Category: Mental Health

A new study reveals that cognitive therapy over the phone is just as effective as meeting face-to-face. The research was published September 28, in the journal PLoS ONE.

Researchers at the University of Cambridge together with the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care (NIHR CLAHRC) and NHS Midlands & East also found that providing talking therapy over the phone increases access to psychological therapies for people with common mental disorders and potentially saves the NHS money.

For the study, data from 39,000 patients in seven established Improving Access to Psychological Therapies (IAPT) services (an initiative which aims to expand the availability of psychological therapies) in the East of England were used to compare Cognitive Behavioural Therapy (CBT) delivered face-to-face versus over the phone. For all but an infrequent, identifiable clinical group with more severe illness, therapy over the phone was as effective as face to face, and the cost per session was 36.2% lower.

Patients may be unable to access health services due to transport problems, work commitments and physical disability, among many reasons. So increasing availability of talking therapies over the phone will make mental health services more accessible to patients.

On the back of the study results, NHS Midlands & East has instigated a regional training programme to standardise service delivery and ensure therapists are competent at phone contacts. The training programme has recently been extended into a partnership with a third party organisation.

Professor Peter Jones, Principal Investigator of the study from the University of Cambridge, said: "Providing therapy over the phone will not only help individuals gain much-needed access to mental health treatment, it will provide a more cost effective way of providing these services at a time when everyone is concerned about cutting costs."

Mental health illnesses affect one in four adults in Britain every year. Additionally, the NHS spends more on mental health than it does on cancer, heart disease, stroke and asthma put together (a total of £9.95 billion in 2010-2011), with general practitioners spending more than a third of their time on mental health issues.

NewsPsychology (Oct. 3, 2012) — Mental health workers are more likely to be depressed or anxious when they experience discrimination from their managers than when it comes from patients, a study has found.

Discrimination from the patients’ visitors also causes more distress than discrimination from the patients.

A research team led by Professor Stephen Wood at the University of Leicester’s School of Management looked at the effects of prejudice, including sex, racial and age discrimination, from different groups of people on mental health workers.

The study, funded by the Department of Health’s National Institute for Health and Clinical Excellence, draws on the experience of 1,733 mental health workers in the UK, including doctors, nurses, psychiatrists and support staff. The researchers distributed questionnaires to every worker in 100 wards and 36 outpatient teams, measuring four states of mind: anxiety, depression, emotional exhaustion and job satisfaction. It also looked at whether they had experienced discrimination in the past year, alongside more general questions such as how fair they perceived their organisation to be.

They then used advanced statistical analysis to assess whether workers who suffered discrimination at the hands of four different groups of people — patients, visitors, managers and co-workers — were more or less likely than other workers to have negative feelings.

From the four different discrimination sources, discrimination from managers had the largest impact on the anxiety, depression, emotional exhaustion and job dissatisfaction of the mental health worker. In addition, and perhaps surprisingly, discrimination from patients’ visitors had a larger impact on depression and emotional exhaustion than discrimination from the patients themselves. Discrimination from one’s fellow workers had less effect on any form of distress than that from managers or visitors.

Stephen Wood, Professor of Management at the Leicester School of Management, said: “The finding that managers can distress workers the most can be explained by managers’ large power over staff’s working lives, including their chances of keeping a job and winning promotion. Moreover, workers feel distressed if they feel the organisation employing them is not treating them fairly — and the behaviour of managers is key to this sense of fairness.

“Aggression from relatives and other visitors is, like aggression from managers, viewed as reflecting badly on the procedures and fairness of the organisation. However, aggression from patients is not readily attributed to failings in the organisation.”

The researchers suggest in a paper on the findings that a tightening of policy towards visitors may be desirable, arguing: “The option of permanently excluding them from the premises or involving the police might increase the sense that the organisation is concerned about their staff’s welfare and treats them fairly.”

Professor Wood’s co-authors are Johan Braeken, Professor of Methodology and Statistics at Tilburg University in the Netherlands, and Karen Niven of Manchester Business School.

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The above story is reprinted from materials provided by University of Leicester.

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NewsPsychology (Oct. 3, 2012) — A new Indiana University study is the first of its kind to show it may be possible to improve memory and thought process speed among breast cancer survivors.

Diane M. Von Ah, Ph.D., R.N., assistant professor at the IU School of Nursing and a researcher at the Indiana University Melvin and Bren Simon Cancer Center, and colleagues studied two different treatment options for breast cancer survivors because they often report problems with memory or feelings of mental slowness, which can lead to depression, anxiety, fatigue and an overall poorer quality of life. These symptoms can be severe and may persist after cancer treatment ends.

To date, there have been very few treatment options available for patients to deal with these problems. The IU researchers compared no treatment to two different training programs.

The results, recently published in the journal Breast Cancer Research and Treatment, showed that a memory training program improved memory performance, while a program called Insight, developed by Posit Science, improved both memory performance and the ability and speed in which the survivors processed information.

Memory training, for example, involved teaching participants strategies for remembering word lists, sequences and text material.

Insight is a computer program in which study participants followed a series of progressively more difficult information tasks.

“These results are encouraging in that both training programs led to positive improvements for breast cancer survivors. The results suggest that the Insight program may have a greater impact on these women,” Dr. Von Ah said. “Even though this was the largest cognitive training study in breast cancer survivors, we need to confirm our findings in a larger study.”

The study included 82 breast cancer survivors who reported concerns about their cognitive function, such as poor memory and mental slowness. All of the women had undergone chemotherapy. Each woman completed cognitive assessments prior to, immediately after, and two months after training.

The study was supported by the Robert Wood Johnson Foundation Nurse Faculty Scholar Program, an American Cancer Society Institutional Research Grant, the IU School of Nursing Center for Enhancing Quality of Life in Chronic Illness, and the Mary Margaret Walther Program of the Walther Cancer Institute.

Co-authors included the following IU Simon Cancer Center researchers: Janet S. Carpenter, Ph.D., R.N., and Michael Weaver, Ph.D., R.N., both of the IU School of Nursing; Andrew Saykin, Psy.D., Patrick Monahan, Ph.D., Bryan Schneider, M.D., Fred Unverzagt, Ph.D., and Jingwei Wu, M.S., of the IU School of Medicine; Menggang Yu, Ph.D., of the University of Wisconsin; George Rebok, Ph.D., of Johns Hopkins University; and Karlene Ball, Ph.D., of the University of Alabama at Birmingham.

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The above story is reprinted from materials provided by Indiana University School of Medicine.

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A study of children in the New Bedford, Mass., area suggests that low-level prenatal mercury exposure may be associated with a greater risk of attention-deficit/hyperactivity disorder (ADHD)-related behaviors and that fish consumption during pregnancy may be associated with a lower risk of these behaviors, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

ADHD is one of the most common neurodevelopmental disorders of childhood and affects 8 percent to 12 percent of children worldwide, although its cause is not well understood. The developmental neurotoxicity of mercury is known, but the findings from epidemiological studies are inconsistent with some studies showing associations between mercury exposure and ADHD-related behaviors and others reporting null associations, according to the study background.

Nonoccupational methylmercury exposure comes primarily from eating fish, and the U.S. Environmental Protection Agency and the U.S. Food and Drug Administration have recommended pregnant women limit their total fish intake to no more than two, six-ounce servings per week. However, fish is also a source of nutrients, such as omega-3 fatty acids, which have been shown to benefit brain development, potentially confounding mercury-related risk estimates, the study background also indicates.

Sharon K. Sagiv, Ph.D., M.P.H., of the Boston University School of Public Health, and colleagues analyzed data from the New Bedford birth cohort, a group of infants born between 1993 and 1998, to investigate the association of peripartum maternal hair mercury levels (n=421) and prenatal fish intake (n=515) with ADHD-related behaviors at age 8 years.

"In this population-based prospective cohort study, hair mercury levels were consistently associated with ADHD-related behaviors, including inattention and hyperactivity/impulsivity. We also found that higher prenatal fish consumption was protective for these behaviors," the authors comment.

Statistical analysis indicates mercury exposure appeared to be associated with inattention and impulsivity/hyperactivity and some outcomes had an apparent threshold with associations at 1 μg/g (microgram/per gram) or greater of mercury. For example, at 1 μg/g or greater, the adjusted risk ratios for mild/markedly atypical inattentive and impulsive/hyperactive behaviors were 1.4 and 1.7 respectively, according to the study results.

There also appeared to be a "protective" (lower risk) association for fish consumption of greater than two servings per week with ADHD-related behaviors, particularly impulsive/hyperactive behaviors (relative risk = 0.4), the study results show.

"In summary, these results suggest that prenatal mercury exposure is associated with a higher risk of ADHD-related behaviors, and fish consumption during pregnancy is associated with a lower risk of these behaviors," the authors conclude. "Although a single estimate combining these beneficial vs. detrimental effects vis-à-vis fish intake is not possible with these data, these findings are consistent with a growing literature showing risk of mercury exposure and benefits of maternal consumption of fish on fetal brain development and are important for informing dietary recommendations for pregnant women."

Editorial: Attention-Deficit/Hyperactivity Disorder a Preventable Epidemic?

In an editorial, Bruce P. Lanphear, M.D., M.P.H., of Simon Fraser University, Vancouver, British Columbia, Canada, writes: "The study by Sagiv et al, which tested whether prenatal exposure to methyl mercury was associated with the development of ADHD-related behaviors, is an important and rigorously conducted prospective birth cohort study."

"What are the implications of the Sagiv et al study and other research on environmental contaminants and ADHD? First, we can take some comfort in recent legislation to reduce mercury contamination, at least from domestic sources. Second, these studies should spur our efforts to enhance the collection of data needed to calculate national estimates and trends in ADHD," Lanphear continues.

"Third, it is time to convene a national scientific advisory panel to evaluate environmental influences of ADHD and make recommendations about what can be done to prevent it. Fourth, this study and a flurry of new evidence linking environmental contaminants with ADHD reinforce the urgency of revising the regulatory framework for environmental contaminants and toxicants," Lanphear concludes.