Friday Factoid- Rising Mortality Rates for Middle-Aged White Americans

Case and Deaton (2015), both economists from Princeton, found that mortality rates for middle-aged white Americans have risen since 1999. In contrast, the death rate for middle-aged blacks and Hispanics continued to decline during the same period, as did death rates for younger and older people of all races and ethnic groups. They analyzed health and mortality data from the Centers for Disease Control and Prevention and other sources.

 

First, the authors ruled out an increase in deaths from chronic diseases such as heart disease, cancer, and diabetes. Those numbers were all either stable or trending downward. Murder and accidents were also declining. The authors concluded the rising annual death rates among this group are being driven by an epidemic of suicides. Most of the drug-related deaths in America are now caused by prescription medicines, and nearly three-quarters of those deaths are from opioid painkillers. Reliance on opioid painkillers is an epidemic that started in the late 1990s. Chronic liver diseases related to drug and alcohol use in this group were also on the rise.

 

Studies have found white patients with pain are more likely to be prescribed opioid painkillers. And whites have been more likely to attempt suicide when faced with physical or mental hardships. The New York Times reported 90 percent of people who tried heroin in the last decade were white. Drug addiction in black communities ultimately resulted in mass incarceration, while heroin and prescription drug abuse has been met with a more sympathetic approach, possibly because its victims are white. The only other time that death rates increased among middle-aged whites in the last century was in the 1960s because of smoking-related diseases. There was also a spike in mortality among younger adults in the 1980s during the AIDS epidemic.

 

One possible factor behind the substance abuse is this demographic group has faced a rise in economic insecurity over the past decade, driven by things like the financial crisis and the collapse of manufacturing. Education is also a factor. The effect was largely confined to people with a high school education or less. In that group, death rates rose by 22 percent while they actually fell for those with a college education. Mortality among the middle-aged population plummeted in the six other countries that the authors examined: Australia, Canada, France, Germany, United Kingdom, and Sweden. Although these countries also had economic problems in recent years, its residents might have been less affected because they have more social safety nets in terms of unemployment benefits and health care.

 

References:

 

Case, A. & Deaton, A. (2015) Rising morbidity and mortality in midlife among non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences. Retrieved from http://www.pnas.org/content/early/2015/10/29/1518393112.full.pdf

 

Gold, A. (2015, November 4). Why is death rate rising for white, middle-aged Americans? BBC News, Washington. Retrieved from http://www.bbc.com/news/world-us-canada-34714842

 

Kolata, G. (2015, November 2). Death Rates Rising for Middle-Aged White Americans, Study Finds. The New York Times. Retrieved from http://www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-aged-white-americans-study-finds.html

 

Storrs, C. (2015, November 4). Death rate on the rise for middle-aged white Americans. Retrieved from http://www.cnn.com/2015/11/03/health/death-rate-middle-age-white-americans/

 

 

Jonathan Torres, M.S.

WKPIC Doctoral Intern

Friday Factoids: Psychedelic-Assisted Therapy a Paradigm Shift in Mental Health?

In 1938, Albert Hoffman synthesized lysergic acid diethylamide (LSD). After accidentally ingesting it in 1943 he deemed it the “medicine of the soul.” Psychedelic drugs carry a stigma and it is easy to have very different views about them. Some have long claimed that, when taken responsibly and with the proper supervision, psychedelics like LSD and psilocybin are safe to consume. These drugs were researched extensively in the 1950s and 1960s, but funding stalled when the substances were classified as dangerous and lacking medical value. The Controlled Substance Act of 1970 classified psilocybin, LCD, and MDMA as Schedule 1 substances, which is defined as having “no currently accepted medical use and a high potential for abuse.” Interestingly, approximately 0.005% of emergency department visits in the US involve LSD or psilocybin according to the US Department of Health and Human Services.

A growing body of evidence is beginning to show that psychedelics have therapeutic potential beyond what pharmaceutically made prescription drugs can do. A recent article published in the Journal of Psychopharmacology highlights the potential of LSD, psilocybin, and MDMA for treating a wide range of mental illnesses. Several other studies have shown positive results can come from short courses or single sessions of psychedelic-assisted psychotherapy. A study conducted for cigarette smoking at Johns Hopkins had a very high success rate with 80% of people was abstinent after six months after using psilocybin. A pilot study found a strong affect with alcoholism as well. In 2014, Swiss researchers studied the therapeutic benefits of LSD-assisted therapy in reducing anxiety in 12 patients who had been diagnosed with life-threatening illnesses. One year later, nearly all patients showed sustained reductions in anxiety with no adverse reactions. Lastly, one pilot study on 19 participants with drug-resistant PTSD showed a “significant and sustained-reduction in PTSD symptoms” in 83% of those given MDMA-assisted therapy.

The data suggest it’s the nature of the subjective experience that one has while under the effects of the substances that make psychedelics affective. Gasser P, Kirchner K, & Passie T (2015) study found the following:

Evaluations of subjective experiences suggest facilitated access to emotions, confrontation of previously unknown anxieties, worries, resources and intense emotional peak experiences. The experiences created led to a restructuring of the person’s emotional trust, situational understanding, habits and worldview.

Johansen and Krebs (2015) wrote:

Psychedelics are not known to harm the brain or other body organs or to cause addiction or compulsive use; serious adverse events involving psychedelics are extremely rare. Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure.
Continued research into psychedelic drugs may one day offer new ways to treat mental illness and addiction. The emerging paradigm shift of psychedelics in a therapeutic setting may open new doors.


References:

Gregoire, C. (2015, September 16). Psychedelics Could Trigger A ‘Paradigm Shift’ In Mental Health Care. The Huffington Post. Retrieved from http://www.huffingtonpost.com/entry/psychedelics-mental-health-care_55f2e754e4b077ca094eb4f0

Johansen, P. and Krebs, T. (2015). Psychedelics Not Linked to Mental Health Problems or Suicidal Behavior: A Population Study. Journal of Psychopharmacology. 1-10. doi: 10.1177/0269881114568039

Gasser P, Kirchner K, & Passie T (2015). LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: a qualitative study of acute and sustained subjective effects. Journal of Psychopharmacology, 29 (1), 57-68

Rivas, A. (2015, March 15). Psychedelics May Improve Mental Health Disorder, But We’ll Have to Support the Research to Find Out. Medical Daily. Retrieved from http://www.medicaldaily.com/psychedelics-may-improve-mental-health-disorders-well-have-support-research-find-out-325780

Jonathan Torres, M.S.
WKPIC Doctoral Intern

Friday Factoids: Challenges in Serving Rural Areas

Mental health disorders cause more disability and suffering in rural areas of our country. The presence of high rates of depression, domestic violence and child abuse creates increased risk for behavioral health issues. In addition, rural areas have higher rates of abuse of alcohol, tobacco, opiates, meth, inhalants, marijuana and cocaine. Suicide attempts and deaths by suicide occur more often in rural settings, with the rate of deaths by suicide running as much as 300% higher than an equivalent urban sample in some areas. Reasons for these disparities are certainly complex, but can be summarized under three primary categories: accessibility of mental health treatment, availability of services, and the acceptability of receiving services in rural culture.

 

Accessibility to services is a complex problem that rural health providers are attempting to address. Rural residents are likely to live further apart from one another, further away from services, and have less access to transportation. Telehealth is one recent technique being used to address some of these issues but it must be considered that due to the higher poverty levels in rural areas, some people may not have access to the technology required to receive telehealth in their home. The prevalent rates of domestic violence could provide a significant barrier for the use of telehealth in such situations. Many community mental health agencies provide i- school services in order to overcome some accessibility problems. Additionally, some rural mental health centers are creating “hubs” for telehealth services, but continue to struggle with transportation to get patients in need to these hubs for sessions.

 

The availability of services is limited in rural areas. A major problem in service provision is a relatively low number of doctoral level psychologists, coupled with high turn-over rates for any degreed professional attempting to practice in rural areas. Structured treatment locations are even more limited. Treatment centers for substance abuse or inpatient mental health can frequently be 1-4 hour commutes each way, and the lack of the availability of services closer to home may create an unbearable financial hardship due to time away from work, transportation costs, and childcare. Additionally, rural residents may have been aware of their behavioral health difficulties but unable or unwilling to access far away services until a crisis has occurred. This same pattern exists in accessing medical services as well, but less stigma is present in seeking medical versus psychological help. As such, treatment facilities that have a rural catchment area tend to have higher levels of acuity than urban centers, and thus face working with more urgent and challenging patients and conditions with minimal resources.

 

Finally, as mentioned, there is a lower rate of acceptability of mental health services by many rural people. While there have been recent gains made in decreasing mental health stigma, rural areas lag behind urban environments in understanding and accepting mental health issues.

 

A potential solution to some of these troubling difficulties may be integrated health clinics. Since medical services are more socially acceptable to rural residents, why not address accessibility and stigma by providing medical and mental health services under one roof? This lessens the patient’s anxiety about being identified by others within their community as receiving mental health services. Also, since medical and mental health issues interact and tend to exacerbate one another, approaching patients more holistically may serve to decrease both mental health and medical crises, and reduce overall acuity levels.

 

An additional hurdle is that many clinicians lack training in rural cultural competencies. Creative ways of working in rural communities are needed at graduate, practicum, and internship levels—and solutions may vary from community to community, needing specific approaches. Community mental health models that work well in urban environments may not be feasible in rural areas, so clinicians need to take a “troubleshooting” approach in the rural area they wish to serve.

 

Solutions to the barriers to mental health care in rural areas can be identified and developed. Most importantly, all mental health services need to be tailored to the culture and way of life of the rural area being served.

 

References
Smalley, K. B., Rainer, J., & Warren, J. (2012). Rural Mental Health : Issues, Policies, and Best Practices. New York: Springer Publishing Company

 

Rain Blohm, MS
WKPIC Doctoral Intern

 

Friday Factoids: Hoarding Disorder

 

 

Hoarding Disorder (HD) has been in the media spotlight. HD is a new psychiatric diagnosis added to DSM-5 in 2013. I have heard others ask in casual conversation “why would someone do that?” While this may sound like an answerable question to some, research has just begun to touch on the complexities of this disorder.

 

The DSM-5 describes HD as a “persistent difficulty discarding or parting with possessions, regardless of their actual value.” Patients suffering from HD often have co-morbid psychological conditions such as depression, substance abuse, Attention-Deficit/Hyperactivity Disorder (ADHD), obsessive-compulsive personality disorder, and schizophrenia. While middle aged and elderly people are more likely to be diagnosed with HD, many patients report their symptoms began in late childhood or adolescence. Trauma and other significant stress may not be a cause of HD but can significantly exacerbate it. Hoarding seems to follow a pattern of slow and insidious symptoms starting in late childhood, and then accelerating after age 40. Every patient with HD is unique but categories of some items seem to occur more frequently. Paper items such as newspapers, magazines, books and junk mail are frequently stacked in the home. Various types of containers such as food containers, boxes and bins may be present. “Freebie” items are sometimes sought after and stored in excess. Food, clothing and kitchen items are a prevalant category of items. Broken items that a patient with HD feels may be repaired “someday” may be difficult for the patient to part with. Some items pose a higher sanitation and health risk. Rotting food, urine, feces, or used toilet paper may be a primary issue for the patient. Subsets of patients with HD keep large numbers of animals as pets. The patient may feel they are providing adequate care to their pets despite the presence of feces, urine and a large number of animals in poor condition present in the home.

 

While a higher number of patients with HD are identified in urban areas, those in rural environments are more likely to die from problems in their environment. One theory about this disparity is that HD is identified more quickly in urban areas due to the complaints of neighbors regarding sanitation problems. Patients who are residing in a more isolated environment may not come to the attention of authorities until there is EMS contact for fire, injuries from falling items, the patient falling, or other medical crises. Patients with HD report a higher number of chronic medical conditions with less medical care contacts than those of the same age. There seems to be a cluster of medical illnesses occurring at higher rates and younger than average age. Obesity, hypertension (HTN), diabetes, lung disease, and obstructive sleep apnea (OSA) are a cluster of problems that seem to be more prevalant for these patients. Neurological problems such as stroke, dementia, seizure disorder and traumatic brain injury are reported more often by patients with HD. More systemic disease processes such as Systemic Lupus Erythematosus (SLE), and Fibromyalgia seem to be somewhat more prevalant. Researchers have begun to examine the genetics of HD. The presence of HD and Obsessive-Compulsive Disorder (OCD) seem to be more prominent in some families.

 

Treatment of HD has proven difficult for mental health professionals. Research in this area is urgently needed. HD accelerates with age so mental health professionals are likely to see more cases of this disorder as the number of older adults increases. Some patients have poor insight and can seem oblivious to their plight. Many describe themselves as “thrifty” or “saving things” for others should a need arise.  Drastic interventions, like a forced clean-up of the home, have been shown to significantly increase the risk of suicide. Questions linger over what point hoarding behavior may constitute a danger to self, requiring involuntary hospitalization. HD seems to have a very high relapse rate with current treatments of SSRI medications and Cognitive Behavioral Therapy. Case management with routine home visits proved to be of benefit but legal and ethical dilemmas are present in this form of treatment. HD seems to be a condition of equifinality, meaning there are many paths involved in the earlier question of “why someone would do that.”

 

References

Ayers, C. R., Iqbal, Y., & Strickland, K. (2014). Medical conditions in geriatric hoarding disorder patients. Aging & Mental Health, 18(2), 148-151. doi:10.1080/13607863.2013.814105

Bratiotis, C., Steketee, G., & Schmalisch, C. S. (2011). The Hoarding Handbook: A Guide for Human Service Professionals. Oxford: Oxford University Press.

Drury, H., Ajmi, S., Fernandez de la Cruz, L., Nordsletten, A. E., & Mataix-Cols, D. (2014). Caregiver burden, family accommodation, health, and well-being in relatives of individuals with hoarding disorder. Journal of Affective Disorders, 159, 7-14. doi:http://dx.doi.org/10.1016/j.jad.2014.01.023

Saxena, S. (2007). Is compulsive hoarding a genetically and neurobiologically discrete syndrome? Implications for diagnostic classification. The American Journal of Psychiatry, 164(3), 380-384. doi:http://dx.doi.org/10.1176/appi.ajp.164.3.380

Rain Blohm, MS

WKPIC Doctoral Intern

Friday Factoids: The Search for Causation of Autism Spectrum Disorder

 

With the diagnosis of Autism Spectrum Disorder (ASD) on the rise, professionals and parents from all walks of life have been increasingly steadfast and diligent in their research and support for families and people contending with these issues. One of their goals is to find a suitable treatment for the millions who currently experience difficulties, that would greatly reduce or permanently eliminate symptoms of the often debilitating disorder. Another main focus for many is the development of preventative guidelines or an inoculation that would drastically reduce the number of sufferers who develop ASD.

 

To achieve any of these goals, it is imperative that we understand the root cause(s) of ASD. Scientist and medical professionals have been testing hypothesis after hypothesis but have yet to discover the origin of the disorder. Medical Science and families were hopeful when the announcement was made that the prevalence of ASD in the Amish Community was 0%. Unfortunately, we now know this information is inaccurate, but not all hope has been lost. Research data obtained from 1899 Amish children ages 3-21 years was collected. The results proved that the disease does in fact exist in the Amish population at the rate of approximately 1 in 271 children. This is a significantly reduced rate when associated with the national average of 1 in 68 children today in the U.S. It’s a comparison of .0037% to .0147% but what does that mean for explorations of causation?

 

Research into how Amish Communities differ from everyday society is currently being conducted. The lack of radiation, radio waves, and gamma waves is being considered, as well as a comparison of the amount of artificial ingredients, preservatives and hormones added to the processed, manufactured foods ingested by most Americans. Another area being looked at is the number of chemicals we are subjected to through use of common household products including shampoos, household cleaners and pesticides. Since the Amish have no religious objections to vaccines, with many getting them as recommended by the CDC guidelines, inoculations can be ruled out. Future research should test for ASD in remote populations. A comparison can then be made with the percentage of incidence with the data obtained from the Amish Community in hopes of finding a correlation or pattern.

 

Reference
Reynolds, A. (n.d.). Combating Autism from Within: Guess what? The Amish vaccinate! Retrieved September 20, 2015, from http://combatingautismfromwithin.blogspot.com/2008/01/guess-what-amish-vaccinate.html

 

Robinson, J., Nations, L., Suslowitz, N., Curraco, M., Haines, J., & Vance, M. (2010, May 22). Prevalence Rates of Autism Spectrum Disorders Among the Old Order Amish. Lecture presented at International Meeting for Autism Reseach in Franklin Hall B Level 4 (Philadelphia Marriott Downtown, Philadelphia, PA.

 

Crystal K. Bray, BS
WKPIC Doctoral Intern