In The News
Sadly, close to 300,000 American women are diagnosed with breast cancer each year. For many, initial reactions to learning that they have the illness include fear, anger, and denial.
Unfortunately, the feelings may escalate. Dealing with the psychological fallout of such a diagnosis can be crucial to patients’ physical recovery. As they weigh their medical options, patients also should consider their emotional and mental options.
“Breast cancer is more than skin deep. It’s not just about your external body image. It’s not just about secondary sexual characteristics. It’s not just about breasts. It’s more than that.
“The psyche and the physical body are interconnected, so you really can’t address one and not the other,” said Dr. Georita Frierson, director of Clinical Training for the Clinical Psychology Ph.D. Program at Rowan University, Glassboro, New Jersey.
Frierson believes breast cancer patients should consider the following, based on research she and others have conducted, as they fight their illness:
1. Severe and acute stress may occur at the time of cancer diagnosis.
2. Physical activity can improve mood and other outcomes in breast cancer patients following diagnosis.
3. The acute distress accompanying diagnosis can lead to lower quality of life for cancer patients.
4. Patients with poorer coping at time of diagnosis may report lower meaning in life in the year following the end of cancer treatments.
5. Cancer treatments have the potential to impact intimate relationships.
6. Patients may have body image distress following breast cancer surgeries.
7. Treatment or recovery can disrupt one’s employment, including job loss for some.
8. Distressed individuals can have appetite disturbances and/or dietary changes.
9. The taste of foods may change with stress.
10. Disturbances of taste or eating habits (e.g., food restriction or taste aversions from chemotherapy) can occur in breast cancer patients.
11. Disturbed sleep can occur in breast cancer patients, too.
Frierson has conducted a range of research related to breast cancer and other medical topics including a pilot study of the psychosocial and behavioral outcomes in triple negative breast cancer patients during the first year of treatment.
She has been published in peer-reviewed journals on topics that include evidence-based treatment for cancer patients, emotional and psychosocial consequences of cancer, and physical activity among women treated for breast cancer. She has also contributed chapters to books on racial/ethnic minority health.
Source: Rowan University/Newswise
New research from the UK suggests that if you want to be considered as good-looking, then it is best to hang out with a group of relatively unattractive individuals.
In the study, Royal Holloway University of London investigators discovered judgements of attractiveness vary depending on who is nearby, and how good-looking they are in comparison.
A person will rank higher on a scale of attractiveness when compared alongside less attractive people, than they would when judged alone.
The finding runs counter to common opinion that a person’s perceived level of attractiveness is somewhat fixed. However, the new study shows that context is key to assessing attractiveness.
Dr Nicholas Furl, a psychology professor and author of the study explains: “Rightly or wrongly, the way people look has a profound impact on the way others perceive them. We live in a society obsessed with beauty and attractiveness, but how we measure and understand these concepts is still a grey area.”
He continued, “Until now, it’s been understood that a person’s level of attractiveness is generally steady. If you saw a picture of George Clooney today, you would rate him as good-looking as you would tomorrow. However, this work demonstrates that the company we keep has an effect on how attractive we appear to others.”
The study, published in the journal Psychological Science, demonstrates that how attractive we are is far from static, it can fluctuate. According to the paper, an averagely attractive face surrounded by undesirable faces will become more appealing than it would on its own.
Participants in the study were asked to rate pictures of different faces for attractiveness, one by one. They were then asked to assess the same faces, placed alongside ones perceived to be undesirable. When adding these ‘distractor faces’, the attractiveness of the same faces increased from the first round of ranking.
Participants were then shown two attractive faces, alongside a ‘distractor’ face and asked to judge between them. The presence of the less attractive face was found to make the viewers more critical between the attractive face, as Dr Furl explained:
“The presence of a less attractive face does not just increase the attractiveness of a single person, but in a crowd could actually make us even more choosey! We found that the presence of a ‘distractor’ face makes differences between attractive people more obvious and that observers start to pull apart these differences, making them even more particular in their judgement.”
Furl concluded, “It’s perhaps not too surprising that we are judged in relation to those around us. This is a trope often seen in teen movies and romantic comedies, where a character associates themselves with a less attractive friend to elevate their own dating stakes.
“Last year’s film The Duff, – an acronym for the rather unfortunate and unfair term ‘Designated Ugly Fat Friend’ explored how the main character felt being physically compared to her friendship group. As in life, this film showed that how we perceive beauty and attractiveness isn’t fixed.
There are many other ways in which we decide who we are attracted to. There will certainly be more research in years to come on this complicated area of human interaction, and I am excited to see where this research takes us.”
Source: Royal Holloway
New research suggests having a few drinks when you are down may indeed help your mood.
In the mouse study, investigators found that alcohol produces the same neural and molecular changes as drugs that have proven to be rapidly effective antidepressants.
Wake Forest investigators say the effects are explained by biochemistry.
“Because of the high comorbidity between major depressive disorder and alcoholism there is the widely recognized self-medication hypothesis, suggesting that depressed individuals may turn to drinking as a means to treat their depression,” said the study’s principal investigator, Kimberly Raab-Graham, Ph.D.
“We now have biochemical and behavioral data to support that hypothesis.” This, however, does not at all suggest that alcohol can be regarded as an effective treatment for depression.
“There’s definitely a danger in self-medicating with alcohol,” Raab-Graham said. “There’s a very fine line between it being helpful and harmful, and at some point during repeated use self-medication turns into addiction.”
In their study, Raab-Graham and her colleagues found that a single dose of an intoxicating level of alcohol worked in conjunction with the autism-related protein FMRP to transform an acid called GABA from an inhibitor to a stimulator of neural activity. This amount of alcohol has been shown to block NMDA receptors (proteins associated with learning and memory).
Investigators discovered that these biochemical changes resulted in non-depressive behavior of the mice lasting at least 24 hours.
This study demonstrated that alcohol followed the same biochemical pathway as rapid antidepressants in the animals, while producing behavioral effects comparable to those observed in people.
In recent years, single doses of rapid antidepressants such as ketamine have proven capable of relieving depressive symptoms within hours and lasting for up to two weeks, even in individuals who are resistant to traditional antidepressants.
“Additional research is needed in this area, but our findings do provide a biological basis for the natural human instinct to self-medicate,” Raab-Graham said.
“They also define a molecular mechanism that may be a critical contributor to the comorbidity that occurs with alcohol use disorder and major depressive disorder.”
The study was published in the journal Nature Communications. The research was supported by an National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism pilot grant along with additional grants from the National Science Foundation and other awards.
Source: Wake Forest University
Losing weight is often not as difficult as maintaining the weight loss over time. A new study suggest a new behavioral treatment method can help people lose more weight and keep it off longer than traditional methods.
The new approach is called Acceptance-Based Behavioral Treatment (ABT), a strategy that links the weight loss effort to a larger personal value beyond weight loss for its own sake. This approach was found to help people adhere to diet and physical activity goals better than a traditional approach in a randomized clinical trial.
Traditional weight loss strategies or Standard Behavioral Treatment (SBT) classically encourage reduced caloric intake and increased physical activity.
The study was part of the well regarded Mind Your Health trial, and is one of the first of its kind. Investigators found that participants who received ABT (which includes all behavioral skills taught in SBT) lost 13.3 percent of their initial weight at one year, compared to 9.8 percent weight loss at one year for participants who received SBT only.
This difference represents a clinically significant 36 percent increase in weight lost for those in the ABT group. In addition, the likelihood of maintaining a 10 percent weight loss at 12 months was one-third greater for ABT with a rate of 64 percent versus 49 percent for ABT alone.
As Thomas Wadden, PhD, FTOS, and Robert Berkowitz, MD, FTOS point out in their accompanying commentary, weight loss with ABT is among the largest ever reported in the behavioral treatment literature without use of an aggressive diet or medication.
“We’re excited to share this new proven therapy with the weight-loss community, and in fact this is one of the first rigorous, randomized clinical trials to show that an alternative treatment results in greater weight loss than the gold standard, traditional form of behavioral treatment” continued Forman.
The ABT sessions emphasized the following principles with the participants to achieve adherence to diet and exercise goals in order to lose weight. Principles include:
• Choose goals derived from freely-chosen personal life values, such as living a long and healthy life or being a present, active grandparent.
• Recognize that weight-control behaviors will inevitably produce discomfort (such as urges to eat, hunger, cravings, feelings of deprivation and fatigue) and a reduction of pleasure (such as choosing a walk over watching TV or choosing an apple over ice cream).
• Increase awareness of how cues impact eating and activity-related decision making.
In the study, 190 participants with overweight or obesity were randomly assigned to SBT alone, or ABT (which fused both behavioral skills from SBT with acceptance-based skills). Participants attended 25 treatment groups over a one-year period, which consisted of brief individual check-ins, skill presentations and a skill-building exercise.
All interventionists were doctoral-level clinicians with experience delivering behavioral weight loss treatments.
“These findings are a boon to clinicians, dietitians and psychologists as they add a new dimension to behavioral therapy that can potentially help improve long-term outcomes for people with obesity,” said Steven Heymsfield, MD, FTOS, a spokesperson for The Obesity Society.
“This study is one of the first of its kind, and offers promise of a new tool to add to the toolbox of treatments for overweight and obesity.”
This is the second study of ABT as part of the Mind Your Health trial, and it found an even more pronounced advantage from ABT than the first study. Forman offers several potential explanations, including the use of experienced clinicians and a revised ABT protocol that focuses on general willingness and accepting a loss in pleasure and less on coping with emotional distress, cravings and hunger.
“These are exciting findings for which I congratulate the authors,” said Wadden in an accompanying commentary.
“Like all new findings, they need to be replicated by other researchers before ABT can be considered a reliable means of increasing weight loss with SBT,” he added. Wadden noted that treatment comparison studies of different psychotherapies have shown that when researchers feel strongly that their therapy will work best, it can influence outcomes.
Therefore, Wadden believes future research should be conducted by therapists who did not develop ABT. Additionally, he said, “Future studies of ABT would be enriched by reporting on changes in depression, susceptibility to food cues and motivation for change in both the ABT and SBT groups.
Long-term follow-up after treatment would also be beneficial to determine if ABT improves weight-loss maintenance compared with SBT.”
The study and its accompanying commentary appear in Obesity, the scientific journal of The Obesity Society (TOS).
Source: The Obese Society
UK researchers have discovered that maternal depression in pregnancy increases the risk of behavioral and emotional problems in children.
This association is especially pronounced in low and middle income countries where interventions such as cognitive behavioral therapy, may not be available.
Depression in pregnancy is thought to affect up to one in five women globally in the late stages of pregnancy and shortly after birth. Depression often presents as a low mood and feelings of hopelessness.
Experts believe it can result from a number of factors including life events such as bereavement, and changes in brain chemistry.
Previous work from a team at Imperial College London suggests depression during pregnancy may affect the development of the baby while in the womb, as well as affecting bonding between mother and child after birth.
Now, the same team have shown that depression or anxiety can reduce the enzyme in the placenta that breaks down the “stress hormone” cortisol, possibly causing more fetal exposure to the hormone.
The fetus may also undergo epigenetic changes under stress, where underlying DNA stays the same but expression of that DNA is altered, perhaps affecting mental health during childhood.
Investigators explain that much of the research into depression during pregnancy has focused on high income countries. They now argue that the problem is more common in low- and middle-income countries, and hence more resources are now needed in these areas to help expectant and new mothers.
Researchers believe that research is sorely needed in the less well-to-do countries. In addition to research, investigators believe the development of low cost interventions are urgently needed.
Professor Vivette Glover, co-author of the research from theDepartment of Surgery and Cancer at Imperial, said: “Our review of available literature suggests that treating the depression itself is crucial in reducing the risk to the child, as well as for helping the mother.
“It shows targeting specific symptoms of depression by using cognitive behavioral therapy, for example, can be useful in reducing depression and therefore its effect on the child. However, there is a substantial lack of research specific to women in poorer countries, where interventions such as cognitive behavioral therapy may not be available.”
Professor Glover added that in severely deprived regions where there are wars, political violence, food insecurity, and little help after natural disasters, healthcare workers have little time or resources to meet basic physical needs, let alone mental health ones like maternal depression.
The new review, published in The Lancet Psychiatry, examined studies of mental health in children under five years old in low and middle income countries such as Bangladesh and Brazil.
The report highlights the specific mental health requirements of mothers and children in poorer countries that are not necessarily relevant to high-income countries.
Investigators discovered depression in mothers in low- and middle-income countries is common during and just after pregnancy. Moreover, women are more likely than in richer countries to experience intimate partner violence and have little social support.
Furthermore, unintended pregnancies are more common, as are malnourishment, infections, and crowded living conditions.
A mother’s risk for depression is much greater in less affluent countries as risk factors are often more intense. These factors also intensify one another — for example, a malnourished mother or child may have too weak an immune system to fight an infection, exacerbating the mother’s stress which then contributes to depression.
Maternal depression in these countries is also more likely to result in poor nutrition, increased substance use, inadequate antenatal care, pre-eclampsia, low birthweight, preterm delivery, and suicide.
The authors argue that because of the varying risk factors between different income countries, interventions for poorer countries should focus on the issues that affect these countries specifically.
They add that mitigating the global burden of maternal depression will require a multi-faceted approach that targets child development, poverty, education, health, and prevention of violence in low- and middle-income countries.
Last week in Melbourne, Professor Glover and colleagues launched a new organization, “The Global Alliance for Maternal Mental Health”, which aims to foster more knowledge about these issues, and to generate more resources to tackle them, around the world.
Source: Imperial College London
For many women, menopause is a welcomed stage of life as they are through with childbearing and are ready to end monthly periods and worries about pregnancy.
New research from the University of Michigan, however, finds that women should be careful what they wish for as menopause may be a time of unintended consequences. Specifically, investigators discovered menopause may be prolonged and accompanied by physical and mental health issues.
Researchers from the University of Michigan School of Public Health and Medical School found that women who are younger than 45 when they first notice changes in their monthly cycles and other symptoms can have a longer menopausal transition than those who begin it at age 51 or later.
The length of the transition can be nearly double for younger women than for those who enter the transition later, 8.57 versus 4.37 years.
“The duration of the menopausal transition — the time from when a woman notices a distinct change in the frequency or regularity of her menstrual cycles to the time of her last menstrual period — varies from just a couple of years up to eight to 10 years,” said Sioban Harlow, professor of epidemiology at the University of Michigan School of Public Health.
“Understanding that age at onset of the menopausal transition influences how long the transition will last can help inform women’s health care decisions related to symptom management, contraception, and preventive care.”
Menopausal transition symptoms include irregular periods, mood swings, hot flashes, night sweats, and difficulty sleeping. Some women also suffer from emotional issues, vaginal dryness, and decreased sex drive. Some research suggests long-term health considerations include bone loss and changes in cardiovascular risk.
Researchers followed 1,145 ethnically diverse women participating in the Study of Women’s Health Across the Nation. They tracked their monthly cycles and symptoms from 1996 to 2006. The women were recruited from Boston, southeastern Michigan, Los Angeles, and Oakland, California.
The study found the age-of-onset difference across four racial/ethnic groups: white, Chinese, Japanese, and African-American women. Interestingly, the only difference researchers found among the ethnic groups was that African-American women had a longer transition than white women.
“As the duration and amount of menstrual bleeding increases significantly during the menopausal transition, a longer transition may signify that women with fibroids or with abnormal uterine bleeding may have increased difficulty in coping effectively with their blood loss,” Harlow said.
“This issue may be particularly salient for African-American women who had longer transitions and are also at greater risk of having fibroids.”
The researchers say their findings can inform physicians and their patients about how best to manage the symptoms of menopausal transition. The decision regarding the use of hormones, for instance, is one that women and their doctors wrestle with because the treatments are not without side effects.
“Women with an earlier onset may opt for intervention in anticipation of a longer duration of concerns, whereas women with a later onset may forego therapy with the expectation of a shorter timeframe of change,” said Dr. John Randolph, professor of obstetrics and gynecology at the University of Michigan Health System.
“The relative risks, benefits, and costs of medical therapy versus surgery can be discussed with greater confidence by knowing how long a treatment may be required.”
Also noteworthy in the research is that cigarette smoking was associated with an earlier onset of menopausal symptoms and shorter duration, and obesity was linked to a later start but no difference in duration.
Source: University of Michigan
A new study may have implications across the globe as researchers determined first time users of birth control pills may have an increased risk of depression.
As published in JAMA Psychiatry, researchers discovered the link between a first diagnosis of depression among women in Denmark when beginning hormonal contraception. The link was especially pronounced among adolescents.
Few studies have quantified the effect of low-dose hormonal contraception on the risk for depression. Mood symptoms are known reasons for cessation of hormonal contraceptive use.
Øjvind Lidegaard, M.D., D.M.Sc., of the University of Copenhagen, Denmark, and coauthors used registry data in Denmark for a study population of more than one million women and adolescent girls (ages 15 to 34). They were followed up from 2000 through 2013 with an average follow-up of 6.4 years.
During the follow-up, 55 percent of the women and adolescents were current or recent users of hormonal contraception. There were 133,178 first prescriptions for antidepressants and 23,077 first diagnoses of depression during follow-up.
When compared to nonusers, women who used combined oral contraceptives had 1.23-times higher relative risk of a first use of an antidepressant and the risk for women taking progestin-only pills was 1.34-fold.
Estimated risks for depression diagnoses were similar or lower. The risk for women varied among different types of hormonal contraception.
Some of the highest risk rates were among adolescent girls, who had 1.8-times higher risk of first use of an antidepressant using combined oral contraceptives and 2.2-times higher risk with progestin-only pills.
Adolescent girls who used non-oral products had about 3-times higher risk for first use of an antidepressant. Estimated risks for first diagnoses of depression were similar or lower.
Despite the provocative findings, researchers note that the study has limitations.
“Use of hormonal contraceptives was associated with subsequent antidepressant use and first diagnosis of depression at a psychiatric hospital among women living in Denmark. Adolescents seemed more vulnerable to this risk than women 20 to 34 years old.
Further studies are warranted to examine depression as a potential adverse effect of hormonal contraceptive use,” the authors conclude.
Individuals who experience chronic lack of sleep are at greater risk of becoming overweight and obese, in part because sleep deprivation leads to eating more, making unhealthy food choices and craving high-calorie foods.
In a new study, researchers at Uppsala University investigated how levels of endocannabinoids — which target the same receptors as cannabis — are affected by lack of sleep, and whether acute exercise can modulate this effect. They found instead that exercise tends to increase hunger, even in sleep deprivation, potentially due to its ability to reduce stress.
“Previous studies have shown alterations in the levels of some hunger hormones after sleep loss, but the results have been mixed and hormones that drive hedonic food intake have been less investigated,” says lead author of the new study Jonathan Cedernaes, M.D., Ph.D, at Uppsala University.
“Furthermore, whereas exercise has many beneficial effects, whether exercise can modulate the effects of sleep loss on various hormonal pathways is currently unknown.”
For the study, healthy normal-weight participants stayed in a sleep laboratory on two separate occasions. They were studied after three consecutive nights of normal sleep and after three nights of only sleeping four hours each night. Meals and activity patterns were kept standardized while participants were in the lab, and blood was drawn several times to measure endocannabinoid levels in blood. This was also done on the last day both before and after a short bout of intensive exercise.
The researchers found that the levels of 2-arachidonoylglycerol (2AG) — the most abundant endocannabinoid in the brain — was about 80 percent higher after the nights of short sleep compared with after the normal sleep session. When the participants exercised, the levels of 2AG still went up almost by half, regardless of whether participants had gotten three nights of plenty of sleep or only four hours of sleep each night.
“As previously shown by us and others, sleep loss increased subjective hunger compared with the well-rested state,” said senior author associate professor Christian Benedict. “Given the role of endocannabinoids for promoting hunger and hedonic eating, this could offer an explanation as to why.”
“Meanwhile, we instead saw lower stress ratings after exercise in the sleep deprivation condition, which could also possibly be attributed to the observed endocannabinoid levels following our exercise intervention.”
So even when sleep-deprived, the participants experienced the same amount of increase in endocannabinoid levels just after exercising.
“Endocannabinoids are thought to confer both the “runner’s high” as well as at least some of the neuroprotective effects of exercise. Therefore, this may suggest that even under conditions of chronic sleep loss, exercise may exert similar centrally active, and possibly neuroprotective, properties as under conditions of sufficient sleep,” said Cedernaes.
“This is an important area for future research as we and others have found that short sleep duration by itself may be harmful to the brain, and in the long run increase the risk of e.g. Alzheimer’s disease.”
The findings are published in the journal Psychoneuroendocrinology.
Source: Uppsala University
New research finds that older people are even more willing that young adults to take medical risks if they perceive the benefits to be high enough.
The discovery was surprising as we tend to think that older people are likely to avoid taking risks, especially compared with younger people. Investigators discovered, however, that when confronted with decision on risky medical treatments, such as vaccines and chemotherapy, older people are even more willing than younger adults to take medical risks if the benefits are aligned.
“Given the high financial and personal costs associated with medical-related risk behavior, gaining better insights into adult lifespan changes in medical risk-taking tendencies and perceptions is paramount,” the study authors note.
In the United States, the average 85-year-old spends about $17,000 per year on his or her health, while adults in their 20s spend less than one tenth of that sum, or $1,448.
Despite the growing importance of medical decision-making by the elderly, surprisingly little data exists on how age affects risk attitudes and perceptions in the medical domain.
The “Does Medical Risk-Perception and Risk-Taking Change with Age?” by Yaniv Hanoch of University of Plymouth, Jonathan J. Rolison of the University of Essex, and Alexandra M. Freund of the University of Zurich addresses this information void.
For the study, published in the online version of the journal Risk Analysis, investigators interviewed 317 adults, ages 20 to 77.
Beliefs about the elderly taking fewer risks are based mainly on financial risk-taking studies that do confirm elderly people’s financial risk aversion, say the investigators. However, “Older adults do not seem to be as generally averse to taking risks as that literature on financial risk-taking suggests,” says Dr. Hanoch.
“Instead, when it comes to the essential domain of health or medical decision making, older adults also focus strongly on the benefits of a given procedure.” The findings have important implications for medical decisions by the elderly, Hanoch adds.
When giving such patients medical and health information, “then, of course the potential risks need to be communicated to older patients, but also the potential benefits.”
In their study of age-related differences in risk-taking behavior, the authors gave the participants four different scenarios to read. In the first two scenarios, the authors explain, participants were asked to imagine that their local area had been sealed off due to a highly contagious and deadly flu.
They were then told that either they (Scenario 1) or their child (Scenario 2) had a 10 percent chance (10 of 100 people) of dying from the flu. Next, they were informed that a vaccine had been developed and tested that would prevent them (Scenario 1) or their child (Scenario 2) from contracting the flu with absolute certainty. However, there was a five percent (five of 100 people/children) risk of dying from the vaccine.
After reading the scenarios, participants indicated whether they would accept the vaccine for themselves (Scenario 1) or have the vaccine administered to their child (Scenario 2). A similar design was followed for Scenarios 3 and 4, but the participants were asked to imagine that either they (Scenario 3) or their child (Scenario 4) had been diagnosed with a deadly, slow-growing cancer.
The study also used a psychological measurement instrument, the Domain-Specific Risk-Taking Scale — Medical (DOSPERT-M) to gauge whether a participant would “Immediately go to the doctor’s when something in my body is aching or bothering me.”
The DOSPERT-M recorded responses on a seven point scale ranging from one (very unlikely) to seven (very likely). Results showed that if a participant expected greater benefits they would be more willing to take a risk. Conversely, if they perceived higher risks, they would be less likely to take the risk.
“Our data revealed no age-related differences in medical risk-taking tendencies,” the authors conclude. “This result stands in contrast to the prevailing notion that older adults are more risk averse than younger ones.”
Among other findings, overall, participants were more likely to accept medication (vaccine or chemotherapy) for their child than for themselves. Also, increasing age was associated with a higher likelihood of passive risk taking, whereby older adults avoided options, such as accepting a treatment or vaccine that could lower their chance of dying.
“Taken together, our study provides important insights about changes in medical risk taking across adulthood when people face an increasing number of complex and risky medical decisions,” according to the authors.
A new doctoral dissertation finds that talking about suicide is associated with such strong stigma that young people whose parents have taken their own life often must turn to the internet to express their grief and receive support.
The thesis represents the view of Anneli Silvén Hagström from Linköping University in Sweden. Given that Sweden has a socialist health care system, Hagström laments that the healthcare system is not providing support for young people in the difficult life situation.
However, she admits the root problem is cultural. The topic is relevant as around 1,500 people take their own life in Sweden each year, five times as many as deaths in road accidents in the country. They leave behind relatives, who in many cases are left to cope with their grief on their own.
“If your house is burgled, several organizations whose task is to support the victims of crime may contact you and ask how you’re feeling. But not many people ask how you’re feeling when a parent has taken his or her own life. Nor does the healthcare system, which really should take this up. It’s clear that the system often does not know what young people need,” says Hagström, a social worker who recently received her doctoral degree.
In the paper, Hagström examines how young people in Sweden cope with the suicide of a parent. Hagström takes a unique focus with an analysis of young people’s narratives of the suicide. She did this by performing research interviews, two different chat forums on the internet, and a theatre performance put on by a young woman that deals with her mother’s suicide.
As may be expected, the central element in a person’s grief is the question as to why? The thesis shows that young people become extremely concerned with the question of why their parent died, which is unusual following other causes of death. They wonder about the true identity of the parent and, as an extension of this, their own true identity, as a child of someone who could take their own life.
The study also shows that the stigma associated with suicide is very strong, and this contributes to the difficulty of dealing with the loss. The stigma is reinforced by, for example, people around the young people avoiding them, or by the idea that may reach their ears that the parent who took his or her own life was selfish, leaving the child behind.
These are preconceived ideas that the young people absorb, and adopt as their own. This means that the image of the parent — who has in most cases been a good figure before death — becomes colored by the suicide. The consequence may be, in addition to feelings of shame, guilt, and abandonment, powerful anger targeted against the dead parent.
The young people describe also how they avoid talking about the suicide with people close to them — even in some cases with their family. In order to free themselves and the dead parent from the stigma, they seek actively a space outside of their everyday relationships, which may be on the internet, for example.
“Our refusal to talk about suicide is a cultural problem. What I noticed in the interviews was that the young people eventually reach the conclusion that their parent had not actively chosen to commit suicide, nor had they had the ability to predict the long-term consequences.
“The young people were able to start to reach an alternative understanding of the suicide through their conversations with others, in non-judgmental contexts. It was possible for them in this way to become reconciled with the dead parent,” says Anneli Silvén Hagström.
Hagström believes several proactive strategies could be implemented to both reduce suicide risk and improve survivor mental health. She explains that previous research has shown that children of people who commit suicide run a higher risk of experiencing social and psychological problems, and even committing suicide themselves. Therefore, starting to work actively with this group would thus be a measure to reduce the rate of suicide.
Hagström believes that the professional groups that come into contact with these young people, such as teachers, social workers, and psychologists, must acquire deeper knowledge about how to deal with people affected. It is important to create space for the question of why the parent took his or her own life, and to break the stigma.
The thesis shows also that death does not mean the end of a young person’s relationship with the parent. The continued relationship can provide healing in grief, and professionals should for this reason encourage it.
“The grief here is a complicated grief. The last thing that the young people want is to be like the dead parent, to be in a bad way, and reactions to the loss can arouse the fear that they themselves will take their own life. But knowing how the young people think makes it possible to calm their fears and assure them: ‘This is normal for someone in your situation’.”
A new book by a University of Virginia psychology professor has a simple message: divorcing parents should be parents so that kids can be kids.
The advice is salient as divorce rates push near 50 percent in the United States with more than 40 percent of children being born outside of marriage. As a result, more and more children are at risk of losing their childhoods because their parents cannot, or will not, put their differences aside.
Behaviors like bickering and pitting one parent against the other endanger kids’ few precious years of childhood and can set them on the path to unhealthy relationships in their own lives, Emery said.
“Two Homes, One Childhood: A Parenting Plan to Last a Lifetime,” is Emery’s fifth book on divorce and his second aimed specifically at parents.
He says as hard as it can be, parents must rise above the sadness, anger, and heartache to focus on their parenting plan, one that takes into account a growing child’s evolving physical and emotional needs.
“Really, the only plan for raising kids in two homes that will last a lifetime is one that grows and changes along with kids’ and families’ changing needs,” Emery said in his office in Gilmer Hall.
“Sometimes in the legal system the feeling is, ‘We need to come up with a decision that is going to be a final decision.’ But how do you come up with a final decision for how you are going to raise a baby for 18 years? Or a toddler? Or even a school-aged kid?,” Emery asked.
Parents need to take charge of their own plans, not the courts, and Emery’s book offers practical advice on how to parent throughout the span of a child’s life, from infancy to emerging adulthood and beyond.
Emery understands that “Divorce Stinks,” no matter the circumstances, be they infidelity or incompatibility. Still, couples are bound together forever if they have children.
“You’re there at soccer games, you’re there at high school and college graduation, and you’re there when your grandkids are born,” he said.
So what happens if one parent is willing to do the hard work to provide a good childhood and the other is not?
“It’s all about keeping the kids out of the middle,” he said.
“I tell parents in a really bad situation that many people who think they cannot settle in mediation eventually find that they can. I tell people to keep trying, because maybe it’s horrible now, but maybe after a couple of years things will change.
“If nothing else, even if the parent is a complete jerk, I still really urge parents to do the right thing, partly because it takes two to keep a conflict going and if you don’t play your end, it’s hard for the other parent to keep fighting back.
“If they are jerks, the kids will know, they will discover it and the parent who puts his or her children first will benefit in the long run.”
Emery knows of what he speaks. In addition to directing University of Virgina’s Center for Children, Families and the Law, he is a divorce mediator and the father of five children from two marriages.
In the book, Emery based his original, evidence-based hierarchy on the needs of children growing up in two homes crafting a model similar to Maslow’s hierarchy of needs.
In his book, Emery stresses that he wants very much for children to have good relationships with both parents. But if that is not possible, his research finds “living in the middle of a war zone between two parents is more harmful to children than having a really involved relationship with only one of them.”
Emery believes parents need an evolving plan when children are young. While there is not a “one-size-fits-all” solution, Emery said for infants during the attachment phase, it’s usually best for the child to spend most nights in a “headquarters” home, usually with the mother.
“As that child becomes a toddler, more overnights with Dad get built into the equation. By the time they get to preschool, maybe parents are dividing the week and then go to a week-to-week arrangement by the time a child is school-aged,” he said.
Dealing with teens and their evolving maturity and desires becomes more nuanced. “I think when you decide to involve your teen in decisions on [where they would like to live] is really the same as when you decide to involve teens in all kinds of important decisions,” Emery said.
However, while teens get input, they don’t get to decide. Emery tells the story of his oldest child, Maggie. “She came to me and said she was tired of the back-and-forth. She wanted to live in one house. At that time, I had four more kids and her mother didn’t have any more children, so she said, ‘I want to live mostly with Mom.’”
But instead of agreeing to that immediately, Emery told her, “‘We’ve got to talk about it,’ and we did. We had long talks and we went on drives, which I always recommend for talking to teenagers because they can’t run away,” he said.
“Eventually, I agreed with her point of view. But I made it very clear to her that it was not her decision. It was my decision.”
That point, Emery said, is essential, because he didn’t want teenage Maggie to have the authority — or the weight of the responsibility — for making that decision. “It’s an adult decision,” he said.
In this regard, Emery said divorced parents and married parents are not so very different, yet society treats them very differently. One of his big goals is for parents, regardless of marital status, to act more the same and for practitioners in legal and mental health systems to treat them more the same.
“I’d like parents who live apart to think of my book as kind of a ‘Dr. Spock’ for raising kids in two homes,” he said. Spock’s influential book, “Baby and Child Care,” published in 1946, became a best-seller and remains popular today.
Source: University of Virginia
Sustained economic hardship among young people is strongly linked to poor cognitive function in midlife and may contribute to premature aging, according to a new study in the American Journal of Preventive Medicine.
Although previous research has shown that exposure to poor socioeconomic conditions during childhood and/or adulthood is associated with cognitive deficits, most of these studies involved older adults, offering little data on whether poverty can influence cognitive health earlier in life.
“Income is dynamic and individuals are likely to experience income changes and mobility especially between young adulthood and midlife,” said lead investigator Adina Zeki Al Hazzouri, Ph.D., of the Division of Epidemiology, Department of Public Health Sciences at the University of Miami.
“Monitoring changes in income and financial difficulty over an extended period of time and how these influence cognitive health is of great public health interest.”
The researchers investigated the effects of sustained poverty and perceived financial difficulty on cognitive function in midlife using income data for about 3,400 adults who took part in the ongoing Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study. The CARDIA study tracked black and white males and females 18 to 30 years of age at the start of the study in 1985-86.
Income information was gathered from study participants six times between 1985 and 2010. Sustained poverty was defined as the percentage of time the participants’ household income was less than 200 percent of the federal poverty level.
Participants were divided into four groups: never in poverty; less than a third of the time; from third to nearly 100 percent of the time; or always in poverty. The annual income cut-offs for 200 percent of the federal poverty level for a four-person household were $26,718 in 1990, $28,670 in 1992, $31,138 in 1995, $35,206 in 2000, $39,942 in 2005, and $44,630 in 2010.
In 2010, at a mean age of 50 years, participants underwent a series of tests that are widely used and considered reliable to detect cognitive aging. The findings show significant and graded associations between greater exposure to economic hardship and worse cognitive function, suggesting that poverty and perceived hardship may be important contributors to cognitive aging.
People living in chronic poverty scored significantly worse than individuals never in poverty. Similar results were found in individuals with perceived financial difficulty.
“Maintaining cognitive abilities is a key component of health,” said Zeki Al Hazzouri. “Findings among this relatively young cohort place economic hardship as being on the pathway to cognitive aging and as an important contributor to premature aging among economically disadvantaged populations. It is important to monitor how trends in income and other social and economic parameters influence health outcomes.”
New data released from the London School of Economics shows that workplace depression is a major issue across different cultures and economies.
The effects of employee depression are “wide and devastating” consequences for thousands of organizations worldwide, say the investigators.
In a study of eight countries spanning diverse cultures and GDP, researchers discovered depression is collectively costing the nations of Brazil, Canada, China, Japan, Korea, Mexico, South Africa, and the USA more than $246 billion a year.
Data from a survey of 8,000 employees across these countries reveals that more highly educated employees, in particular, have a more negative impact if they remain at work while depressed. Researchers believe this occurs because managers and professionals are more likely to manage others and therefore their issues may cause problems that are felt down the line.
Researchers explain that this is the first study of its kind in the world to analyze the impact of depression on workplace productivity across a range of countries that differ both culturally and economically. The findings follow on the heels of a major European study on workplace depression by the same researchers in March 2014, signaling an urgent need for employers to take a more pro-active approach to tackling mental health issues.
Lead researcher Dr Sara Evans-Lacko says the enormous costs of depression due to absence and loss of productivity are set to increase unless governments and employers make it a priority.
The study, published online in Social Psychiatry and Psychiatric Epidemiology, also reveals:
- On average, one percent of a country’s GDP is lost due to workers with depression attending work while unwell — a condition called presenteeism.
- Absenteeism is higher than presenteeism in Japan due to people’s fear of losing their job if their depression is revealed at work.
- The costs of employees attending work while dealing with depression is five to 10 times higher than those who take time off work to recover from depression.
- The USA ($84.7 billion) and Brazil ($63.3 billion) experience the highest productivity losses due to presenteeism.
- Less than 10 percent of respondents in China (6.4 percent) and South Korea (7.4 percent) reported having a previous diagnosis of depression compared to more than 20 percent in Canada, 22.7 percent in the USA, and 25.6 percent in South Africa.
- Asian countries report lower productivity losses due to depression, attributed in part to a cultural reluctance to disclose mental health issues, so the actual figures (above) relating to China and South Korea are likely to be higher.
- Japan, however, has the highest aggregate costs associated with employees taking time off for depression, with 22 percent (costing $14 billion) of people taking 21 or more days. This suggests that employees stay at work longer until their depression is severe.
- The prevalence of depression in South Africa (25.6 percent) is nearly two times higher than the average (15.7 percent) reported across the eight countries.
Overall, researchers discovered depression is the leading cause of disability worldwide, affecting up to 350 million people, according to the World Health Organization.
“These findings suggest that depression is an issue deserving global attention, regardless of a country’s economic development, national income or culture,” Dr Evans-Lacko says.
“The growth of mental illness worldwide also suggests the scale of the problem is likely to increase.”
The data provides compelling evidence for global workplace programs to be implemented to address mental health issues, Dr Evans-Lacko adds.
“Interventions which support employees with depression need to be developed, adapted, implemented and evaluated across all countries to mitigate the high costs of workplace depression.”
Source: London School of Economics
Amazing new research provides clinicians with visual evidence of brain networks and how electrical stimulation of the brain helps to reset or stimulate specific brain regions.
It is well established that stimulating the brain via electricity or other means may help to ease the symptoms of various neurological and psychiatric disorders. Clinical practices often use the approach to treat conditions ranging from epilepsy to depression.
But what really happens when doctors zap the brain?
Little is known about what makes this technique effective, or which areas of the brain should be targeted to treat different diseases.
A new study led by the University of Pennsylvania and the University at Buffalo marks a step forward in filling these gaps in knowledge. The research describes how the stimulation of a single region of the brain affects the activation of other regions and large-scale activity within the brain.
“We don’t have a good understanding of the effects of brain stimulation,” said first author Sarah Muldoon, Ph.D., an assistant professor of mathematics in the University at Buffalo
“When a clinician has a patient with a certain disorder, how can they decide which parts of the brain to stimulate? Our study is a step toward better understanding how brain connectivity can better inform these decisions.”
“If you look at the architecture of the brain, it appears to be a network of interconnected regions that interact with each other in complicated ways. The question we asked in this study was how much of the brain is activated by stimulating a single region.
“We found that some regions have the ability to steer the brain into a variety of states very easily when stimulated, while other regions have less of an effect,” said Danielle S. Bassett, Ph.D., an associate professor of bioengineering in the University of Pennsylvania School of Engineering and Applied Science.
The research was performed in collaboration with cognitive neuroscientist Jean M. Vettel, Ph.D., of the Army Research Laboratory; control theorist Fabio Pasqualetti of the University of California, Riverside; Scott T. Grafton, M.D., and Matthew Cieslak of the University of California, Santa Barbara; and Shi Gu of the University of Pennsylvania Department of Psychiatry.
The study, published in PLOS Computational Biology, used a computational model to simulate brain activity in eight individuals whose brain architecture was mapped using data derived from diffusion spectrum imaging. This imaging technique creates a type of brain image taken by an MRI scanner.
Researchers examined the impact of stimulating each of 83 regions within each subject’s brain. While results varied by person, common trends emerged.
Network hubs — areas of the brain that are strongly connected to other parts of the brain via the brain’s white matter — displayed what researchers call a “high functional effect”. They discovered stimulating these regions resulted in the global activation of many brain regions.
This effect was particularly notable in two sub-networks of the brain that are known to contain multiple regional hubs.
The areas include the subcortical network (which is composed of regions that evolved relatively early on and are critical for emotion processing) and the default mode network (which is composed of regions that evolved later and are critical for self-referential processing when a person is at rest, or not completing any task).
Stimulating regions in the subcortical network culminated in global changes, in which a diversity of areas within a subject’s brain lit up.
Stimulating regions in the default mode network also led easily to a plethora of new brain states, though the patterns of activation were constrained by the brain’s underlying architecture — by the white matter links between the nodes of the network and other parts of the brain.
Despite this limitation, the network’s agility supports the idea that the brain at “rest” is well suited for shifting quickly into an array of new states geared toward completing specific tasks.
In contrast to regions within the default mode network and subcortical networks, more weakly connected areas, such as in the sensory and association cortex, had a more limited effect on brain activity when activated.
These patterns suggest that doctors could pursue two classes of therapies when it comes to brain stimulation: a “broad reset” that alters global brain dynamics, or a more targeted approach that focuses on the dynamics of just a few regions.
The study confirms the findings of past research by Bassett and others on the controllability of the brain’s structural networks. In contrast to past work that used linear modeling to arrive at results, the new study employed nonlinear models that more accurately reflect the brain’s complex activity, Muldoon said.
Source: University of Buffalo
New research suggests the symptoms of Alzheimer’s disease may be different for Hispanics than other ethnic groups.
Researchers explain that certain symptoms associated with the development of Alzheimer’s disease affect Hispanics more frequently and severely than other ethnicities. The symptoms include agitation and depression, as well as other behavioral presentations.
“Our study shows that the severity and proportion of neuropsychiatric symptoms is significantly higher in a Hispanic group compared to non-Hispanic whites,” said lead researcher Ricardo Salazar, M.D., a geriatric psychiatrist at Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso).
“This could have a significant impact on the treatment and understanding of how Alzheimer’s disease progresses in Hispanics.”
Study findings appear in the Journal of Neuropsychiatry and Clinical Neuroscience (JNCN).
Both cognitive and behavioral decline can occur with Alzheimer’s disease, said the researchers. Cognitive signs of the disease include memory loss and problems with orientation and physical functioning.
Behavioral, or neuropsychiatric symptoms, include depression, elation, anxiety, hallucinations, delusions, and apathy. These neuropsychiatric symptoms have been associated with higher rates of institutionalization and more rapid progression of the disease.
Curious to understand how neuropsychiatric symptoms manifest in Hispanics with dementia, Dr. Salazar and his team gathered data on more than 2,100 individuals in the Texas Alzheimer’s Research and Care Consortium (TARCC) database.
Patients profiled in the database are predominantly non-Hispanic whites and Mexican-Americans who have been diagnosed with Alzheimer’s disease or mild cognitive impairment (MCI), or are otherwise healthy subjects.
The team specifically focused on each individual’s Neuropsychiatric Inventory Questionnaire (NPI-Q), an exam used to assess the extent of 12 neuropsychiatric symptoms.
A review of the data showed that during MCI — the intermediate state between healthy cognition and Alzheimer’s disease — all ethnicities were affected equally by neuropsychiatric symptoms. But once the condition had progressed to full-on Alzheimer’s disease, the severity of neuropsychiatric symptoms in Hispanics increased significantly.
Salazar believes these divergent symptoms may reflect a different disease process in Hispanics.
“When patients have neuropsychiatric symptoms, that signifies deterioration of different areas of the brain,” he explains.
“I believe functional imaging studies of the brain may show differences in the locations of amyloid or plaque collection in the brains of Hispanics with Alzheimer’s disease.”
The JNCN study also showed that depression and anxiety were more frequent in healthy Hispanics age 50 years and older than in healthy, non-Hispanic whites of the same age. This corroborates past studies suggesting that depression may be one of the first signs of Alzheimer’s disease.
“Hispanics tend to get Alzheimer’s disease at an earlier age than other [ethnic groups], and our study shows that these neuropsychiatric symptoms of depression and anxiety manifest earlier in them, too,” Salazar said.
“This suggests that depression and anxiety in older Hispanics could be an early warning for Alzheimer’s disease — and that treatment of these symptoms could even delay the disease.”
As a geriatric psychiatrist in an overwhelmingly Hispanic region, Salazar has witnessed this phenomenon firsthand.
“I am a strong believer that if you use antidepressants to treat MCI that appears with symptoms of depression, you can slow the progression of Alzheimer’s,” he said. “Maybe even avoid full-on progression to the disease.”
Salazar implored physicians to be aware that depression can mask dementia, particularly in the Hispanic population.
Salazar said the study has limitations. Ethnicity was self-reported by individuals, and there were also fewer Hispanic participants with Alzheimer’s disease than white participants with the disease.
While additional research is clearly needed, Salazar’s study could be a window to how to better treat — and even prevent — Alzheimer’s disease in this rapidly-growing demographic.
A new European Union (EU) project established guidelines to prepare individuals for life after full-time retirement. Researchers from the University of Alicante urge people to start planning as soon as age 50 so as to life a fulfilling third life after retirement.
Improper planning of retirement may lead to depression and related mental health issues.
“Start early” is the main message from project partners after a two-year project led by the Evris Foundation in Iceland, and in which several EU Universities participated.
The project addressed the urgent need to establish directives and best practices for preparing individuals early for retirement. Researchers stressed the importance of on-going learning, environment and cultural factors, and knowledge sharing.
Research partners created a model awareness-raising campaign, the “Personal Development Academy” and the “Warehouse of Opportunities,” all of which are outlined in the directives and recommendations document, “Towards a Dynamic Third Age.”
Specifically, the University of Alicante led the development of the awareness-raising campaign model with the intention of enabling any center, institute or association to prepare the local population for retirement.
Researchers Concepción Bru and Ronda and Nuria Ruiz of UPUA first made a European map of retirement and carried out surveys on the retirement situation. They then used this data to design the awareness campaign.
Researchers explain that it is important to prepare for retirement when a person is between the ages of 50-55 when they have between ten and fifteen years before retirement. During this period, individuals should also plan for twenty more years of a full and active life after that.
Investigators urge individuals to self-reflect on what they want to do with their time during this retirement phase of their life. That is, what might we need to train on beforehand, from financial and legal issues, to preventive health, social skills, leisure activities, and even dependence prevention.
In short, we need to be prepared for retirement to fully embrace this period in our life.
Bru stresses the importance of carrying out awareness-raising campaigns on the value of the third age in society, aimed both at the general public and those approaching retirement.
“More and more people are living longer and in better health [and] the sudden stop in the activity you have spent your whole life engaged in” can lead to depression and related mental health issues.
Encouraging physical activity and inspiring a sense of inclusion and purpose is the overarching goal of the project, but the key for Bru is that retirees, or those approaching retirement, are able to “reinvent themselves.
She recommends a strategy in which a person engages in something they’ve never done before, like volunteering. “If you prepare yourself in good time and with good organization and guidance, a better retirement is possible,” explains Bru.
The idea, Bru tells us, is to continue work in the EU to put these recommendations into practice. Indeed, they are already being implemented by companies that took part in the project, as well as at an institutional level, via the regional ministry of education and the University of Alicante.
Source: Asociación RUVID/ScienceDaily
New research suggests that if you are middle-aged or older, having a happy spouse may improve your health.
The study suggests spousal happiness provides a distinctive link to health among older adults.
Michigan State University researchers studied a nationally representative study of 1,981 middle-age heterosexual couples and found that people with happy spouses were much more likely to report better health over time.
This occurred above and beyond the person’s own happiness, according to the study, published in the American Psychological Association journal Health Psychology.
“This finding significantly broadens assumptions about the relationship between happiness and health, suggesting a unique social link,” said William Chopik, Ph.D., an assistant professor of psychology at Michigan State University and principal investigator of the study.
“Simply having a happy partner may enhance health as much as striving to be happy oneself.”
Researchers had previously identified that happy people are generally healthy people, but Chopik wanted to take it one step further by exploring the health effects of interpersonal relationships.
According to Chopik, there are at least three potential reasons why having a happy partner might enhance a person’s health, irrespective of one’s own happiness:
- happy partners likely provide stronger social support, such as caretaking, as compared to unhappy partners who are more likely to be focused on their own stressors;
- happy partners may get unhappy people involved with activities and environments that promote good health, such as maintaining regular sleep cycles, eating nutritious food, and exercising;
- being with a happy partner should make a person’s life easier even if not explicitly happier.
“Simply knowing that one’s partner is satisfied with his or her individual circumstances may temper a person’s need to seek self-destructive outlets, such as drinking or drugs, and may more generally offer contentment in ways that afford health benefits down the road,” Chopik said.
Researchers assessed the survey information of couples age 50 to 94, including happiness, self-rated health and physical activity over a six-year period.
The results showed no difference between husbands and wives in the study.
Eighty-four percent of study participants were white, eight percent were African-American, and six percent were Hispanic.
The survey asked participants about their health, including level of physical impairment, chronic illnesses and level of physical activity, as well as any concerns they had regarding their spouse’s health.
Participants rated their own happiness and life satisfaction.
New research finds a computer-based cognitive-behavioral therapy program can be an effective strategy for treating alcohol use disorders.
Yale researcher Kathleen M. Carroll, Ph.D., and other members of the Yale Psychotherapy Development Center created the program called CBT4CBT.
The program was created to provide consistent and high-quality delivery of cognitive behavioral therapy skills training to avoid substance use.
A new study, published in the journal Alcoholism: Clinical and Experimental Research, demonstrated that CBT4CBT is effective at reducing rates of alcohol use when delivered as an add-on to standard outpatient addiction treatment.
The study evaluated a web-based version of CBT4CBT for alcohol use disorders developed by Carroll and Brian D. Kiluk, Ph.D., assistant professor of psychiatry.
Sixty-eight people who were seeking treatment for an alcohol use disorder were randomly assigned to one of three treatment conditions for eight weeks: standard treatment as usual (TAU); standard treatment plus CBT4CBT; and CBT4CBT with brief clinical monitoring.
Those assigned to either of the CBT4CBT conditions remained in treatment longer than those assigned to TAU, according to the results.
While there was an overall increase in rates of alcohol abstinence in the full sample during the 8-week treatment, people assigned to TAU and CBT4CBT demonstrated a greater increase in abstinence rates than those assigned to TAU.
The study also showed that the CBT4CBT treatments generated cost savings compared to TAU alone.
Source: Yale University
New research finds that children with attention-deficit hyperactivity disorder (ADHD) will avoid situations that may have a risk of failure thereby missing opportunities to learn and grow.
Researchers explain that children with ADHD are potentially more exposed to criticism than typically developing children. Their difficulties with focusing, elevated activity levels and impulsive actions often get them into trouble with their parents, teachers, and friends.
This makes it important to find out how punishment affects the behavior of children with ADHD. Are they more sensitive to punishment, or are they less sensitive to punishment? A team of researchers from Japan and New Zealand presented children with ADHD and typically developing children with a computer-based game that involved reward and punishment.
“When we first began this study, there had not been a lot of experimental research done,” said Dr. Gail Tripp, one of the authors of the paper and director of the Human Developmental Neurobiology Unit at the Okinawa Institute of Science and Technology Graduate University (OIST).
“We need to be extremely careful about using punishment, especially when working with children. Some of our first attempts to study ADHD and punishment were not very successful, because the children simply abandoned the task when they kept losing points or did not get enough rewards.”
This time, the researchers were able to develop a computer-based game that was engaging but still incorporated an element of punishment. Children with ADHD and typically developing children chose between playing two simultaneously available games.
Both games were presented at the same time on a computer screen, and looked the same: a two by two grid in which a mix of fun characters and sad faces appeared after pressing a button on the screen. Four matching characters equaled a “win,” while four sad faces equaled a “loss.”
Any other combination was a neutral outcome. The children could switch between playing the two games as often as they liked. Altogether, 210 children took part in the research, with 145 diagnosed with ADHD. All children were living in Japan or New Zealand and spoke English as their first language.
“The chance of winning rewards was equal for the two games, but one of the games was designed to have a four times higher likelihood of losing: playing on that game, a child would be ‘punished’ more often than with the other one,” Tripp said.
In both games, when a child won, the computer gave him or her 10 points and played a simple animation; when a child lost, the computer took away five points and played a laughing sound. All children began with a positive balance of 20 points and the game continued until either they reached 400 points or completed 300 trials. Each child won a prize at the end of the game.
The rewards were also arranged to discourage children from playing on one game exclusively or switching every time. A session lasted typically half an hour. The reason for such an extended game was to observe fairly stable performance over time.
“What we actually saw was that both typically developing children and children with ADHD developed a preference — what we call ‘bias’ — for the less ‘punishing’ game,” Tripp said.
“Both groups played the less punishing game more often. But over time, the children with ADHD found losing points and the laughter more punishing than typically developing children.”
During the first 100 trials, there was no difference between the two groups of children. But later on, the preference for the less punishing alternative increased substantially in the children with ADHD, while the choices of the typically developing children were stable for the duration of the task.
By the 200th trial, the children with ADHD were much less likely to play the more punishing game. The results suggest that children with ADHD avoid punishment more often over time than typically developing children. The latter seemed less distracted by punishment and kept their focus on winning.
Researchers believe this finding has important implications. “If a child with ADHD is reluctant in doing a task, or if the child gives up easily, it might be important for the parent or the teacher to check if the task has the appropriate balance of reward and punishment,” Tripp said.
“We are not saying that the task has punishment built in, rather that the effort needed to do the task might be perceived as punishing by the child. The more effortful a task is, the more incentives a child is going to need to keep persisting, and simple but frequent rewards, such as smiles or words of encouragements, can help children with ADHD to stay on the task.”
The same could be said for typically developing children, but this is especially important for children with ADHD, as they seem more sensitive to repeated experiences of punishment or failure, and are more likely to miss opportunities for success.
The study appears in the Journal of Child Psychology and Psychiatry.
Emerging research finds that American youths in 10th grade have a high illicit drug use compared to their European counterparts. The American adolescents, however, have among the lowest rates of drinking and smoking.
The findings come from a 2015 survey of 15- and 16-year-olds in 35 European countries. The results provide perspective on the substance-using habits of American adolescents.
The results of the European School Survey Project on Alcohol and Other Drugs (ESPAD), show country-by-country results for the use of various licit and illicit drugs. In all but a few of the 35 countries included, the findings are based on national samples of the same age group.
In the U.S., data from the Monitoring the Future study’s national survey of 10th-graders — upon which much of the design of the European study is based — provide results for comparison.
This survey is conducted by scientists at the University of Michigan’s Institute for Social Research and is sponsored by the National Institute on Drug Abuse.
Among the key findings for illicit drug use are the following:
- Europe has shown recent trends in the use of several important substances similar to those seen in the U.S., including a rise in marijuana use and declines in the use of cigarettes and alcohol by teens;
- On average, only 18 percent of the European students had used an illicit drug in their lifetime, compared to 35 percent of U.S. students the same age. Only the Czech Republic ranked higher than the U.S. at 37 percent;
- The U.S. was tied with France for second highest in lifetime cannabis use at 31 percent. In the European countries, the average was about half of that (16 percent), and the highest rate again was in the Czech Republic at 37 percent. There were large variations in the rates for individual countries, ranging down to four percent in Moldova;
- Cannabis use in the prior 30 days was highest in the U.S. (15 percent) and France (17 percent) — more than twice the average across all 35 European countries of seven percent;
- Lifetime use of amphetamines was by far the highest among the U.S. teens at 10 percent. The average for the 35 ESPAD countries was only two percent;
- The U.S., Ireland and Georgia had the highest rates of ecstasy use (which has been in decline in the U.S.) at four percent lifetime prevalence;
- The U.S. and Poland had the highest rates of lifetime hallucinogen use at five percent, compared to an average of two percent across the European countries;
- Lifetime cocaine use by U.S. teens was above average at three percent versus two percent on average in Europe, but there were somewhat higher rates in Bulgaria (five percent), France (four percent), and Poland (four percent);
- Lifetime heroin use in the U.S. sample was at the average for the European countries at one percent lifetime prevalence, but several countries had higher rates of two percent to three percent.
Researchers said that while U.S. teens stand out for having high levels of use of controlled substances, their use of cigarettes and alcohol is equally noteworthy for being low in comparison to most of the countries of Europe.
Daily cigarette smoking in the prior 30 days by U.S. teens is tied with Iceland at next to lowest (three percent). Only Norway is lower at two percent, while the average for the 35 ESPAD countries was 12 percent (with national estimates ranging widely from two percent to 25 percent).
The percentage of U.S. 15- and 16-year-old students who drank any alcohol in the 30 days prior to the survey was 22 percent — less than half the average proportion in the European countries (48 percent). Only Iceland had a lower prevalence of use (nine percent) and the U.S. was tied with Norway for second lowest.
The percentage of students who said they had five or more drinks on one or more occasions in the prior 30 days was 35 percent, on average, in Europe. The U.S. sample had 11 percent indicating such binge drinking in the prior two weeks, second lowest only to Iceland at eight percent.
“While the U.S. number would be a bit higher if it referred to the prior 30 days rather than the prior two weeks, it likely would not change its overall ranking,” according to principal investigator Lloyd Johnston, Ph.D.
Overall, the considerable differences in terms of substance use between U.S. teens and those in Europe are not entirely new, said Johnston, University Distinguished Research Scientist at the U-M institute.
“The popular illicit drug use epidemic first emerged in the U.S. in the 1960s and eventually spread to be a pandemic affecting countries around the world,” he said. “But it has not blossomed in Europe to the extent it did in this country.
“On the other hand, smoking and drinking are long established behaviors in many countries of Europe, and we can see in these coordinated surveys of adolescents that smoking and drinking — while declining some — are still more entrenched there than in the U.S., where we have seen substantial declines among youth in recent years.”
Marijuana was seen as available to a greater proportion of students in the U.S. than in any of the European countries. Two thirds of U.S. 10th-graders said it would be fairly easy or very easy to get, compared with an average of only 30 percent among those the same age in Europe.
On the other hand, alcohol and cigarettes were seen as readily available to slightly more of the U.S. students 15 and 16 years old, than to their counterparts in Europe, despite the fact that use of both cigarettes and alcohol is relatively low among the U.S. teens compared to teens in Europe.
Source: University of Michigan