Groundbreaking Mental Health Study To Be Repeated 30 Years Later

Article by Denise Davy | CBC News 

A Hamilton study that became the gold standard globally for measuring children’s mental health is being updated and will once again be lead by Hamilton experts. The Ontario Child Health Study was co-authored by the late Dr. Dan Offord in 1983 and found that one in five children has some type of mental health problem. It was the first time that one in five figure had been determined with such comprehensive data. The study involved 3,294 children (ages 4 to 16) from 1,869 families across Ontario.

It also established Canada as a world leader in the study of child health and development and confirmed Hamilton’s place among those experts who were working to pull theissue of children’s mental health out from the shadows.

Mike Boyle, lead investigator, professor in the department of psychiatry and behavioural neurosciences at McMaster UniversitY (Courtesy of McMaster University)

This time the study will be even more ambitious in both the number of children who are involved and the goals. This one will include more than 10,000 children, ages 4 to 18, who are living in Ontario in 7,020 families and 180 neighbourhoods and attending 240 schools throughout the province.

 Has mental illness increased? 

The study will be done in collaboration with Statistics Canada and will look at specific risk factors to children, including increases in family breakdowns as well as the growth of visible minorities and poverty. It will also look at the prevalence of childhood mental disorders such as depression, anxiety and ADHD (Attention Deficit Hyperactivity Disorder) and assess how they may be linked to other health conditions as well as with social and academic difficulties.

Perhaps the most important aspect of the new study is that it will determine if the prevalence of childhood mental disorders increased in the 30 years between 1983 and 2013. Dr. Marie Bountrogianni, Interim Dean at the G. Raymond Chang School at Ryerson University, said the study is important because “it will confirm whether the incidence of mental health problems among children is going up or whether it’s just being reported more often.”

“This is significant because it will shed some new light on the rates. I hear all these stories anecdotally from acquaintances and people around me and it does seem to be going up which concerns me.”

Information will also be collected from parents, teachers, older children, and administrative records from Ontario service providers. Alex Thomson, executive director of Lynwood Services, said he wouldn’t be surprised if the numbers have gone up. “I wouldn’t be surprised if the study confirmed it’s an even bigger issue,” said Thomson.

“This data will help us in terms of what we need to do about about it and how we can help these children.” Several key people from across Canada will be involved in the study, including Ian Manion, executive director from the Centre of Excellence for Children’s Mental Health in Ottawa.

The study will be co-lead by Kathy Georgiades, assistant professor in the department of psychiatry and behavioural neurosciences and also a member of Offord Centre. (Courtesy of McMaster University)

Key investigators

The lead investigator will be Dr. Michael Boyle, who is a professor in the department of psychiatry and behavioural neurosciences at McMaster University and a member of the Offord Centre for Child Studies affiliated with McMaster University and Hamilton Health Sciences.

The study will be co-lead by Kathy Georgiades, assistant professor in the department of psychiatry and behavioural neurosciences and also a member of Offord Centre. Offord was considered one of the world’s leading experts on child development and his study lead to the founding of the Canadian Centre for Studies of Children at Risk at McMaster University. The centre was later renamed in honour of Offord’s commitment to children’s mental health. It was this commitment to helping children that earned him the Order of Canada in 2001.

There were two follow-up studies to the original 1983 study which included the same group of children and were done in 1987 and 2000. At the time of the second follow-up, the children were between 21 and 33 years old. The second follow-up examined the significance of how childhood experiences effected a person when they grew up in terms of how successful they were at work, in their parenting and in social integration.

The new study is being funded by the Canadian Institutes of Health Research.

Article from  CBC News |  Visit UACF

Study of Suicide Motivations to Advance Prevention

From UBC News: A University of British Columbia study sheds important new light on why people attempt suicide and provides the first scientifically tested measure for evaluating the motivations for suicide.

Published in the official journal of the American Association of Suicidology, the work gives doctors and researchers important new resources to advance suicide prevention, improve treatments, and reduce the likelihood of further attempts.

The study finds that suicide attempts influenced by social factors – such as efforts to elicit help or influence others – generally exhibited a less pronounced intnet to die, and were carried out with a greater chance of rescue. In contrast, suicide attempts motivated by internal factors – such as hopelessness and unbearable pain – were preformed with the greatest desire to die.

Prof. David Klonsky

“It may be surprising to some, but focsing on motivations is a new approach in the field of sucide research – and urgently needed, says Prof. David Klonsky”. “Until now, the focus has been largely on the types of people attempting suicide, their demographics, their genetics, without actually exploring the motivations. Ours is the first work to do this in a systematic and comprenhensive way.

The study’s 120 participants were outpatients and undergraduate students who had attempted suicide with “intnet to die” within the past three years.

Lead author Alexis May, UBC Psychology

For the study, participants completed a questionaire related to 10 different motivations for attempted suicide. The resulting questionaire is now available for clinical use. The Inventory of Motivations for Suicide Attempts (IMSA) is the most accurate and first scientifically tested tool for evaluating a person’s motivation for suicide.

Despite massive prevention efforts, suciide rates have increased globally over the past 50 years, with almost one million people taking their lives, annually.

Early Violent Behavior Increases Chance of Post-Diagnosis Violence

From Psychiatric News Alert: Individuals who engage in antisocial behavior before showing symptoms of schizophrenia are more likely to be violent when a first schizophrenia episode occurs, according to a new prospective study reported in JAMA Psychiatry. The study was conducted by Catherine Winsper, Ph.D., and psychiatrist Swaran Singh, M.D., of the University of Warwick in England and colleagues.

The study included 670 young adults being treated for a first episode of psychosis. The subjects were divided into four groups depending on whether they had engaged in antisocial behavior before their first psychotic episode or not, and if so, to what degree. The researchers then followed up to see which subjects committed violence and  compared the four groups regarding their antisocial behavior histories. Subjects who had engaged in moderate or high levels of antisocial behavior on a regular basis before their first psychotic episode were four times as likely to engage in violence as were subjects who had engaged in little or no antisocial behavior before experiencing their first psychotic episode.

Said Paul Appelbaum, M.D., former APA president, the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University, and chair of the APA Committee on Judicial Action, to Psychiatric News:

“These data have implications for violence prediction and treatment in patients with schizophrenia [and] suggest that treatment targeting psychotic symptoms in higher-risk patients may not be enough to prevent violent behavior—interventions aimed specifically at propensities for violence may be needed as well.”

According to Thomas McGlashan, M.D., professor of psychiatry at Yale University and an expert on the prodromal phase of schuzophrenia:

“Simply put, these data point out that youth with a history of delinquent behaviors and a vulnerability for psychosis are clearly at risk for behaving violently once that vulnerability becomes expressed as a first episode of schizophrenia. For this sub-sample of young people, early detection and intervention at the pre-onset of prodromal phase of the disorder may be doubly protective by preventing not only the onset of psychosis, but also the perpetration of any associated…antisocial behaviors.”

More information about the link between antisocial behavior, violence, and psychosis can be found in the Psychiatric News articles “High Rates of Mental Illness Associated With Gang Membership” and “Threat Delusions Linked to Violence in First Episode Psychosis.”

Study: Cognitive Restructuring Helps Prevent Depression in At-Risk Teens

(From Psychiatric News Alert) A cognitive-behavioral prevention program, when compared with usual care, showed significant sustained effects in preventing depression in teens at high risk for depressive illness, said William Beardslee, M.D., a professor of child psychiatry at Harvard Medical School, and colleagues in JAMA Psychiatry.

The study included teens that were (a) offspring of parents with current or past depressive disorders, and (b) had themselves present or past depressive symptoms. The teens were randomly assigned to either (1) usual care, or (2) a cognitive-behavioral prevention (“CBP”) program. The CBP program involved eight weekly group sessions and six monthly group booster sessions, in which the teens learned how to deal with negative or unrealistic thoughts. The subjects were evaluated for depression at intervals over 33 months. Over the period, and for the sample as a whole, the intervention was significantly effective, with 37% of the teens in the CBP group experiencing a depression, compared with 48% in the usual-care group.

“We were quite pleased that the effects noted in our earlier analysis nine months after enrollment were sustained at 33 months, as it is difficult to demonstrate longer-term prevention effects,” Beardslee told Psychiatric News. At the nine-month follow-up, 21 percent of the teens randomized to the CBP condition had experienced depression, in contrast to 33 percent in the usual-care group.

During the past decade or so, there has been an explosion in mental illness prevention research such as that conducted by Beardslee and his colleagues. See the Psychiatric News article “Future Looks Promising for Mental Illness Prevention” to read more about the research. Also see “Maintenance Cognitive-Behavioral Therapy and Manualized Psychoeducation in the Treatment of Recurrent Depression…” in the American Journal of Psychiatry.

CDC Finds Up to 20% of U.S. Children Have Mental Health Disorders

As many as one in five individuals in the U.S. under the age of 18 experience a mental health disorder each year, and that rate is climbing, according to a CDC report. The CDC report, which is the first comprehensive examination of the mental health of children, found that such illnesses cost about $247 billion annually in decreased productivity, juvenile justice, special education and treatment.

The CDC cites a pair of studies that found mental health disorders among adolescents are on the rise. For instance, one recent study found that hospital stays among children for mood disorders increased from 10 to 17 admissions per 100,000 individuals between 1997 and 2010. Another recent study found admissions from mental-health-substance-use disorders among children increased by 24% from 2007 to 2010.

The report also found that suicide among children was more prevalent in boys than in girls. According to the CDC, 35.5% of children who commit suicide were diagnosed with a mental health disorder when they died, while more than one in four children who died by suicide were being treated for a mental disorder at the time of their death, and 21% had made a previous suicide attempt (Washington Post, 5/19/13). Suicide was the second-leading cause of death among U.S. Children ages 12 to 17 in 2010 (Science Now, Los Angeles Times, 5/17/13).

The problem seems exacerbated by the fact that just 21% of children with mental disorders receive treatment because of a shortage of pediatric sub-specialists and psychiatrists. According to the Washington Post, the shortage has been caused by more children’s mental health providers retiring from the workforce and fewer medical students taking their place.

Short Hospitalizations Found to Be Risk Factor for Readmission of Schizophrenia Patients

From Psychiatric News Alert. Short hospital stays for patients with schizophrenia are associated with risk of early readmission, possibly because the person is insufficiently stabilized, according to a report in Psychiatric Services in Advance. Researchers at the University of South Florida and other institutions used Medicaid and service-use data to identify adults with schizophrenia discharged from hospitals and crisis units who were taking anti-psychotics. Data were extracted on demographic characteristics, service use before admission, psychopharmacologic treatment after discharge, and readmission to acute behavioral health care.

Study subjects had 6,633 inpatient episodes. Readmission occurred for 84 percent of the episodes, 23 percent of them within 30 days after initial discharge. Variables associated with an increased readmission risk in the first 30 days were shorter hospital stay, shorter time on medication before discharge, greater prehospitalization use of acute care, serious general medical comorbidity, and prior substance abuse treatment.

“This finding suggests that some patients may have been discharged before they were sufficiently stabilized,” the researchers said. “Patients with shorter stays and those not sufficiently stabilized on their medication should receive more vigorous discharge planning and follow-up care to ensure smoother transition to treatment in the community.”

Common Genetic Variation May Underlie Different Mental Health Conditions

An international research group has identified a 15% overlap between inherited schizophrenia and bipolar-disorder attributable to common genetic variation. The Cross Disorders Group of the Psychiatric Genomics Consortium published the study online in Nature Genetics August 11.

The group used genomewide-genotype data from thousands of people and compared them with control subjects. Besides the relationship between schizophrenia and bipolar disorder, there was a 10% inheritability overlap between bipolar disorder and depression, a 9% overlap between schizophrenia and depression, and a 3% overlap between schizophrenia and autism. The common genetic variants with small effects revealed in this and related studies will eventually be supplemented by other research on other variations. Study co-leader Naomi Wray, Ph.D., of the University of Queensland in Australia, said in a statement accompanying the study:

“Shared variants with smaller effects, rare variants, mutations, duplications, deletions, and gene-environment interactions also contribute to these illnesses. Since our study only looked at common gene variants, the total genetic overlap between the disorders is likely higher.” 

The study was funded in part by the National Institute of Mental Health. Read more about the work of the Psychiatric Genomics Consortium in Psychiatric News.