The risk of all-cause mortality among patients with chronic, non-communicable diseases is more than doubled if they also have a psychiatric comorbidity, according to a new study published inPLOS Medicine.
Non-communicable diseases such as diabetes and heart disease are a global public health challenge accounting for an estimated 40 million excess deaths annually. Researchers drew on Swedish health data for 1 million patients born between 1932 and 1995 who had diagnoses of chronic lung disease, cardiovascular disease, and diabetes. More than a quarter of the people in the analysis also had a co-occurring psychiatric disorder during their lives.
Within 5 years of diagnosis, 7% of the people included in the study had died from any cause and 0.3% had died from suicide. Comorbid psychiatric disorders were associated with higher all-cause mortality (15.4% to 21.1%) when compared to those without such conditions (5.5% to 9.1%). When compared with an unaffected sibling to account for familial risk factors, patients with psychiatric comorbidity remained consistently associated with elevated rates of premature mortality and suicide (7.2–8.9 times higher). Different psychiatric diagnoses affected mortality risks; in those with comorbid substance use disorder it was 8.3–9.9 times compared to unaffected siblings, and by 5.3–7.4 times in those with comorbid depression.
“Improving assessment, treatment, and follow-up of people with comorbid psychiatric disorders may reduce the risk of mortality in people with chronic non-communicable diseases,” the authors concluded.
Suicide and motor vehicle traffic accidents are two of the most common forms of death among adolescents. A new study published in JAMA Pediatrics found that adolescents who reported at least one suicide attempt within the last year, compared to those reporting no attempts, were also more likely to report infrequent seat belt use and driving with a drunk driver. There were also over twice as likely to report driving drunk.
The researchers analysed data from over 13 500 U.S. high school students who participated in the 2019 Youth Risk Behavior Survey, and found that 19% of the sample reported suicidal ideation. Texting or e-mailing while driving was the most commonly reported form of risky driving behaviours.
Study lead author Kyle T. Ganson, PhD, assistant professor at the University of Toronto, said: “The findings from this study emphasise the need for mental health support for adolescents experiencing suicidality as a means of increasing safety for themselves and their communities, as accidental injury deaths via car accidents were the leading cause of death among adolescents in 2019.”
“The more severe the suicidality, the stronger the association with risky driving behaviours,” Dr Ganson continued. “Adolescents who reported a suicide injury, such as a poisoning or overdose needing to be treated by a medical professional, had the highest likelihood to report all four risky driving behaviors we examined.”
The researchers stress the importance of the implications their findings have to protect the health and well-being of adolescents. “Health care professionals should consider discussing risky driving behaviours with teens who report suicidality,” said co-author Jason M. Nagata, MD, MSc, assistant professor at the University of California, San Francisco.
A study found that, when a companion is present virtually as an avatar, people respond with less anxiety to fear-inducing noises. This effect was found to be most pronounced in women.
Led by Professor Grit Hein, the study is published in the journal Translational Psychiatryand could have implications for the treatment and management of social anxiety.
“In a nutshell, we have shown that anxiety can also be reduced by the ‘presence’ of a virtual person, especially in socially anxious women. And women in general seem to benefit more from social presence,” Prof Hein said. She believes that this insight might have practical significance.
The study recruited 208 men and women, who were all exposed to fear-inducing sounds alternating with neutral ones – either alone or in the company of another person. Women had female companions, men had male companions. The researchers determined the level of the participants’ anxiety response through changes in skin conductance. Moreover, the participants had to rate the sounds on a scale.
But the series of experiments differed in one key aspect: One group had a real person at their side during the experiment whereas the second group completed the task in a virtual reality – accompanied by an avatar that was an image of the real companion.
“Earlier experiments have shown that the presence of a third party can significantly reduce fear responses. In such situations, social support thus has a stress-buffering effect,” said Prof Hein.
However, not all people are equally sociable: for some, the presence of others might actually trigger apprehension or anxiety. They fear that their companion might notice their anxious responses, such as trembling, flushing or sweating, causing them stress in the first place. Thus far it was unclear whether an avatar is also capable of triggering such a response.
The results of Prof Hein’s study have now provided clarity in this regard. They show that:
women respond much more strongly to fear-inducing sounds than men do.
the presence of another person reduces anxiety, especially in women. This is especially true for women without social anxiety disorder.
the presence of a virtual person also reduces the anxiety response in women – regardless of the level of social anxiety they experience. So a virtual agent may increase feelings of safety in women suffering from social anxiety disorder.
social anxiety does not have a comparable effect on men.
“Our findings provide new insights into the individual differences that influence the social modulation of the autonomic human anxiety responses,” the authors concluded in their study. The researchers’ next aim is to study long-term effects and replicate the findings in real life.
Future studies should systematically explore the effect of the gender of the present person, they suggested. This would also allow scientifically sound evidence to be provided as to how men respond when they have a woman at their side in fear-inducing situations and vice versa.
The former Gauteng deputy director-general for mental health services, Hannah Jacobus, has the process to move Life Esidimeni patients was rushed. She was being cross-examined by the State’s Advocate Willem Pienaar.
The much-delayed inquest meant to determine any criminal liability for the deaths of 144 mental health patients in the 2016 Life Esidimeni disaster continued virtually on Monday.
Jacobus’ role was in downscaling of patients at Life Esidimeni for cost savings, and says there was no indication of it closing at the time. When its closure was announced, these downscaling plans were not implemented and there was no timeframe given for when patients were to move out.
The former deputy DG admitted to writing false licences for NGOs, under pressure from then head of Gauteng mental health services, Dr Makgoba Manamelashe. However, Jacobus maintained that while she assessed their suitability, she ultimately did not issue any licences.
Dr Manamela signed licences authorising inexperienced‚ underfunded‚ poorly equipped NGOs to look after patients with profound mental illnesses.
After the Gauteng health department terminated the contract with Life Esidimeni, NGOs were used to care for the 1712 patients.
Dr Manamela admitted to Solidarity advocate Dirk Groenewald that the NGOs to which she gave authority did not comply with the legal requirements. In 2017, it was found that patients were transferred to NGOs that had been issued “unlawful and knowingly fraudulent” licences.
Many NGOs were subsequently found to be entirely unprepared for the patients they received, some lacking sufficient food, water, medication, staff or blankets. According to Jacobus, the process have only been completed by 2020 according to the downscaling schedule.
“From December 2015 to the end of March 2016 [is not] a sufficient period to determine and appoint suitable NGOs to receive mental healthcare [patients]. No NGOs were ready by the end of March. We needed more time,” she said.
According to a new US study, all the political jockeying is harmful to our health, has been for some time, and even a change in party power didn’t help.
Political scientist Kevin Smith followed up a landmark 2017 survey study where he measured the effects of the political climate on Americans’ physical, social, mental and emotional health. Smith repeated the same 32-question survey twice in 2020 – two weeks prior to the election, and two weeks after. The 2020 findings mirrored the 2017 results, and again found that a large proportion of American adults blame politics for causing them stress, loss of sleep, fractured relationships and more.
Similar to the 2017 findings, the results of the 2020 surveys, published in PLOS One, showed that an estimated 40% of Americans identified politics as a significant source of stress. Between a fifth and a third of US adults also blamed politics for causing fatigue, feelings of anger, loss of temper and triggering compulsive behaviours. About a quarter of adults reported they’d given serious consideration to moving because of politics.
That the results remained mostly stable after nearly four years is cause for alarm, Smith said.
“This second round of surveys pretty conclusively demonstrates that the first survey was not out of left field – that what we found in that first survey really is indicative of what many Americans are experiencing,” Smith, chair and professor of political science, said. “It’s also unpleasant to think that in that span of time, nothing changed. A huge chunk of American adults genuinely perceive politics is exacting a serious toll on their social, their psychological and even their physical health.”
Smith repeated the survey with the same group of people both before and after the election to see if the election’s outcome would recast people’s perceptions.
“We wondered if a change in presidency, which indeed was the case, would shift attitudes, and the short answer is no,” Smith said. “If anything, the costs that people perceive politics is exacting on their health increased a little bit after the election.”
Smioth was most surprised at the repeated finding that 5% of Americans blame politics for having suicidal thoughts.
“One in 20 adults has contemplated suicide because of politics,” Smith said. “That showed up in the first survey in 2017, and we wondered if it was a statistical artifact. But in the two surveys since, we found exactly the same thing, so millions of American adults have contemplated suicide because of politics. That’s a serious health problem.”
Those most likely to be negatively affected by politics were younger, more often Democratic-leaning, more interested in politics and more politically engaged.
“If there’s a profile of a person who is more likely to experience these effects from politics, it’s people with those traits,” Smith said.
This could mean problems for democracy if this trend continued. Smith suggested investigating whether civic education had a positive effect, as those who were more knowledgeable about politics seemed to be less affected.
Not properly ‘switching off’ and disconnecting from work-related electronic communications can be more than just annoying, it can damage your health, research shows.
Researchers from the University of South Australia surveyed more than 2200 academics and professional staff across 40 Australian universities, and found that employees who responded to work emails and texts out of hours had greater odds of experiencing burnout, psychological distress, and poor physical health.
Researchers found that in 2021:
26% of employees felt that they had to respond to work-related texts, calls, and emails from supervisors during their leisure time;
57% said that they’d sent work-related digital communications to other colleagues in the evenings;
50% reported that they often receive work-related texts, calls and emails from colleagues on the weekend;
36% reported that it was the norm to respond immediately to digital communication in their organisation.
UniSA researcher Dr Amy Zadow says that the expectations for employees to be available 24-7 is putting pressure on workers.
“Since COVID, the digitalisation of work has really skyrocketed, blurring work boundaries, and paving the path for people to be contactable at all hours,” Dr Zadow said.
“But being available to work both day and night limits the opportunity for people to recover – doing things such as exercise and catching up with friends and family – and when there is no recovery period you can start to burn out.
“Our research shows that high levels of out-of-hours work digital communication can have a significant impact on your physical and mental wellbeing, affecting work-family relationships, causing psychological distress, and poor physical health.
“Conversely, workers who kept their work boundaries in check experienced less stress and pressure.”
The study found that those who were expected to respond to after-hours work communications on the weekends reported higher levels of psychological distress (56% vs 42%); emotional exhaustion (61% vs 42%); and poor physical health (28% compared to 10%).
UniSA’s Professor Kurt Lushington said that dealing with work-related stress is becoming increasingly important.
“Managing out-of-hours communications can be challenging, but organisations do have the power to discourage ‘work creep’,” Prof Lushington said.
“Setting up policies, practices and procedures to protect psychological health by developing a strong Psychosocial Safety Climate is likely to limit damaging out-of-hours digital communication. And, on a broader scale, this is already being considered in various Enterprise Bargaining Agreements and National Employment Standards.
“The starting place is measuring work demand so that an organisation can mitigate the risk in the first place. Once they do this, they can develop protective actions that can prevent the development or continuations of harmful workplace norms.
“At the end of the workday, everyone should have the right to disconnect.”
In a study published in Addiction Biology, researchers uncovered significant associations between use of electronic devices and signs of depression and anxiety, as well as cigarette smoking and alcohol drinking. The team also found certain genetic variants that were linked with these traits.
A review of studies on smartphone addiction found that anxiety and depression were commonly mediated mental health problems. A wide range of physical health sequelae was also associated with smartphone addiction. Furthermore, there was an association between smartphone addiction and neurological disorders.
The study included data on hundreds of thousands of individuals from the UK Biobank. Three indicators of use of electronic devices were included in the study: TV watching, computer using, and computer playing.
Their findings suggested that electronic devices use was associated with common mental traits and provided new clues for understanding genetic architecture of mental traits.
The authors wrote that the study’s findings suggest that reducing time spent using electronic devices may help reduce mental health burdens.
In a new study published in International Psychogeriatrics, researchers report that a shortened, seven-item scale can help determine a person’s level of wisdom, a potentially modifiable personality trait shown to be strongly associated with well-being.
Previously, the researchers had developed the 28-item San Diego Wisdom Scale (SD-WISE-28), which has been used in large national and international studies, biological research and clinical trials to evaluate wisdom.
But researchers found that an abbreviated seven-item version (SD-WISE-7 or Jeste-Thomas Wisdom Index), was comparable and reliable.
“Wisdom measures are increasingly being used to study factors that impact mental health and optimal aging. We wanted to test if a list of only seven items could provide valuable information to test wisdom,” said senior author Dilip V. Jeste, MD.
Past studies have shown that wisdom is comprised of seven components: self-reflection, pro-social behaviours (such as empathy, compassion and altruism), emotional regulation, acceptance of diverse perspectives, decisiveness, social advising (such as giving rational and helpful advice to others) and spirituality.
The latest study surveyed 2093 participants online, ages 20 to 82. The seven statements, selected from SD-WISE-28, relate to the seven components of wisdom and are rated on a 1 to 5 scale, from strongly disagree to strongly agree. Examples of the statements include “I remain calm under pressure” and “I avoid situations where I know my help will be needed.”
“Shorter doesn’t mean less valid,” said Dr Jeste. “We selected the right type of questions to get important information that not only contributes to the advancement of science but also supports our previous data that wisdom correlates with health and longevity.”
In addition, the SD-WISE-7 was found to strongly and positively correlate with resilience, happiness and mental well-being and strongly and negatively correlate with loneliness, depression and anxiety.
“There are evidence-based interventions to increase levels of specific components of wisdom, which would help reduce loneliness and promote overall well-being,” said Dr Jeste.
“Like the COVID vaccine protects us from the novel coronavirus, wisdom can aid in protecting us from loneliness. Thus, we can potentially help end a behavioural pandemic of loneliness, suicides and opioid abuse that has been going on for the last 20 years.”
Next steps include genetic, biological, psychosocial and cultural studies of large numbers of diverse populations to assess wisdom, as well as various factors related to mental, physical and cognitive health in people across the lifespan.
“We need wisdom for surviving and thriving in life. Now, we have a list of questions that take less than a couple of minutes to answer that can be put into clinical practice to try to help individuals,” said Dr Jeste.
The findings of a study published in Science Translational Medicine paint a new picture of how current antidepressant drugs work and suggest a new drug target in depression. As with most drugs, antidepressants were developed through trial and observation. Some 40% of patients with the disorder don’t respond adequately to the drugs, and when they do work, antidepressants take weeks to provide relief. Why this is has remained largely a mystery.
To figure out why these drugs have a delayed onset, the team examined a mouse model of chronic stress that leads to changes in behaviours controlled by the hippocampus. The hippocampus is vulnerable to stress and atrophies in people with major depression or schizophrenia. Mice exposed to chronic stress show cognitive deficits, a hallmark of impaired hippocampal function.
“Cognitive impairment is a key feature of major depressive disorder, and patients often report that difficulties at school and work are some of the most challenging parts of living with depression. Our ability to model cognitive impairment in lab mice gives us the chance to try and understand how to treat these kinds of symptoms,” said Professor Dane Chetkovich, MD, PhD, who led the study.
The study focussed on an ion transporter channel in nerve cell membranes known as the HCN channel. Previous work has shown HCN channels have a role in depression and separately to have a role in regulation of cognition. According to the authors, this was the first study to explicitly link the two observations.
Examination of postmortem hippocampal samples led the team to establish that HCN channels are more highly expressed in people with depression. HCN channel activity is modulated by a small signaling molecule called cAMP, which is increased by antidepressants. The team used protein receptor engineering to increase cAMP signaling in mice and establish in detail the effects this has on hippocampal HCN channel activity and, through that connection, on cognition.
Turning up cAMP was found to initially increase HCN channel activity, limit the intended effects of antidepressants and negatively impact cognition (as measured in standard lab tests).
However, a total reversal took place over a period of some weeks. Previous work by the researchers had established that an auxiliary subunit of the HCN channel, TRIP8b, is essential for the channel’s role in regulating animal behaviour. The new study shows that, over weeks, a sustained increase in cAMP starts to interfere with TRIP8b’s ability to bind to the HCN channel, thereby quieting the channel and restoring cognitive abilities.
“This leaves us with acute and chronic changes in cAMP, of the sort seen in antidepressant drug therapy, seen here for the first time to be regulating the HCN channel in the hippocampus in two distinct ways, with opposing effects on behaviour,” Prof Chetkovich said. “This appears to carry promising implications for new drug development, and targeting TRIP8b’s role in the hippocampus more directly could help to more quickly address cognitive deficits related to chronic stress and depression.”
To find better solutions to mental illness, a Virginia Tech researcher has found that long-banned psychedelic drugs can treat several forms of mental illness and, in mice, have achieved long-lasting results from just one dose.
Using a process his lab developed in 2015, Professor Chang Lu is helping his collaborators study the epigenomic effects of serotonergic hallucinogens, commonly known as psychedelics.
Their findings, published in Cell Reports, give insight into how psychedelic substances like psilocybin, mescaline, LSD, and similar drugs may relieve symptoms of addiction, anxiety, depression, and post-traumatic stress disorder. The drugs seem to work faster and last longer than current medications, all with fewer side effects.
Prof Lu’s genomic analysis allows researchers to use very small samples of tissue, down to hundreds to thousands of cells, and draw meaningful conclusions from them. Older processes require much larger sample sizes, so Prof Lu’s approach enables the studies using just a small quantity of material from a specific region of a mouse brain.
And looking at the effects of psychedelics on brain tissues is especially important.
While researchers can do human clinical trials with them, taking blood and urine samples and observing behaviours, Prof Lu said. “But the thing is, the behavioural data will tell you the result, but it doesn’t tell you why it works in a certain way,” he said.
But looking at molecular changes in animal models, such as the brains of mice, allows scientists to peer into what Prof Lu calls the black box of neuroscience to understand the biological processes at work. While the brains of mice are very different from human brains, Prof Lu said there are enough similarities to make valid comparisons between the two.
VCU pharmacologist Javier González-Maeso has made a career of studying psychedelics, which had previously been banned since the 1960s. Other research, primarily on psilocybin, a substance found in more than 200 species of fungi, González-Maeso said psychedelics have shown promise in alleviating major depression and anxiety disorders. “They induce profound effects in perception,” he said. “But I was interested in how these drugs actually induce behavioral effects in mice.”
To explore the genomic basis of those effects, he teamed up with Prof Lu.
In the joint study, González-Maeso’s team used 2,5-dimethoxy-4-iodoamphetamine, or DOI, a drug similar to LSD, administering it to mice that had been trained to fear certain triggers. Prof Lu’s lab then analysed brain samples. They discovered that the epigenomic variations were generally more long-lasting than the changes in gene expression, thus more likely to link with the long-term effects of a psychedelic.
After one dose of DOI, the mice that had reacted to fear triggers no longer responded to them with anxious behaviours. Their brains also showed effects, even after the substance was no longer detectable in the tissues, Prof Lu said.
As well as the science, it’s personal for him too, saying: “My older brother has had schizophrenia for the last 30 years, basically. So I’ve always been intrigued by mental health,” Lu said. “And then once I found that our approach can be applied to look at processes like that – that’s why I decided to do research in the field of brain neuroscience.”
González-Maeso said research on psychedelics is still in its early stages, and there’s much work to be done before treatments derived from them could be widely available.
