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11/09/2023

Practicing Kindness Has Positive Impact on Mental Health, APA Poll Finds

In a world where much feels outside of our control, U.S. adults largely recognize the positive feelings that stem from practicing small acts of kindness.

This was one of the major takeaways from APA’s most recent Healthy Minds Poll, which asked 2,210 adults living in the United States about the ways in which they practice kindness, most often see others practicing acts of kindness, and more. According to the survey, 89% said that showing others kindness made them feel better, and 90% said receiving an act of kindness made them feel better.

Those polled were also asked to reflect on their feelings of anxiety over current events. (The survey took place October 16 to 19—less than two weeks after the attack by Hamas on Israel.) Two-thirds of respondents (67%) reported feeling anxious about international conflict—up 12% from last month’s poll.

“When we are feeling stressed or sad, doing something for others, no matter how small, boosts our mood,” said APA President Petros Levounis, M.D., M.A., in a news release. “Whether it is an innate response that rewards altruistic behavior or a mental reframing that puts positivity in the world, doing something for someone else makes us feel better.”

In the past three months, 93% of respondents did something kind, including 69% who had greeted a stranger, 68% who reported holding a door open for someone, and 65% who had given someone a compliment. Other ways that respondents reported practicing kindness included the following:

39% had checked in on someone who seemed down or depressed.
33% had donated goods to a charitable cause.
24% had donated money to a charitable cause.
19% had given up their seat for someone.
17% had paid for someone else’s tab.
11% had volunteered or participated in a charity event.
Those surveyed also reported on how they have felt in the past when others showed them an act of kindness. Some of the most common feelings included happiness (56%), gratitude (51%), and hope (29%).

“The next time you are in line to pay for food, tell the cashier to take care of the next person’s bill—say ‘I am paying it forward for the person behind me’ and leave. Then, consider what you have just done to make that person’s day and the smile it will bring them,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “Especially now as we enter the holiday season, and especially as we encounter so many disturbing horrific events in the news, little gestures become meaningful in bolstering us in the day-to-day.”

The poll also asked respondents to reflect on what they are most grateful about as another holiday season begins. Most answered their family (70%), their partner (33%), their home (32%), and their physical health (31%).

10/26/2023

American Psychiatric Association
Psychiatric News Alert
The Voice of the American Psychiatric Association and the Psychiatric Community

Should Psychiatrists Advocate Banning Screens From Kids’ Bedrooms?

Numerous studies have established a strong link between evening screen time and poor sleep quality. Yet should that association result in guidance from a child and adolescent psychiatrist, urging families to institute blanket bans on screens in bedrooms? That question was debated yesterday at this year’s American Association of Child and Adolescent Psychiatry’s (AACAP) annual meeting in New York City by members of AACAP’s Media Committee.

At the start of the debate, Paul Weigle, M.D., the session’s chair, took a poll of the room, asking if attendees thought child and adolescent psychiatrists should advocate banning screens from bedrooms. Fifty-four percent of participants agreed, while 25% disagreed, and 21% were unsure.

Argelinda Baroni, M.D., Lauren Hale, M.D., and Dale Peeples, M.D., argued in favor of banning screens from bedrooms. Some of their reasons included the following:

Screens in bedrooms contribute to poor sleep; they outlined the numerous consequences of poor sleep and the importance of sufficient, restorative sleep as fundamental to optimal functioning of the human body, especially the developing mind.
Screens and social media apps are addictive.
Unrestricted access to screens in the middle of the night is unhealthy.
While the ban proponents acknowledged that screen time in some capacity can have benefits for youth, they emphasized that those benefits can also be achieved in the living room, without disrupting sleep. “As your doctor, I can honestly tell you that you will feel better, sleep better, and have better concentration if you keep electronics out of your bedroom,” Peeples said.

On the opposite side of the debate were Gino Mortillaro, M.D., Ray Pan, M.D., and Michael Tsappis, M.D. They acknowledged the negative impact that screens have on sleep, but argued that bans are rarely ever followed. Other points of opposition included the following:

Blanket bans have the potential to compromise the alliance between the psychiatrist and the youth, as well as the parents and the youth.
Parents need to have a supportive alliance with their children. Banning screens from the bedroom reduces the opportunity for parents to have conversations with their youth.
Banning screens also reduces opportunities for the youth to learn how to regulate themselves as they enter adulthood.
Further, they argued that banning screens reinforces a negative emphasis on real, but also imagined, effects of screens, without allowing room to acknowledge the numerous benefits provided by screen access. “Screens are increasingly relied upon for everyday activities, especially by young people,” Tsappis said.

In the rebuttal phase of the debate, Baroni noted that science is on the side of the ban proponents. Hale argued that encouraging moderation and limit setting are one in the same. If youth put their phones away an hour before bed, they may sleep 20 minutes more, which is just enough to reduce the risk of car crashes and improve grades, Hale argued.

On the opposition side, Pan pointed out that when treating substance use disorders, the literature encourages a harm reduction approach rather than an absolute ban. “The idea of making a black-and-white ban really runs the risk of us being hammers and only seeing nails,” Mortillaro said.

The lively debate also drew numerous audience questions from AACAP members, who shared their thoughts and experiences in their own practices. By the end of the debate, Weigle took another poll to determine if either side had swayed more audience members. The result was almost a total reversal of the original poll: By the end, 55% were against advocating for bans on screens in bedrooms, while 35% were in favor of such bans, and about 10% were unsure.

The AACAP meeting will run through Saturday, October 28. Look for additional meeting coverage in Psychiatric News.

For related information, see the Psychiatric News article “Sleep Problems in Late Childhood, Early Adolescence Linked to Psychiatric Symptoms.”

08/01/2023

More Youth Drive Under the Influence of Cannabis Than Alcohol

Nearly a quarter of drivers between the ages of 16 and 20 years who have used cannabis in the past year have driven under the influence of the drug, a study in Addictive Behaviors has found. Overall, more people in this age group reported driving under the influence of cannabis than under the influence of alcohol.

Christopher P. Salas-Wright, Ph.D., M.S.W., M.A., of Boston College and colleagues examined data from 12,863 drivers aged 16 to 20 years who participated in the 2020 and 2021 National Survey on Drug Use and Health.

Overall, 6.27% of the participants reported driving under the influence of cannabis and 2.63% reported driving under the influence of alcohol in the past year; 1.83% reported both behaviors in the past year.

Among participants who reported past-year cannabis use, 24.46% reported driving under the influence of the drug in the past year as well. Among participants who reported past-year alcohol use, 6.1% reported driving under the influence of alcohol as well. Among participants who reported using both cannabis and alcohol in the past year, 8.41% reported driving under the influence of cannabis and alcohol in the past year as well.

White participants were more likely than Black and Latinx participants to report driving under the influence of cannabis. However, there were no differences among different racial groups in terms of driving under the influence of alcohol.

“These estimates translate to more than a million young people each year who are taking part in illegal behaviors that risk putting their lives and the lives of others in serious danger,” Salas-Wright and colleagues wrote. “In all, [the] findings make clear that [driving under the influence] is by no means limited to adults and underscore the importance of prevention efforts targeting teen and underaged cannabis and alcohol misuse and impaired driving.”

For related information, see the Psychiatric News article “Experts Clear the Smoke on Cannabis Use Disorder.”

07/06/2023

American Psychiatric Association
Psychiatric News Alert
The Voice of the American Psychiatric Association and the Psychiatric Community

Stimulant Treatment in Youth Not Associated With Substance Use Later in Life

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are treated with stimulants do not have an increased risk of frequent alcohol, ma*****na, cigarette, or other substance use later in life, according to a study published yesterday in JAMA Psychiatry.

“Childhood [ADHD] carries risk for elevated substance use and substance use disorder (SUD) by adulthood,” wrote Brook S.G. Molina, Ph.D., of the University of Pittsburgh and colleagues. Because stimulant medications decrease impulsivity in patients with ADHD, some researchers believe the medications decrease substance use in these patients, they continued. “However, early exposure to stimulants may cause neurobiological and behavioral sensitization to other drugs and thus increase the risk for harmful substance use.”

Molina and colleagues used data from the Multimodal Treatment Study of ADHD, a 14-month randomized clinical trial of medication and behavior therapy. Participants aged 7 to 9 years who were diagnosed with ADHD were randomly assigned to one of four treatment groups: medication management, multicomponent behavior therapy, a combination of the two, or referral to usual community care. Participants were assessed prior to randomization, at months three and nine, and at the end of treatment. They were then followed for 16 years and were assessed at years 2, 3, 6, 8, 10, 12, 14, and 16.

During the 12-, 14-, and 16-year follow-ups, the participants completed a questionnaire on their use of alcohol, ma*****na, ci******es, and several illicit and prescription drugs. Information on the participants’ stimulant treatment was collected via the Services for Children and Adolescents Parent Interview until the participants reached the age of 18 years; after age 18, the participants reported on their stimulant treatment.

A total of 579 participants were included in the analysis. Substance use increased steadily through adolescence and remained stable through early adulthood. After accounting for developmental trends in substance use through adolescence into early adulthood, there was no association between current or prior stimulant treatment and substance use. Further, there was no evidence that a longer duration of stimulant treatment was associated with less substance use in adulthood. However, while cumulative stimulant treatment was associated with increased heavy drinking, the authors noted that the effect size of this association was small.

The authors concluded that their study “failed to support any hypotheses of substance use protection or harm from stimulant treatment for ADHD.”

They continued: “Although these results contrast with recent conclusions of protection found in other data sets, across all studies the findings lend a measure of comfort in the consistent lack of evidence that stimulant treatment predisposes children with ADHD to later substance use.”

For related news, see the Psychiatric News article “Symptoms, Impaired Function of ADHD Often Persist Beyond Childhood.”

06/29/2023

Medical, Recreational Ma*****na Legalization Associated With Higher Rates of Youth Su***de, Study Shows

Female youth aged 12 to 24 and youth of both s*xes aged 14 to 16 living in states with legalized medical ma*****na or recreational ma*****na between 2000 and 2019 had higher rates of death by su***de than youth in states with no such laws, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

These effects remained significant after controlling for a wide array of possible confounding variables and employing statistical analysis to examine the effect of other state-level variables that might influence su***de rates. The findings translate to nearly 5,000 excess su***de deaths of female adolescents and young adults related to medical ma*****na and recreational ma*****na legalization in the study period, noted lead author Christopher J. Hammond, M.D., Ph.D., of Johns Hopkins University School of Medicine, and colleagues.

“Given dramatic shifts in cannabis policy over the past 20 years, it is important for clinicians and policymakers to understand potential downstream public health outcomes related to changing cannabis policy,” they wrote.

The researchers analyzed data on su***de rates using the 2000-2019 National Vital Statistics System Multiple Cause of Death files for age groups 12-13, 14-16, 17-19, 20-22, and 23-25. Depending on the year of death and state (since many states changed their cannabis laws during this time), the decedents were characterized as having lived in a state with medical ma*****na legalization (MML), recreational ma*****na legalization (RML), or no ma*****na legalization (no ML). By 2019, 23 states had MML, and 10 states and D.C. had RML; all remaining states did not enact ma*****na legalization.

The final analysis included 113,512 su***de deaths, corresponding to an unadjusted annual rate of 10.93 per 100,000 people. Hammond and colleagues found that across all ages, female youth who lived in MML and RML states had a 10% and 16% greater risk for su***de, respectively, compared with those who lived in no ML states. There was no elevated su***de risk in male youth overall in RML and MML states, and in fact the analysis suggested a 3% decreased risk of su***de for male youth in effective MML states compared with no ML states.

When examining individual age brackets, the researchers found that male youth aged 14 to 16 living in RML states had a 15% higher risk of su***de compared with male youth in MML states. When data on both s*xes were combined, youth aged 14 to 16 in RML states had an increased su***de risk ranging from 9% to 14% compared with same-age youth living in states with MML or no ma*****na legalization, respectively.

The authors emphasized that the study is limited in its ability to explain the mechanism for increased youth su***de and ma*****na legalization.

“Mechanisms through which MML and RML are related to su***de risk in female youth and younger-aged adolescents warrant further study and should be used to reform cannabis legislation with the goal of mitigating risk for vulnerable subgroups,” they wrote. “Over the past two decades, U.S. cannabis policy has been primarily profit driven. Shift to a public health-centric approach is needed.”

For related information see the Psychiatric News article “Ma*****na: Dangerous for Developing Brain”.

05/02/2023

Sleep Problems in Late Childhood, Early Adolescence Linked to Psychiatric Symptoms

Children aged 9 to 13 who experience sleep problems may be more likely to experience internalizing symptoms (such as depression and anxiety) and/or externalizing symptoms (such as aggression and rule-breaking behaviors) than children who do not experience sleep problems, according to a report in JAMA Psychiatry.

“Our findings emphasize the need for early identification and treatment of sleep problems in childhood to ameliorate or potentially prevent mental health difficulties in early adolescence,” wrote Rebecca Cooper, M.P.O., and Vanessa Cropley, Ph.D., both of the University of Melbourne, and colleagues.

The researchers analyzed data collected from 10,313 participants whose caregivers completed the Sleep Disturbance Scale for Children (SDSC) as part of the Adolescent Brain Cognitive Development (ABCD) Study when the youth were between the ages of 9 and 11 years and again two years later. Using the SDSC, the caregivers were asked about the youth’s experiences over the prior six months with such sleep problems as sleepwalking, nightmares, night sweats, sleep breathing disorders, troubles falling and/or staying asleep, and more. The caregivers also completed the 113-item Child Behavior Checklist, which asked about any internalizing or externalizing symptoms displayed by the youth in the previous six months.

The children were then categorized into four sleep disturbance profiles at baseline and at two-year follow-up:

Low disturbance (25.2% at baseline; 30.3% at follow-up).
Sleep onset/maintenance problems (16.0% at baseline; 32.6% at follow-up).
Moderate and nonspecific disturbance, or “mixed disturbance” (42.3% at baseline; 22.1% at follow-up).
High disturbance (16.5% at baseline; 15.0% at follow-up).
Compared with youth in the low sleep disturbances group, those who reported greater sleep problems had a greater risk of both internalizing and externalizing symptoms at baseline and at the two-year follow-up than those in the low disturbance profile. For instance, those in the high disturbance profile were 1.44 times more likely to experience internalizing problems and 1.24 times more likely to have externalizing symptoms than children in the low disturbance profile.

“[T]he strongest associations were observed for somatic distress, with an approximate 60% increase in symptom severity between the low disturbance and high disturbance profiles,” Cooper and Cropley wrote. “Clinically, these findings underline the importance of routine assessment and management of both sleep and psychopathology symptoms in youth, with special emphasis on symptoms of somatic distress.”

They concluded, “Follow-up of individuals in each of the sleep profiles will elucidate the developmental trajectory of different sleep problems into mid and late adolescence and their prospective association with later mental health outcomes.”

For related information, see the Psychiatric News article “Studies Highlight Impact of Sleep on Mental Health of Youth.”

12/07/2022

Limiting Consumption of Ultra-processed Foods May Help Slow Cognitive Decline, Study Suggests

People who consume more than 20% of their total daily calories in ultra-processed foods may experience faster cognitive decline than adults who consume fewer ultra-processed foods daily, a study published yesterday in JAMA Neurology suggests. Ultra-processed foods include cookies and cakes, diet and regular soda, processed meats, frozen meals, and more.

“Our findings are in line with previous studies linking consumption of [ultra-processed foods] and adverse health outcomes, such as the increased risk of overweight and obesity, metabolic syndrome, cancer, cardiovascular diseases, and all-cause mortality,” wrote Natalia Gomes Gonçalves, Ph.D., of the University of São Paulo Medical School in Brazil and colleagues.

The researchers analyzed data collected from participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). Public servants aged 35 to 74 years from six Brazilian cities were recruited for the study and followed up in three waves, approximately four years apart, from 2008 to 2017. Upon enrollment in ELSA-Brasil, these participants were asked about their food and drink consumption over the last 12 months using a validated Food Frequency Questionnaire. The researchers classified the participants’ consumption of foods and beverages into three categories, according to the extent of industrial processing:

Unprocessed or minimally processed foods (for example, fresh or frozen fruits and vegetables and grains) and processed culinary ingredients (for example, table sugar, oils, and salt)
Processed foods, which are manufactured using unprocessed or minimally processed foods (for example, canned fruits and smoked meat)
Ultra-processed foods, which are formulations of processed culinary ingredients with food additives not used in home preparations, such as flavors, colors, sweeteners, emulsifiers, and other substances
The ELSA-Brasil study participants received multiple cognitive assessments over the follow-up period. These tests included evaluating the participants’ immediate recall, late recall, word recognition, and semantic and phonemic verbal fluency.

Gomes Gonçalves and colleagues focused their analysis on 10,775 adults (mean age of 52 years, 53% White, and nearly 57% with at least a college degree). After a median follow-up of eight years, participants who reported consumption of ultra-processed foods of more than 19.9% of daily calories at baseline had a 28% faster rate of global cognitive decline compared with those who reported consumption of ultra-processed foods less than 19.9% of daily calories, Gomes Gonçalves and colleagues reported.

“Limiting [ultra-processed food] consumption, particularly in middle-aged adults, may be an efficient form to prevent cognitive decline,” Gomes Gonçalves and colleagues wrote. “Future studies investigating the mechanism by which [ultra-processed food] may lead to cognitive decline are needed, as well as confirmation of our findings in other longitudinal studies and randomized clinical trials.”

10/03/2022

Antidepressant Use During Pregnancy Not Associated With Neurodevelopmental Risk in Children

Children who were exposed to antidepressants in the womb do not appear to have an increased risk of neurodevelopmental disorders, according to a report published today in JAMA Internal Medicine.

Elizabeth Suarez, M.P.H., Ph.D., of Harvard Medical School and colleagues used national public and private health insurance databases to compile information on mothers who filled a prescription for an antidepressant medication during the second half of pregnancy (a period of marked fetal brain development). The total sample included over 145,000 women who took an antidepressant during the second half of pregnancy and over 3 million who did not. The children of these women were tracked from birth until they were diagnosed with a neurodevelopmental disorder, died, disenrolled, or reached age 14.

The researchers specifically focused on the rates of the following neurodevelopmental disorders in the children: autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorder, speech or language disorder, developmental coordination disorder, intellectual disability, and behavioral disorder.

Overall, children who were exposed to any antidepressants had a 1.76-fold increased risk of being diagnosed with any neurodevelopmental disorder; this risk was similar regardless of the class of antidepressants taken by the mother (selective serotonin reuptake inhibitors, serotonin norepinephrine uptake inhibitors, and tricyclics), Suarez and colleagues reported. The risk of neurodevelopmental disorders in the children was also similar when limiting the comparison to those whose mothers took sertraline, fluoxetine, bupropion, citalopram, or escitalopram.

However, when the researchers adjusted for multiple variables, including the maternal mental health diagnoses, sociodemographic factors, and lifestyle behaviors (such as smoking and drinking), they found that the neurodevelopmental risk associated with antidepressants dropped to 1.15-fold increased risk of any disorder. The risk was even lower when comparing women who took antidepressants during pregnancy with women who stopped taking antidepressants shortly before pregnancy.

Finally, Suarez and colleagues compared families in which some siblings had been exposed to antidepressants while others had not. There was no evidence of increased risk from antidepressant exposure for any neurodevelopmental disorder when comparing these groups, they reported.

“The results of this cohort study suggest that antidepressant use in pregnancy itself does not increase the risk of neurodevelopmental disorders in children,” Suarez and colleagues concluded. “However, given strong crude associations, antidepressant exposure in pregnancy may be an important marker for the need of early screening and intervention.”

09/13/2022

Exposure to Cannabis in Womb Associated With Behavioral Issues in Tweens, Study Finds

Children who were exposed to cannabis in the womb appear to be at a heightened risk of behavioral problems into at least early adolescence, suggests a report published Monday in JAMA Pediatrics. The findings—which are based on data collected as part of the Adolescent Brain and Cognitive Development Study (ABCD Study)—add to a growing body of evidence about the risks of cannabis use during pregnancy.

According to a media release from the National Institute on Drug Abuse, cannabis use among pregnant women increased from 3% in 2002 to 7% in 2017. In 2018, 4.7% of pregnant women reported cannabis use; 5.4% reported cannabis use in 2019.

A 2020 study by Ryan Bogdan, Ph.D., of Washington University in St Louis and colleagues found that children whose mothers used cannabis after learning they were pregnant were slightly more likely to have sleep, attention, and social problems at ages 9 and 10, among other issues. To determine if these associations remained as the children grew older, David A.A. Baranger, Ph.D., Bogdan, and colleagues followed up with these youth one and two years later. (As was done in the 2020 study, children and caregivers provided feedback on the Child Behavior Checklist and the Prodromal Questionnaire–Brief Child Version.)

The analysis included 10,631 individuals and 30,091 longitudinal assessments (baseline: n = 10,624; mean age, 9.9 years; one-year follow-up: n = 10,094; mean age, 10.9 years; two-year follow-up: n = 9,373; mean age, 12.0 years). The analysis revealed no significant changes in the rate of psychiatric conditions as the children aged.

“[Prenatal cannabis exposure] is associated with persisting vulnerability to broad-spectrum psychopathology as children progress through early adolescence,” Baranger and colleagues wrote. “Increased psychopathology may lead to greater risk for psychiatric disorders and problematic substance use as children enter peak periods of vulnerability in later adolescence.”

For related information, see the Psychiatric News article “Exposure to Alcohol, Cannabis in Womb Can Have Long-Term Consequences.”

07/26/2022

American Psychiatric Association
Psychiatric News Alert
The Voice of the American Psychiatric Association and the Psychiatric Community

Youth Who Transition to Another Gender Not Likely to Transition Back, Study Finds

Youth who socially transition to a gender other than the s*x they were assigned at birth are likely to continue identifying as that gender five years later, according to a study published in Pediatrics.

“These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way,” wrote Kristina Olson, Ph.D., of Princeton University and colleagues. “Nonetheless, understanding retransitions is crucial for clinicians and families to help make them as smooth as possible for youth.”

Olson and colleagues used data from the Trans Youth Project, a longitudinal study involving 317 youth aged 3 to 12 years old. All participants were recruited between July 2013 and December 2017. Prior to joining the study, the youth had to have socially transitioned to a gender other than their s*x assigned at birth—a process that typically involves changing their pronouns, first names, hairstyles, and clothing.

The authors used reports from youth and their parents to determine whether the youth retransitioned (meaning they transitioned again after their initial transitions) or if they continued to identify as their transitioned gender several years later. Participants were classified into three categories based on the pronouns they used: binary transgender (the child identified as the transitioned gender), nonbinary (the child used they/them pronouns), or cisgender (the child again identified as the s*x they were assigned at birth).

An average of 5.37 years after their initial transitions, 94% of participants were living as binary transgender, 2.5% identified as cisgender, and 3.5% identified as nonbinary. The rate of retransitions among the participants was 7.3%, and four participants (1.3%) had retransitioned twice, to a nonbinary then back to transgender. Most retransitions occurred before the youth reached age 10. Youth who initially socially transitioned before age 6 were more likely to be living as cisgender five years later compared with youth who transitioned at age 6 or later.

Concerns that youth will experience regret after transitioning, particularly after starting hormone therapy, has led some physicians and even legislatures to question the ability of minors to consent to gender-affirming treatment, wrote Christina Roberts, M.D., M.P.H., of Children’s Mercy in Kansas City in an accompanying editorial. The “stability of transgender identity” five years after the initial transition, as evidenced in Olson’s study, should reassure physicians when recommending gender-affirming treatment, Roberts wrote.

She continued: “The low risk of regret should also inform the actions of legislators attempting to substitute their judgment for the judgment of patients, parents, and providers by denying transgender adolescents access to this evidence-based and potentially life-saving treatment.”

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