongest for news stories about teenage suicides.

“Although we cannot show causality,” lead author Dr. Madelyn Gould explained, “our study indicates that media portrayals of suicide might have a role in the emergence of some teenage suicide clusters.”

This suggests that perhaps the CDC guidelines, which were first published at the start of that study’s investigation period, were not effective during their first 7 years of implementation. But have journalists and editors taken up the recommendations in following years? Evidence suggests not.

A 2010 study by Prof. Canetto, published in the journal Suicide and Life-Threatening Behavior, analyzed 968 local and national newspapers published in 2002-03 and concluded that American newspaper coverage did not follow the CDC’s updated 2001 guidelines on media reporting of suicide.

In particular, 56% of stories broke with the recommendations by describing the suicide method and 58% described location. Further contravening the guidelines, only 1% provided information about warning signs and risk factors for suicide, 4% highlighted the role of depression, 2% the role of alcohol, and only 6% recommended prevention-related resources.

The study by Canetto and colleagues could only find one instance of a high-profile suicide where these recommendations had been followed – the death of Nirvana singer Kurt Cobain, back in 1994.

How do the suicide reporting recommendations apply to modern media?

Since then, the media landscape has changed in ways that no one could have predicted, and so a new approach to how such guidelines might be applied to modern media may be required. Examining the outpouring of grief over Robin Williams’ death, we can see how seemingly innocuous and off-the-cuff announcements may still present a violation of the established public health standards.

screengrab of Robin Williams twitter tribute
A moving, appropriate epitaph, or irresponsible public statement?
Image credit: Twitter

This is perhaps best illustrated in the minor controversy over a tweet published by the Academy of Motion Picture Arts and Sciences following the announcement of Williams’ death. Posting a screengrab of the Williams-voiced genie character from Disney’s Aladdin, the Academy’s elegant 19-character tweet – “Genie, you’re free.” – seemed a moving, appropriate epitaph for a man who had been publicly plagued by mental health and addiction problems.

And it struck a chord with Williams’ fans – the message had been retweeted 361,624 times by the point the American Foundation for Suicide Prevention were quoted as saying the Academy’s tweet may contravene the guidelines by implying that suicide is an option.

With Twitter and other social media – increasingly people’s first stop for news and consensus views – beyond the scope of regulation, and with even trained journalists and editors not heeding the recommendations, to what extent are these guidelines either relevant or enforceable?

Silvia Canetto told MNT that the guidelines are still relevant but points to studies that show American journalists are “generally unaware that imitation suicide was a potential consequence of certain suicide reporting.”

For Canetto, the answer to preventing suicide contagion being spread by the media in the aftermath of high-profile suicides is to work with institutions responsible for training journalists and include education on suicide coverage as a component in their curriculums.

Secondly, Canetto argues that the awareness of and response to the guidelines by the media should be tracked to avoid the guidelines being disregarded if they come into conflict with “marketing journalism priorities.”

To what extent any lessons have been learned from the huge response to Williams’ death remains to be seen, but certainly – whether it is the American Foundation for Suicide Prevention’s response to the genie tweet, or recent newspaper think pieces on media complicity in suicide clusters – the issue of how we should talk about suicide is now being vigorously debated in mass media for the first time in 20 years, which can only be a good thing.

Written by David McNamee

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A new Australian study suggests rather than calling in sick and taking time off, depressed employees might find staying at work helps them better manage their illness.

businesswomen looking at an ipad
In the study, depressed employees who took sickness absence experienced no improved health or quality of life, whereas those who continued to work experienced health benefits.

Researchers from the University Of Melbourne, in collaboration with a team from the Menzies Research Institute at the University of Tasmania, report their findings in the journal PLOS ONE.

In their background information, they note previous research shows that while working through a depressive illness can improve mental health, it can raise risks and costs due to fatigue, poorer concentration and reduced job performance.

But what if, with good management, it was possible for employees with depression not only to benefit themselves, but also their employers by staying at work rather than taking sickness absence? This is where there is a big hole in the evidence base, say the authors, who set out to plug it.

Their study is the first to attempt to put into figures the estimated long-term costs and health outcomes of taking sick leave as opposed to continuing to work through depression-related illnesses.

Lead author Dr. Fiona Cocker, from Melbourne’s School of Population and Global Health, says you can’t expect to make recommendations to workers and employers without such information.

Study used ‘hypothetical cohort’ approach

For the study the researchers did not use “real” workers but an approach that is sometimes used in this type of investigation called the “hypothetical cohort.” This is a method that amasses features and characteristics typical of the target population (workers with depressive illnesses) from published studies and meta-analyses, and then uses a model to produce “results” under certain conditions.

A key component of this study was to define absenteeism (when the sick employee does not attend work for the duration of the illness episode) and “presenteeism” (when the sick employee continues to work for the duration of the illness) as mutually exclusive.

The data plugged into the model included probabilities and costs associated with seven different “health states” that members within the hypothetical 1,000-employee cohort might be expected to experience over the time horizon covered by the study (in this case, the researchers calculated figures for 1- and 5-year timescales).

These costs, included, where relevant, “lost productive time, job turnover, and health service use costs,” note the researchers.

Much of the data on probabilities and costs came from a primary Australian epidemiological data source, the National Survey of Mental Health and Wellbeing (2007). From this source, the team was also able to make some assessments about “subtle quality-of-life differences in areas including mental health.”

Depressed employees do not improve when off sick, but working ones do

What they found is that depressed employees who took sickness absence experienced no improved health or quality of life, whereas those who continued to work experienced certain health benefits.

They also found there were differences in the figures depending on whether the employees were white collar (office workers) or blue collar (manual workers), as Dr. Cocker explains:

“Cost associated with depression-related absence and attending work while depressed were also found to be higher for white collar workers who also reported poorer quality of life than blue collar workers.”

The researchers believe the findings are important not only for employers and employees, but also for GPs and other health care professionals providing support and advice on whether it would be better to continue working or stay at home during a depressive illness.

Mental health strategies should consider promoting continued working

Dr. Cocker says the findings indicate that “future workplace mental health promotions strategies should include mental health policies that focus on promoting continued work attendance via offering flexible work-time and modification of tasks or working environment.”

Having a daily routine and the support of co-workers could be one way that workplace programs and alterations can improve the long-term health and wellbeing of employees with depressive illnesses, she notes.

The researchers suggest their findings may also be useful for making recommendations concerning workers with other health conditions like diabetes and heart disease.

Medical News also recently learned how a new approach could revolutionize the care of depression in cancer patients, raising hope for the nearly three quarters of depressed cancer patients who do not receive any form of treatment for their depression.

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A team from McGill University has discovered that people who take the most common antidepressants (such as Celexa, Paxil, Lexapro, Prozac, and Zoloft, the Selective Serotonin Reuptake Inhibitors or SSRIs) are twice as likely to have dental implants fail as those who are not taking SSRIs.

“Because antidepressants, which are widely used around the world, are reported to increase the risk of bone fracture and reduce bone formation, we were curious to see how they might affect dental implants,” says Prof. Faleh Tamimi, the lead author on the study and a professor in McGill’s School of Dentistry. “Even so, we were surprised to discover that the negative effect of SSRIs on dental implants was so strong, almost equal to that of smoking, a well-established hazard for oral health.”

The researchers reached this conclusion by looking back over the records of dental implants done over a six-year period, between 2007 – 2013, in a clinic in Moncton, New Brunswick. Follow-ups took place with the patients between three and 67 months after the implant was done to see whether it had been successful.

“Unfortunately, because this study was based on data collected after the implants had been done rather than through interviews with incoming patients, it is impossible right now to determine the kind of SSRI dosage that could have this effect,” says Tamimi. “But what this study tells us is both that further work needs to be done in the field and that whether they are planning to have dental implants or hip or knee prostheses, SSRI users should consult their physicians and plan carefully to ensure that the surgical treatment is successful.”

The research was funded by the China Scholarship Council, Clifford Wong Fellowship, Canadian Institutes of Health Research, Institute of Musculoskeletal Health and Arthritis Bridge Funding, and Le Réseau de recherche en santé buccodentaire et osseuse.

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Housework just doesn’t scrub up as a physical activity that brings any mental health benefits, say researchers from Deakin University’s Centre for Physical Activity and Nutrition Research (C-PAN).

Two unique studies by C-PAN researchers Dr Megan Teychenne and Professor Kylie Ball have revealed that dusting, vacuuming and scrubbing the bath generate exertion and physical health benefits yet the monotony of the menial work brings no mental health rewards.

“Running, swimming and gym workouts all help people stay fit and mentally healthy and people who undertake these types of exercise are less likely to suffer depression,” Professor Ball said.

“But housework does not engender the same mental health benefits and shows no protective effects against symptoms of depression.”

In the first studies of their kind, Dr Teychenne and Professor Ball surveyed thousands of Victorian women about the amount and type of physical activity they undertook.

The studies aimed to identify associations between physical activity and the odds of depressive symptoms in women.

“To our knowledge, no previous research had compared leisure time, domestic and transport-related (walking and cycling) physical activity with odds of depressive symptoms in the same study,” Professor Ball said.

“Little research has been put in to what type of physical activity is most beneficial to good mental health and little is known about the optimal domain, dose and social context of physical activity for reducing the risk of depression.”

The first study, funded by the National Heart Foundation of Australia, surveyed 1554 women aged 18-65 from 45 Melbourne suburbs and all walks of life.

The second, funded by the National Health and Medical Research Council, surveyed 3645 women living in 80 socioeconomically disadvantaged Victorian neighborhoods in urban and rural areas.

“People living in disadvantaged neighborhoods are less likely to be regularly physically active than those from wealthier neighborhoods, which is why these areas were targeted in this study.”

The studies both found that women who reported walking or moderate intensity physical activity in leisure time were less likely to experience depressive symptoms.

But a surprise result also revealed that physical activity doing domestic chores contradicted the mental health benefits associated with exercise.

Professor Ball said the key finding of her research indicated the type of physical activity women get may be more important than the amount of exercise, when it comes to mental health.

Past findings have indicated that higher levels of physical activity were associated with lower odds of depressive symptoms, but that even just 30 minutes a week was linked with improved mental health.

“Our studies confirm previous findings that showed women’s moods were generally better when they were getting a workout in their leisure time.”

Professor Ball said the study also revealed the importance of the social aspects of exercise.

“Being a member of a sporting or recreational club, having someone to walk with in the neighborhood and being active with a family member are all associated with improved mental health,” Professor Ball said.

“This finding supports the dose of physical activity recommended in the US, UK and Australian national physical activity guidelines of at least two-and-a-half hours a week or at least 30 minutes on most, if not all days of the week.”

Whilst housework may not confer mental health benefits, it does provide physical health benefits and is a useful form of exercise for many people. “So ‘spring cleaning’ is still good for health,” she said.

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