Across the country, students are preparing to start or return to college. This is an exciting time, though for some its overwhelming and stressful. Depression, substance use and eating disorders are increasingly common mental health issues on college campuses.

According to a 2008 American College Health Association survey1, within the last 12 months, 30 percent of students reported feeling so depressed that it was difficult to function and 49 percent felt overwhelming anxiety. In addition, 10 percent of students also reported being diagnosed or treated for depression and more than six percent seriously considered suicide.

Major depression increases the likelihood of substance abuse, impairs functioning at school, and influences an individuals subsequent development in negative ways. Depression can also cooccur with other disorders, including physical illnesses and other mental disorders, such as anxiety and eating disorders.

College Students and Alcohol, a Sobering Look

College is also a time to enjoy the social atmosphere that thrives on campuses. Most students can balance the mix of academic and social activities, though pressure to participate in binge drinking, drinking large quantities of alcohol most nights during the week, and drinking to feel like a part of the crowd are common occurrences. Most students do not connect alcohol abuse with a potential mental health issue. If a student feels that alcohol has become a problem, it is important for him or her to seek care. Many colleges have excellent mental health resources associated with their student health services. Checking in with them as a part of the orientation process can be very helpful for many students and families.

Visit HealthyMinds.org for additional mental health information.

Follow the APA on Facebook at American Psychiatric Association and APA Healthy Minds. Healthy Lives. andfollow APAPsychiatric and APAHealthyMinds on Twitter.

1 American College Health Association. American College Health AssociationNational College Health AssessmentReference Group Executive Summary Fall 2008. Baltimore American College Health Association; 2008.

Research published today on bmj.com reports that adults taking antidepressants are not at greater risk of suicidal thoughts or behavior. On the other hand, young adults less than 25 years of age are at an increased risk, comparable to that seen in children and adolescents.

The article elaborates on data previously made available by the US Food and Drug Administration (FDA) two years ago. It incorporates different methods, supplementary examinations of the data, and discusses at length the implications of the findings.

There is confirmation in earlier studies that antidepressant drugs are associated with an increased risk of suicidal behavior and feelings in children and adolescents. This is mostly evident in the early stages of treatment. This prompted the FDA to include a black box warning to antidepressants in 2005 and to examine trials of antidepressants in adults to search for comparable effects.

Dr Marc Stone and his collaborators from the FDA studied data on suicidal thinking and behavior from published and unpublished randomized trials on antidepressants in adults. The information was provided by eight manufacturers of antidepressant products. Records from 372 placebo controlled trials involving nearly 100,000 patients were reviewed.

The results revealed eight committed suicides, 134 suicide attempts, 10 patients who had made planning without attempting suicide, and 378 patients who had thoughts about suicide but had not acted on them.

In general, there was no distinction in drug type and diagnostic category and the effect on risk of suicidal behavior. However, there were some differences among selective serotonin reuptake inhibitors (SSRIs).

On the other hand, an increased risk was noted among adults under 25 years of age, comparable to that reported in children and adults. This amplified risk was highest in young patients with psychiatric disorders other than depression.

The authors explain “These results suggest that, compared with placebo, the risks of suicidality associated with antidepressants are strongly age dependent the risk is raised in people under 25, not affected in those aged 2564, and reduced in those aged 65 and older.”

The findings also sustain the suggestion that antidepressant drugs can have two different effects

• Adverse effect in some patients that promotes suicidal thoughts or behavior, with a risk that appears to weaken with age.
• Protective effect in others that alleviates depression and reduces any suicidal risk.

The authors call for further research, particularly in terms of possible mechanisms for age related differences.

Meanwhile, the FDA has extended the suicide warning on antidepressant drugs with this new information, including the significant relation of the findings with age.

In an associated editorial Professor John Geddes from the University of Oxford and collaborators caution that “fundamental uncertainty” persists. They call attention to essential restrictions in the analysis, such as the very low numbers of completed suicides in the primary trials and a lack of precision in some of the methods used. In addition, they consider some significant differences in risk between individual drugs.

They add “It is becoming apparent that antidepressants vary in both their efficacy and adverse effects.” In closing they say “The increased risk of suicidal behavior in adults taking antidepressants is probably restricted to younger people and varies greatly between individual drugs.”

“Risk of suicidality in clinical trials of antidepressants in adults analysis of proprietary data submitted to US Food and Drug Administration”
Marc Stone, medical officer, Thomas Laughren, director, division of psychiatry products, M Lisa Jones, medical officer, Mark Levenson, mathematical statistician, P Chris Holland, mathematical statistician, Alice Hughes, associate director for safety, division of neurology products, Tarek A Hammad, associate director, division of epidemiology, Robert Temple, associate director for medical policy, George Rochester, mathematical statistics team leader
BMJ 2009; 339b2880

“Risk of suicidal behaviour in adults taking antidepressants”
John Richard Geddes,professor of epidemiological psychiatry, Corrado Barbui, lecturer in psychiatry, Andrea Cipriani, lecturer in psychiatry
doi=10.1136/bmj.b3066
bmj.com

Psychosocial therapy combined with medication can effectively improve depression and recovery in stroke patients, according to a new study reported in Stroke Journal of the American Heart Association.

In the first longterm study of psychosocial/behavioral therapy in combination with antidepressants, researchers found that adding psychosocial therapy improved depression scores short term and those improvements were sustained long term. At one year Depression scores dropped 47 percent in patients treated with eight weeks of psychosocial/behavioral therapy and antidepressants.

Scores dropped 32 percent among those having usual care, which included taking antidepressants. The results are clinically and statistically significant, researchers said. Patients with improved depression perceived their recovery as significantly greater and also felt their physical condition and social participation were better than those with lesser improvement in depression.

“Depression following stroke is an important public health problem,” said Richard C. Veith, M.D., coauthor of the study and professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. “Onethird of patients who have strokes develop clinical depression, which makes them less able to recover from the stroke, worsens cognitive functioning, impairs social functioning and is associated with other adverse consequences.”

Researchers studied 101 clinically depressed nonhospitalized stroke patient (59 percent men, ages 25 to 88 years old). Each had suffered modest ischemic stroke (caused by a blood clot) in the previous four months. The participants were divided into two groups 48 received the psychosocial/behavior therapy along with medication for eight weeks, while 53 received medication as part of usual care, usually a selective serotonin reuptake inhibitor such as sertraline (trade name Zoloft).

Research nurses conducted the psychosocial/behavioral therapy, modeled after cognitive behavioral therapy, visiting the patients nine times during eight weeks. The nurses conducted onehour sessions, focusing on education about depression and on positive behaviors. The sessions covered how to increase pleasant events, problem solving, caregiver support and how to identify and modify negative thoughts.

At the beginning of the study, researchers found that all patients had a moderately severe depression rating on a standard rating scale called the Hamilton Rating Scale for Depression. The average scores for both groups were essentially the same about 20. A score of 9 or below is desirable.

At nine weeks, the psychosocial/behavioral treatment group had a reduced depression score of 10, a highly significant improvement, twice as effective as the rating in the usual care group.

Notes
The lead author of the study is Pamela H. Mitchell, Ph.D. Other coauthors are Kyra J. Becker, M.D.; Ann Buzaitis, M.N.; Kevin C. Cain, Ph.D.; Michael Fruin, M.N.; David Tirschwell, M.D.; and Linda Teri, Ph.D. Author disclosures are on the manuscript. The National Institutes of Nursing Research partially funded the study.

Source
Bridgette McNeill

New research indicates that screening children for symptoms of depression, the most common mental health disorder in the United States, can begin a lot earlier than previously thought, as early as the second grade.

A University of Washington study that followed nearly 1,000 children from the second to the eighth grades also found five distinct patterns for the way symptoms of depression develop among adolescents.

“Some children are reporting that they dont have as many friends, feel lonelier and are more anxious than their peers,” said James Mazza, a UW professor of educational psychology and lead author of the study. “They are telling us that they feel different from the typical happy golucky second grader.

“We can start to build a profile of childrens mental health in the second grade. This is important because children who are experiencing depression symptoms early on may be at great risk for mental health concerns during adolescence, based on other research studies. We want to reassure parents that everyone, including children, may feel sad or depressed once in a while, but that doesnt mean they will go on to develop depression. We are trying to understand how depression starts and evolves in childhood so that we can develop interventions to help children,” Mazza said.

The new study relied on annual self reports from the children as well as parental and teacher evaluations collected as part of the Raising Healthy Children study, a larger, longterm investigation looking at the development of healthy and problem behaviors among children at 10 suburban schools in the Pacific Northwest. The depression study used data from 511 boys and 440 girls, and 81 percent of the participants were white.

The study identified five patterns of depression symptoms, but 56 percent of the children showed no or very few symptoms of depression in the second grade.

The five patterns of depression symptoms the researchers found and the percentage of students in each group are Low stables 26 percent. These children showed none or very few signs of depression in the second grade and their rates didnt change over time through the eighth grade.

Low risers 30 percent. Children in this group also had no or few symptoms in the second grade, but the number went up by a small amount in subsequent years.

Mild stables 24 percent. This group had few symptoms and then went up by a small amount in subsequent years.

Moderate changers 11 percent. These children started out with a few more symptoms than the previous group and their number of symptoms rose through elementary school and then dropped in middle school.

Moderate risers 9 percent. This group started off with a similar number of symptoms as the moderate changers, however their symptoms did not decrease in middle school. The study identified different early depression risk factors for boys and girls. For boys, behavior and attention problems predicted membership in the different depression groups. For girls anxiety was an early risk factor. The research also reaffirmed previous findings showing gender differences in underlying depressive symptoms, with girls experiencing more symptoms than boys in the eighth grade

“Our children are our best resource in knowing what they are feeling inside. But it is also important to have multiple perspectives. Collecting assessments from parents, teachers and the child to identify children at early risk for depression is a good method for spotting those who may go on to have later mental health risks,” Mazza said.

The National Institute on Drug Abuse funded the study, which was published in the Journal of Youth and Adolescence. Coauthors are Charles Fleming, Kevin Haggerty and Richard Catalano of the UWs Social Development Research Group, a part of the School of Social Work, and Robert Abbott, of educational psychology.

Source
Joel Schwarz

Socalled empty nest syndrome does not affect parents living in rural areas as much as previously thought, according to a new study carried out in Thailand. In fact, parents whose children have all migrated to urban areas of Thailand are less likely to experience depression than parents whose children stay at home.

Psychiatrists from the Institute of Psychiatry, Kings College London, teamed up with researchers in Thailand to examine the impact of ruralurban migration on the mental health of parents. Such migration is increasing among young people in developing countries, and it has been suggested that parents may experience loneliness, isolation and depression when their children move away.

The team surveyed 1,147 parents aged 60 and over living in villages in rural Thailand. They found that depression was less common among parents with all their children living outside the district, compared to parents with some or all of their children living locally. Depression was highest among parents of poorer families with all their children still living in the local area.

Lead researcher Dr Melanie Abas said the team were surprised by the study results. She said “A commonly held view is that outmigration of young people has starkly negative consequences for parents living in rural areas as they get older. But our findings challenge the popular belief that family separation causes older parents to feel abandoned and lacking in support.”

Dr Abas and her colleagues put forward two explanations for their findings. First, families where all the children migrate to urban areas may have existing advantages over families from where migration is less common.

For example, the parents in the study whose children had all left home tended to be better educated, and were more likely to be younger, married and still working themselves. These factors all reduce their risk for depression. In contrast, having few children migrate could be linked to failed aspirations, increasing the risk for family conflict and depression.

Second, migration can bring financial benefits to families. Children who move away usually send remittances home to their parents, which can lift parents out of poverty and boost their mental health and wellbeing. Very few Thai people receive a pension, and rely on children as their main source of cash income.

Dr Abas concluded “Policies are needed to ensure that the rural poor without urban connections can still reap some of the social and economic advantages of the urban environment.”

Reference
“Ruralurban migration and depression in ageing family members left behind” Abas MA, Punpuing S, Jirapramukpitak T, Guest P, Tangchonlatip K, Leese M and Prince M (2009)
British Journal of Psychiatry, 195 5460

Source

92.8% of patients with systemic lupus erythematosus (SLE) suffer anxiety and depression which significantly affects both their physical and emotional quality of life (QoL), according to the results of a new study presented today at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark. Logistic regression analysis revealed that depression was the most significant factor shown to affect QoL (p=0.015; OR=0.18; CI 95%0.0450.72).

In the study, 92.8% (52 of 56) of the patients who were diagnosed with SLE had an element of confirmed neuropsychiatric (NP) involvement (including anxiety, depression, mild cognitive deficits and major NP involvement). Several other conditions that may occur alongside SLE were also shown to influence aspects of QoL (as measured by a selection of health assessment tools), including

* Cutaneous (skin) conditions as Raynauds phenomenon (identified in 37.5% of the patients)

* Serositis (identified in 8.9% of the patients)

* Hyperhomocysteinemia (a blood disorder that is a risk factor for coronary artery disease) (identified in 39.3% of the patients)

* Antiphospholipid antibodies (a disorder of coagulation) (identified in 66.1% of the patients)

Dr Paola Tomietto of the University of Trieste, Italy, who conducted the study, said “People with SLE experience a range of both psychological and physical symptoms which can negatively impact their quality of life. This study shows that the psychological impact of SLE on quality of life includes elements of anxiety and depression. Thus, clinicians should try to identify and address the presence of mood disorders in their SLE patients in order to improve both their emotional quality of life but and, ultimately, their physical functioning.”

56 consecutive SLE patients undertook the Medical Outcome Survey Short Form 36 (SF36), to assess healthrelated quality of life, the Hospital Anxiety and Depression Scale and a neuropsychological battery for testing cognitive deficits. Neuropsychiatric and extracerebral involvement, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) damage indexes, antiphospholipid antibodies and hyperhomocysteinemia were recorded for all the patients. Data were analysed through the Spearman correlation coefficient and a logistic regression analysis.

SLICCDI was correlated with the physical activity (PA) subscale of the SF36 (r=0.44; p=0.001) and with the physical component summary (PCS) (r=0.267; p=0.047); it was related also to the number of NP events (r=0.35; p=0.007). SLEDAI did not correlate with any of the subscale of SF36. The total summary score, the PCS and the mental component summary (MCS) scores of the SF36 were all inversely correlated with the number of NP events (for all r=0,5, p

A new study of ChineseAmerican youth has found that family obligation, for example caring for siblings or helping elders, plays a positive role in the mental health of ChineseAmerican adolescents and may prevent symptoms of depression in later teenage years.

Published in the Journal of Family Psychology, the study found that 14yearolds who reported a greater sense of family obligation reported fewer depressive symptoms by the time they reached 16. The findings suggest that family obligation may be protective against depressive symptoms. The authors suggest that a greater sense of family obligation in the early teenage years could provide teenagers with a strong family bond that makes them feel secure even when they move through adolescence and become more autonomous.

The longitudinal study surveyed 218 ChineseAmerican teenagers over a twoyear period. As participants grew older, their actions to help and support their families decreased. However, their attitude and respect toward their families remained stable, indicating that immigrant adolescents continue to endorse their traditional cultural values even when their behaviors suggest they are becoming less traditional.

Notes
The study was authored by Linda Juang and Jeffrey Cookston, both associate professors of psychology at San Francisco State University. It will be published in the June issue of the Journal of Family Psychology, a special issue focusing on families and immigration.

Source
Elaine Bible