To improve firefighters’ mental health, we can’t wait for them to reach out – we need to ‘reach in’


Erin Smith, Edith Cowan University

Many firefighters will by now be exhausted, having been on the front line of Australia’s bushfire crisis for weeks or months.

This bushfire season has been unrelenting, and the hottest months of summer may still lie ahead.

In part, the toll is physical. The flames are high, they are intense, and they move fast. It’s hard to breathe because the air is so hot.

At the same time, first responders have witnessed widespread devastation. To land and livelihoods, to people and animals. Meanwhile, grief for the death of fellow firefighters feels raw, and the risk to their own lives very real.

We’re right to be concerned about firefighters’ mental health.




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Emergency responders already have poorer mental health

Every 4.3 weeks, a firefighter, paramedic or police officer dies by suicide – and that’s when it’s “business as usual”.

Research shows our first responders are more likely to be diagnosed with a mental health condition than the overall Australian population. They are more than twice as likely to think about suicide, and three times as likely to have a suicide plan.

This paints a grim picture of the well-being of a population who dedicate their professional lives to helping others.




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It’s likely responding to a disaster on the scale of the current bushfires could increase the risk of mental illness for some.

If firefighters are not coping, they may develop psychological disorders including post-traumatic stress disorder (PTSD), anxiety, depression, and substance abuse.

PTSD

PTSD develops when a person isn’t able to recover after experiencing a traumatic event.

Some firefighters may develop symptoms while they’re still fighting the fires. They may feel on edge, but push down their fears to get on with the job. However, it’s more likely symptoms will only appear weeks, months, even years down the track.

PTSD is associated with significant impairment in day-to-day functioning socially and at work. For firefighters and others with PTSD, typical symptoms or behaviours will include:

  • reliving the traumatic event. People with PTSD describe vivid images and terrifying nightmares of their experience

  • avoiding reminders of what happened. They may become emotionally numb and isolate themselves to avoid any triggers

  • being constantly tense and jumpy, always looking out for signs of danger.

Volunteers in regional communities are particularly susceptible to trauma. They have often joined fire brigades to help protect their own communities, and then face trying to save their own homes or those of neighbours and friends.

We also need to be mindful of retired firefighters for whom these current bushfires will have triggered painful and disturbing memories. They may not currently be on the front lines, but they only need to turn on the television, open the newspaper, or look at social media to be taken straight back to Black Saturday or whatever particular event is distressing for them.




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The problem with reaching out

The increased prevalence of mental health issues among emergency responders suggests many existing emergency service well-being programs are failing those who need them the most.

In Australia, these programs are largely based on a what’s called a “resilience model” that focuses on people “reaching out” and seeking help when they need it.

First responders may be unlikely to take this initiative in the middle of a mental health crisis, when it’s often a struggle even to pick up the phone to a loved one, friend or colleague.

Some firefighters might not reach out for help when they need it.
Jacob Carracher, Author provided

Instead, we need an approach to well-being that removes the onus on the individual. We need to shift our thinking from a model that requires the individual to “reach out”, to a model that also values others “reaching in” to identify those who may be struggling.

Ambulance Victoria’s Peer Support Dog Program, which allows staff to bring in accredited dogs to create social interactions and conversations, is a good example of how “reaching in” helps with first responder well-being. This kind of approach empowers people through social connections and the appreciation they are also supporting others.

While employers need to do more in to facilitate “reach in” programs, anyone can create informal support networks. Whether friendship groups, community groups, sporting groups, or something else, the underlying thread should be a committment to each other’s well-being.




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As we continue to contend with this crisis, ensuring firefighters feel supported can make a difference to their well-being. If you see a responder in the street, say thank you. If you see one in a cafe, shout them a cuppa. If you have kids, get them to write a letter or draw a picture and drop it off to the local emergency services station.

We can’t eliminate the risk firefighters will suffer with mental health problems after what they’ve been through, but these little acts of kindness can make a difference.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For people with a mental illness, loved ones who care are as important as formal supports



People with mental illness are especially vulnerable after they are discharged from hospital.
From shutterstock.com

Emily Hielscher, The University of Queensland; James Graham Scott, QIMR Berghofer Medical Research Institute, and Sandra Diminic, The University of Queensland

People living with mental illness often require support from carers, such as family and friends, on a long-term and somewhat unpredictable basis.

But these support networks are not always in place. Geographical or emotional distance from family members, conflict with friends, and the tendency for people with mental illness to withdraw from others means these individuals are often isolated.

In two Australian surveys – a national snapshot survey of Australian adults with psychosis and another looking at adults with long-term mental health conditions such as depression, anxiety, and psychosis – only one-quarter reported receiving regular assistance from family or friends. About three out of every four people living with mental illness reported the absence of a carer or other informal support.




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For someone living with mental illness, having a carer or support person facilitates continuity of care and provides advocacy and support, particularly during and after episodes of acute illness.

People with mental illness are at their most vulnerable following discharge from hospital or other inpatient facilities. Reintegrating back into society can be challenging. And during this time, the risk of suicide is high.

It’s somewhat unsurprising, then, that people without a carer or support network face poorer outcomes in terms of recovery.

How does having a carer help?

Following hospitalisation for an acute episode of mental illness, people typically require assistance with a myriad of tasks.

They may need help with day-to-day activities like grocery shopping, cooking and cleaning. People in recovery may also need support to re-engage with the community, including returning to work or study.

They will likely benefit from assistance in adhering to care plans, including managing medications and attending follow-up appointments. A person recovering from hospitalisation for an eating disorder may need support from family members to ensure they are eating as much as they need to at mealtimes.

As well as these practical supports, someone recovering from an acute episode of mental illness requires ongoing emotional support which reaffirms their sense of self and capacity to recover.




Read more:
Depression: it’s a word we use a lot, but what exactly is it?


We surveyed 105 Australian mental health carers and found the most commonly reported care tasks were “providing encouragement and motivation”, “prompting their loved ones to do things”, and “liaising with health professionals”.

Carers spent the majority of their caring time providing emotional support, and the least of their care time assisting with activities of daily living, such as feeding and dressing.

Research has shown having a carer increases the likelihood of follow-up care and better health outcomes in the short and long term. Following hospitalisation, carers can recognise and respond to early warning signs of relapse and encourage better engagement in prescribed care plans.

And although it’s rarely considered part of the caring role, safe and stable housing is crucial for recovery. Most mental health carers also live with the person they are caring for.




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Looking after loved ones with mental illness puts carers at risk themselves. They need more support


What about discharged patients who don’t have informal supports?

The transition from hospital to home can be frightening and difficult. Patients tend to become accustomed to the day-to-day hospital routine and in turn can feel increasingly disconnected from the outside world. These challenges are exacerbated in the absence of support from health professionals, family or friends.

Without family or carer involvement at discharge, a person with mental illness may be more likely to relapse and be readmitted, falling into a “revolving door” pattern of multiple hospitalisations.

A support person can help ensure medical appointments are organised and attended.
From shutterstock.com

One study of older psychiatric patients found absent or dysfunctional family support was one of the strongest predictors of hospital readmission in the 18 months after discharge. Patients without reliable family support were nearly twice as likely to be readmitted to hospital than those who had dedicated family carers.

Similar results have been found in broader and larger samples. Among 1,384 adult patients admitted to a psychiatric hospital, unreliable social support at discharge was associated with an increased risk of being readmitted to hospital within one year.

Further, reduced social support and lack of continuity of care has been shown to be an important predictor of suicide following hospital discharge. For self-harm and suicide, the risk is most pronounced in the three months following discharge from hospital.

What needs to improve?

Alongside the absence of family support, lack of connection with community-based services and supports is similarly associated with poor post-discharge outcomes.

Discharge planning and transitional programs have been established to provide additional practical and emotional support to people with mental illness after they leave hospital. These have reported promising results in terms of preventing hospital readmission and promoting engagement with community treatment (such as psychological support services, medication monitoring, and alcohol and drug recovery services). Further research which identifies the key benefits of such programs is needed, using larger controlled studies.

Another solution is improving housing support for mental health patients after discharge. Programs such as Housing Mental Health Pathways in Victoria assist people with mental illness and a history of homelessness who have no suitable accommodation at the time of hospital discharge. More programs like this are needed.




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The time following hospitalisation is one of the most vulnerable for people with mental illness. More needs to be done at both a community and policy level to better support people during this period – particularly those without a carer or informal support network.

If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Emily Hielscher, PhD Candidate, The University of Queensland; James Graham Scott, Associate Professor of Psychiatry, Senior Scientist and Head of Mental Health, QIMR Berghofer Medical Research Institute, and Sandra Diminic, Adjunct Fellow, School of Public Health, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

It’s not only teenage girls, and it’s rarely attention-seeking: debunking the myths around self-injury


Self-injury is associated with underlying psychological distress, and increased suicide risk. But people who self-injure aren’t doing it to end their life.
Author provided

Penelope Hasking, Curtin University and Stephen P. Lewis, University of Guelph

Non-suicidal self-injury is the deliberate damage of body tissue without conscious suicidal intent. It’s more specific than self-harm, a broader term that can also include suicide attempts.

Self-injury is reasonably common, particularly among young people. In community samples, 17% of adolescents and 13% of young adults had engaged in self-injury.

Self-injury is associated with underlying psychological distress, and increased suicide risk. People who self-injure are typically doing so to cope with intense emotions.




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Why do people intentionally injure themselves?


Although we continue to understand more about self-injury, there remains significant public stigma towards people who self-injure.

This stigma can make people who self-injure reluctant to seek help or disclose their experiences to others. Research shows only half the people who are already seeing a therapist for mental health concerns will tell even their therapist about it.

One way to combat stigma, and support disclosure and help-seeking, is to debunk the common myths and misconceptions that surround self-injury.

Myth 1: only teenage girls self-injure

Self-injury is often thought of as a “teen fad”, and as especially prevalent among teenage girls. It’s true self-injury usually starts during adolescence, but people of all ages and genders self-injure. Recent research shows the second most common time to start self-injury is in a person’s early 20s.

Consistent with this, self-injury is common among university students; up to one in five report a history of self-injury, with about 8% self-injuring for the first time during university.

Although more women in treatment settings report self-injury, it’s likely that in community settings, self-injury is equally common among males and females. This may be because women are more likely than men to seek help.

Myth 2: people who self-injure are attention-seeking

One of the more pervasive myths about self-injury is that people self-injure to seek attention. Yet, self-injury is usually a very secretive behaviour, and people go to great lengths to hide their self-injury.

Instead, in the majority of research, people report the main reason they self-injure is to cope with intense or unwanted emotions.




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Other common reasons people self-injure are to punish themselves or to stop an escalating cycle of painful thoughts and feelings. People may self-injure to communicate how distressed they are, particularly if they have trouble verbally expressing their feelings. In other words, their self-injury is a cry for help.

A recent study found influencing and punishing others was the least likely reason for self-injury.

Myth 3: people who self-injure are suicidal

By definition, non-suicidal self-injury is not motivated by a desire to end life. In addition to serving a different function, the frequency of suicidal and non-suicidal behaviours differs. That is, suicide attempts are generally infrequent, whereas non-suicidal behaviours can occur more often.

People who self-injure can benefit from support from friends, family, and health professionals.
From shutterstock.com

The methods used, the outcomes of the behaviours, and appropriate treatment responses also all differ. People at risk of suicide may require immediate and more intensive intervention; although both non-suicidal self-injury and suicidal behaviour need to be taken seriously and responded to compassionately.

For these reasons, it’s important to be clear when we are talking about self-injury and when we are talking about suicidal thoughts or behaviour.

Myth 4: there is a self-injury ‘epidemic’

While many people report at least one instance of self-injury, fewer people engage in repeated episodes.

Further, there is little evidence rates of self-injury have increased in recent years. Hospital records indicate an increase in presentations for “deliberate self-harm”, but these are predominantly poisonings, not self-injury.

Other studies show more people reporting self-injury, but it’s unclear whether this is because people are more comfortable disclosing their self-injury, or because self-injury is increasing.

Research suggests when the methodologies of the studies are taken into account, rates of self-injury have not increased over time.




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Myth 5: social media contributes to self-injury

Internet and social media are highly relevant to many people who self-injure as they offer a means to obtain social support, share their experiences with others who have been through similar things, and obtain coping and recovery-oriented resources (for example, stories about other people’s experiences).

This is not surprising given the stigma attached to self-injury, which leaves many people who self-injure feeling isolated from others.

Despite these benefits, there are concerns online material, including graphic images and videos depicting self-injury, may trigger people to engage in self-injury. While only a few studies explicitly examine this, there is some evidence viewing graphic imagery is associated with self-injury. However, images of scars may not be as triggering.

There are also concerns exposure to messages that carry hopeless themes (for example, “it’s impossible to stop self-injuring”), may contribute to continued self-injury and impede help-seeking.

But at the same time, exposure to more positive messages may offer hope about recovery.

Fostering understanding

Self-injury is a common behaviour engaged in by a broad spectrum of people. Given its association with psychological difficulties and suicide risk, it’s critical self-injury be taken seriously and not dismissed or glossed over.




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People who engage in self-injury need to know it’s okay to seek support (from friends, family, and health professionals) and that people can and do recover.

For anyone who knows someone who self-injures, it’s important to respond to that person in a non-judgemental and compassionate manner. Just knowing there is someone supportive who is willing to listen can make a big difference to a person who self-injures.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Penelope Hasking, Associate Professor of Psychology, Curtin University and Stephen P. Lewis, Associate Professor of Psychology, University of Guelph

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Depression: it’s a word we use a lot, but what exactly is it?



People with depression experience symptoms that affect their mood, cognitive function and physical health.
from http://www.shutterstock.com, CC BY-ND

Samuel Clack, Victoria University of Wellington and Tony Ward, Victoria University of Wellington

Depression is a serious disorder marked by disturbances in mood, cognition, physiology and social functioning.

People can experience deep sadness and feelings of hopelessness, sorrow, emptiness and despair. These core features of depression have expanded to include an inability to experience pleasure, sluggish movements, changes in sleep and eating behaviour, difficulty concentrating and suicidal thoughts.

The first diagnostic criteria were introduced in the 1980s. Now we have an expanded set of concepts for describing depression, from mild to severe, major depressive disorder, chronic depression and seasonal affective disorder.

Over the past 50 years, our understanding of depression has advanced significantly. But despite the wealth of research, there is no clear consensus on how this mental disorder should be explained. We propose a new route through the thicket.




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Classifying mental disorders

How we describe and classify mental disorders is a fundamental step towards explaining and treating them. When carrying out research on people with depression, diagnostic categories such as major depressive disorder (MDD) shape our explanations. But if the descriptions are wrong, our explanations will suffer as a consequence.

The problem is that classification and explanation are not completely independent tasks. How we classify disorders directly impacts how we explain them, and these explanations in turn impact our classifications. In this way, psychiatry is stuck in a circular trap.

The danger – for depression and for other mental disorders – is that we tailor our explanations to fit the classifications available and that the classifications are inadequate.

Traditionally, research has focused on understanding mental disorders as classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders. Most of these disorders are what we call “psychiatric syndromes” – clusters of symptoms that hang together in some meaningful way and are assumed to share a common cause.

But many of these syndromes are poorly defined because disorders can manifest in different ways in different people. This is known as “disorder heterogeneity”. For example, there are 227 different symptom combinations that meet the criteria for major depressive disorder.




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Improving how we classify disorders

The other problem is that diagnostic criteria often overlap across multiple disorders. Symptoms of restlessness, fatigue, difficulty concentrating, irritability and sleep disturbance can be common for people experiencing generalised anxiety disorder or major depressive disorder.

This makes studying disorders like depression difficult. While we may think we are all explaining the same thing, we are actually trying to explain completely different variations of the disorder, or in some cases a completely different disorder.

A significant challenge is how to advance classification systems without abandoning their descriptive value and the decades of research they have produced. So what are our options?

A categorical approach, which sees disorders as discrete categories, has been the most prominent model of classification. But many researchers argue disorders such as depression are better seen as dimensional. For example, people who suffer from severe depression are just further along a spectrum of “depressed mood”, rather than being qualitatively different from the normal population.




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Novel classification approaches such as the hierarchical taxonomy of psychopathology and research domain criteria have been put forward. While these better accommodate the dimensional nature of disorders and are less complex to use, they are conceptually limited.

The former relies on current diagnostic categories and all the problems that come with that. The latter relies on neuro-centrism, which means mental disorders are viewed as disorders of the brain and biological explanations are used in preference to social and cultural explanations.

A new approach called the symptom network model offers a departure from the emphasis on psychiatric syndromes. It sees mental disorders not as diseases but as the result of interactions between symptoms.

In depression, an adverse life event such as loss of a partner may activate a depressed mood. This in turn may cause neighbouring symptoms, such as insomnia and fatigue. But this model is only descriptive and offers no explanation of the processes that cause the symptoms themselves.

A simple way forward

We suggest that one way of advancing understanding of mental disorders is to move our focus from psychiatric syndromes to clinical phenomena.

Phenomena are stable and general features. Examples in clinical psychology include low self-esteem, aggression, low mood and ruminative thoughts. The difference between symptom and phenomena is that the latter are inferred from multiple information sources such as behavioural observation, self-report and psychological test scores.

For example, understanding the central processes that underpin the clinical phenomenon of the inability to experience pleasure (anhedonia) will provide greater insight for cases that are dominated by this symptom.

In this way we can begin to tailor our explanations for individual cases rather than using general explanations of the broad syndrome “major depressive disorder”.

The other advantage is that the central processes that make up these phenomena are also more likely to form reliable clusters or categories. Of course, achieving this understanding will require greater specification of clinical phenomena we want to explain. It is not enough to conclude that a research finding (such as low levels of dopamine) is associated with the syndrome depression, as the features of depression may vary significantly between individuals.

We need to be more specific about exactly what people with depression in our research are experiencing.

Building descriptions of clinical phenomena will help us to better understand links between signs, symptoms and causes of mental disorder. It will put us in a better position to identify and treat depression.The Conversation

Samuel Clack, PhD Candidate, Victoria University of Wellington and Tony Ward, Professor of Clinical Psychology, Victoria University of Wellington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How many people have eating disorders? We don’t really know, and that’s a worry



Eating disorders disproportionately affect females and young people.
From shutterstock.com

Laura Hart, University of Melbourne

Last week, federal health minister Greg Hunt announced that more than 60,000 Australians will be asked about their mental health and well-being as part of the Intergenerational Health and Mental Health Study.

The mental health survey will be run in 2020, with new data on how common mental illness is due the year after. This is a welcome announcement for the mental health sector, because information gathered in a survey like this can be used to shape policy reform.




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But eating disorders, a major category of mental illnesses, have been neglected by all previous important data collection initiatives in Australia so far. Notably, they were missing from the last national mental health surveys in 1997 and 2007.

Eating disorders are not yet an official part of this new survey, but we understand they are being considered.

If people with eating disorders are not counted, they don’t count. In other words, we need to know who has these severe and debilitating conditions, and then work towards improving the treatment and supports available for them.




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Surveys are important

National surveys ask the public if they have experienced symptoms of various mental illnesses, either in their lifetime or during the past 12 months.

People who answer “yes” to particular clusters of symptoms are “diagnosed”, or assumed to have had the illness.

Asking the public about their symptoms is the best way to understand how common mental illnesses are. This is because most people with a mental illness don’t seek treatment and may never have had a diagnosis. So collecting data from health services or based on reported diagnoses doesn’t provide a full picture.

Also, for some mental illnesses, such as anorexia nervosa or psychosis, people might not realise they have a diagnosable illness. But they are likely to respond “yes” to direct questions about their experiences with body dissatisfaction or thinking difficulties.

Eating disorders are more than just anorexia

A person with anorexia nervosa engages in dangerous behaviours to maintain a very low body weight, or to lose more weight. Although most people have heard of it, anorexia is not common. We know this from other countries who have previously studied the prevalence of anorexia in community surveys.

That being said, it’s very serious and can be fatal. It has the highest mortality of all non-substance use mental disorders, and one in five of those deaths is by suicide.




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Other eating disorders include bulimia nervosa, binge-eating disorder, and “other specified feeding and eating disorders” (OSFED), a catch-all group for those who don’t fit anywhere else.

People with bulimia nervosa or binge-eating disorder experience cycles of binge-eating, often after periods of restricting foods, which cause shame, guilt and discomfort.

Those with bulimia compensate for binge-eating through vomiting, fasting, exercise or other methods, while those with binge-eating disorder do not.

Binge-eating disorder is the most common of all eating disorders and occurs more equally across men and women than other eating disorders.

As well as continued weight gain, people with binge-eating disorder are more likely to experience depression and anxiety, and other significant health problems (such as asthma, diabetes, and arthritis) than people with a high BMI (body-mass index) but no binge-eating disorder.

Binge-eating disorder is the most common eating disorder.
From shutterstock.com

One example of OSFED is atypical anorexia nervosa – when someone shows all the symptoms of anorexia and has lost a significant amount of weight but their BMI is in the “normal” or “high” range.

Eating disorders disproportionately affect females, young people, LGBTIQ individuals, and those with a high BMI.

People with eating disorders often have a negative body image, and a strong perception their self-worth is tied to their appearance or body weight.

Burden of disease

Every year in Australia, millions of years of healthy life are lost because of injury, illness or premature deaths in the population. This is known as “burden of disease”.

Like national surveys, burden of disease studies are extremely important for planning and funding health services. They use prevalence statistics, or how many people per 100,000 Australians are assumed to have a particular illness. Given we don’t have good data on how prevalent eating disorders are, we likely underestimate their burden of disease.




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The recently released Australian Burden of Disease Study 2015 lists eating disorders among the most burdensome illnesses for Australian females, being the tenth leading cause of total burden of disease for females aged 5-14 and women aged 25-44.

Importantly, the most common eating disorder – binge-eating disorder – is not included in burden of disease studies, meaning all these figures miscalculate the impact of eating disorders by a long way.

Eating disorders are on the rise

Despite our lack of prevalence data, there is evidence showing eating disorders are an increasing problem and should be regarded as a national priority.

Consecutive population surveys in South Australia showed the numbers of people with eating disorders climbed over a ten-year period.

Annual youth surveys demonstrate body image, the most potent risk factor for eating disorders, is year after year among the top concerns for young people.

A recent study on adolescents in the Hunter Valley region of NSW found one in five had experienced an eating disorder.

Treatment and prevention

People with eating disorders use more health services than people with all other forms of mental illness, but often don’t receive appropriate and effective treatment. They typically receive treatment for weight loss, depression or anxiety, but are rarely treated for their disordered eating.

Eating disorders were estimated to cost the health system A$99.9 million in the year 2012 alone.

Better treatment and prevention of eating disorders would reduce the cost and the burden of disease. But we need the data to show where the treatment gaps are and how to fund better services.

There are many promising elements of the proposed Intergenerational Health and Mental Health Study. These include surveying multiple people in a family, gathering physical and mental health data, and a target of more than 60,000 Australians. But it’s time eating disorders were included.




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The Conversation


Laura Hart, Senior Research Fellow, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, eating chocolate won’t cure depression



If you’re depressed, the headlines might tempt you to reach out for a chocolate bar. But don’t believe the hype.
from www.shutterstock.com

Ben Desbrow, Griffith University

A recent study published in the journal Depression and Anxiety has attracted widespread media attention. Media reports said eating chocolate, in particular, dark chocolate, was linked to reduced symptoms of depression.

Unfortunately, we cannot use this type of evidence to promote eating chocolate as a safeguard against depression, a serious, common and sometimes debilitating mental health condition.

This is because this study looked at an association between diet and depression in the general population. It did not gauge causation. In other words, it was not designed to say whether eating dark chocolate caused a reduction in depressive symptoms.




Read more:
What causes depression? What we know, don’t know and suspect


What did the researchers do?

The authors explored data from the United States National Health and Nutrition Examination Survey. This shows how common health, nutrition and other factors are among a representative sample of the population.

People in the study reported what they had eaten in the previous 24 hours in two ways. First, they recalled in person, to a trained dietary interviewer using a standard questionnaire. The second time they recalled what they had eaten over the phone, several days after the first recall.

The researchers then calculated how much chocolate participants had eaten using the average of these two recalls.

Dark chocolate needed to contain at least 45% cocoa solids for it to count as “dark”.




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The researchers excluded from their analysis people who ate an implausibly large amount of chocolate, people who were underweight and/or had diabetes.

The remaining data (from 13,626 people) was then divided in two ways. One was by categories of chocolate consumption (no chocolate, chocolate but no dark chocolate, and any dark chocolate). The other way was by the amount of chocolate (no chocolate, and then in groups, from the lowest to highest chocolate consumption).




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The researchers assessed people’s depressive symptoms by having participants complete a short questionnaire asking about the frequency of these symptoms over the past two weeks.

The researchers controlled for other factors that might influence any relationship between chocolate and depression, such as weight, gender, socioeconomic factors, smoking, sugar intake and exercise.

What did the researchers find?

Of the entire sample, 1,332 (11%) of people said they had eaten chocolate in their two 24 hour dietary recalls, with only 148 (1.1%) reporting eating dark chocolate.

A total of 1,009 (7.4%) people reported depressive symptoms. But after adjusting for other factors, the researchers found no association between any chocolate consumption and depressive symptoms.

Few people said they’d eaten any chocolate in the past 24 hours. Were they telling the truth?
from www.shutterstock.com

However, people who ate dark chocolate had a 70% lower chance of reporting clinically relevant depressive symptoms than those who did not report eating chocolate.

When investigating the amount of chocolate consumed, people who ate the most chocolate were more likely to have fewer depressive symptoms.

What are the study’s limitations?

While the size of the dataset is impressive, there are major limitations to the investigation and its conclusions.

First, assessing chocolate intake is challenging. People may eat different amounts (and types) depending on the day. And asking what people ate over the past 24 hours (twice) is not the most accurate way of telling what people usually eat.

Then there’s whether people report what they actually eat. For instance, if you ate a whole block of chocolate yesterday, would you tell an interviewer? What about if you were also depressed?

This could be why so few people reported eating chocolate in this study, compared with what retail figures tell us people eat.




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Finally, the authors’ results are mathematically accurate, but misleading.

Only 1.1% of people in the analysis ate dark chocolate. And when they did, the amount was very small (about 12g a day). And only two people reported clinical symptoms of depression and ate any dark chocolate.

The authors conclude the small numbers and low consumption “attests to the strength of this finding”. I would suggest the opposite.

Finally, people who ate the most chocolate (104-454g a day) had an almost 60% lower chance of having depressive symptoms. But those who ate 100g a day had about a 30% chance. Who’d have thought four or so more grams of chocolate could be so important?

This study and the media coverage that followed are perfect examples of the pitfalls of translating population-based nutrition research to public recommendations for health.

My general advice is, if you enjoy chocolate, go for darker varieties, with fruit or nuts added, and eat it mindfully. — Ben Desbrow


Blind peer review

Chocolate manufacturers have been a good source of funding for much of the research into chocolate products.

While the authors of this new study declare no conflict of interest, any whisper of good news about chocolate attracts publicity. I agree with the author’s scepticism of the study.

Just 1.1% of people in the study ate dark chocolate (at least 45% cocoa solids) at an average 11.7g a day. There was a wide variation in reported clinically relevant depressive symptoms in this group. So, it is not valid to draw any real conclusion from the data collected.

For total chocolate consumption, the authors accurately report no statistically significant association with clinically relevant depressive symptoms.

However, they then claim eating more chocolate is of benefit, based on fewer symptoms among those who ate the most.

In fact, depressive symptoms were most common in the third-highest quartile (who ate 100g chocolate a day), followed by the first (4-35g a day), then the second (37-95g a day) and finally the lowest level (104-454g a day). Risks in sub-sets of data such as quartiles are only valid if they lie on the same slope.

The basic problems come from measurements and the many confounding factors. This study can’t validly be used to justify eating more chocolate of any kind. — Rosemary Stanton


Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.The Conversation

Ben Desbrow, Associate Professor, Nutrition and Dietetics, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More Australians are diagnosed with depression and anxiety but it doesn’t mean mental illness is rising



Women are almost twice as likely to be diagnosed with depression or anxiety as men.
Eric Ward

Anthony Jorm, University of Melbourne

Diagnoses of depression and anxiety disorders have risen dramatically over the past eight years. That’s according to new data out today from the Housing Income and Labour Dynamics (HILDA) Survey, which tracks the lives of 17,500 Australians.

The increase spans across all age groups, but is most notably in young people.

The percentage of young women (aged 15-34) who had been diagnosed with these conditions increased from 12.8% in 2009, to 20.1% in 2017.

In young men, there was a similar increase, from 6.1% to 11.2%.

But this doesn’t mean Australians’ mental health is worsening.




Read more:
Explainer: what is an anxiety disorder?


What’s behind the numbers?

HILDA surveys collate data on the “reported diagnosis” of depression and anxiety disorders. Many people with these conditions have remained undiagnosed by a health practitioner, so it could simply be a matter of more people seeking professional help and getting diagnosed.

To find out whether there is a real increase, we need to survey a sample of the public about their symptoms rather than ask about whether they have been diagnosed. This has been done for almost two decades in the National Health Survey.

This graph shows the percentage of the population reporting very high levels of depression and anxiety symptoms over the previous month, from 2001 to 2017-18.

Rather than worsening, the nation’s mental health has been steady over this period.

Shouldn’t our mental health be improving?

So it seems while our mental health is not getting worse, we are more likely to get diagnosed. With increased diagnosis, it’s no surprise Australians have been rapidly embracing treatments for mental-health problems.

Antidepressant use has been rising for decades, with Australians now among the world’s highest users. One in ten Australian adults take an antidepressant each day.




Read more:
If you’re coming off antidepressants, withdrawals and setbacks may be part of the process


Psychological treatment has also skyrocketed, particularly after the Australian government introduced Medicare coverage for psychology services in 2006. There are now around 20 psychology services per year for every 100 Australians.

The real concern is why we’re not seeing any benefit from these large increases in diagnosis and treatment. In theory, our mental health should be improving.

There are two likely reasons for the lack of progress: the treatments are often not up to standard and we have neglected prevention.

Treatment is often poor quality

A number of treatments work for depression and anxiety disorders. However, what Australians receive in practice falls far short of the ideal.

Antidepressants, for example, are most appropriate for severe depression, but are often used to treat people with mild symptoms that reflect difficult life circumstances.

It takes more than a couple of sessions with a psychologist to treat a mental health disorder.
Kylli Kittus

Psychological treatments can be effective, but require many sessions. Around 16 to 20 sessions are recommended to treat depression. Getting a couple of sessions with a psychologist is too often the norm and unlikely to produce much improvement.

Treatments are also not distributed to the people most in need. The biggest users of antidepressants are older people, whereas younger people are more likely to experience severe depression.

Similarly, people in wealthier areas are more likely to get psychological therapy, but depression and anxiety disorders are more common in poorer areas.




Read more:
When it’s easier to get meds than therapy: how poverty makes it hard to escape mental illness


Prevention is neglected

The big area of neglect in mental health is prevention. Australia achieved enormous gains in physical health during the 20th century, with big drops in premature death. Prevention of disease and injury played a major role in these gains.

We might expect a similar approach to work for mental-health problems, which are the next frontier for improving the nation’s health. However, while we have been putting increasing resources into treatment, prevention has been neglected.

There is now good evidence that prevention of mental-health problems is possible and that it makes good economic sense. For every dollar invested on school-based interventions to reduce bullying, for instance, there is an estimated economic return of $14.

Much could to be done to reduce the major risk factors for mental-health problems which occur during childhood and increase risk right across the lifespan.

Parents who are in conflict with each other and fight a lot, for example, may increase their children’s risk for depression and anxiety disorders, while parents who show warmth and affection towards their children decrease their risk. Parents can be trained to reduce these risk factors and increase protective factors.

Yet successive Australian governments have lacked the political will to invest in prevention.

Where to next?

There is an important opportunity to consider whether Australia should be heading in a very different direction in its approach to mental health. The Australian government has asked the Productivity Commission to investigate mental health.

While we’ve had many previous inquiries, this one is different because it’s looking at the social and economic benefits of mental health to the nation. This broader perspective is important because action on prevention is a whole-of-government concern with resource implications and benefits that extend well beyond the health sector.




Read more:
There’s a reason you’re feeling no better off than 10 years ago. Here’s what HILDA says about well-being


The Conversation


Anthony Jorm, Professor emeritus, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Mood and personality disorders are often misconceived: here’s what you need to know


Kathryn Fletcher, Swinburne University of Technology and Kristi-Ann Villagonzalo, Swinburne University of Technology

With each new version of the widely-used manual of mental disorders, the number of mental health conditions increases. The latest version (DSM-5) lists around 300 disorders. To complicate things, many share common features, such as depression and anxiety.

The manual is a useful guide for doctors and researchers, but making a diagnosis is not a precise science. So if the “experts” are still debating what’s what when it comes to categorising disorders, it’s not surprising misconceptions abound in the community about certain mental health conditions.

We learn about mental health conditions in a number of ways. Either we know someone who has experienced it, we’ve experienced it ourselves, read about it or seen something on TV. Movies and TV series commonly portray people with mental illness as dangerous, scary and unpredictable. The most popular (mis)representations are of characters with multiple personalities, personality disorders, schizophrenia and bipolar disorder.




Read more:
The emotion centre is the oldest part of the human brain: why is mood so important?


While the media is an important source of information about mental illness, it can misinform the public if reported inaccurately, promoting stigma and perpetuating myths. And research shows negative images of mental illness in the media (fictional and non-fictional) results in negative and inaccurate beliefs about mental illness.

Dissociative identity disorder

“Multiple personality disorder” or “split personality disorder” are colloquial terms for dissociative identity disorder. Despite being colloquially named a personality disorder, it’s actually a dissociative disorder.

A personality disorder is a long-term way of thinking, feeling and behaving that deviates from the expectations of culture. Whereas in dissociative identity disorder, at least two alternate personalities (alters) routinely take control of the individual’s behaviour. The individual is usually unable to remember what happened when an alter takes over: there are noticeble gaps in their memory, which can be extremely distressing.




Read more:
Dissociative identity disorder exists and is the result of childhood trauma


The popular TV series “The United States of Tara” actually does a pretty good job of portraying dissociative identity disorder. The main character has a series of alters and experiences recurrent gaps in her memory.

While it used to be considered rare, dissociative identity disorder is estimated to affect 1% of the general population, and is typically related to early trauma (such as childhood abuse). People commonly confuse dissociative identity disorder with schizophrenia. Unlike schizophrenia, the individual is not imagining external voices or experiencing visual hallucinations: one personality literally “checks out” and another appears in their place.

Borderline personality disorder

Borderline personality disorder is often misconstrued. People with this condition are often portrayed as manipulative, destructive and violent. In reality, these behaviours are driven by emotional pain: the person has never learned to ask effectively for what they need or want.

It is also often assumed “borderline” means the person almost has a personality disorder. The term “borderline” here creates some confusion. First introduced in the United States in 1938, the term was used by psychiatrists to describe patients who were thought to be on the “border” between diagnoses (mostly psychosis and neurosis). The term “borderline” has stuck in the diagnosis, but there is now a much better understanding of the causes, symptoms and treatment.




Read more:
Borderline personality disorder is a hurtful label for real suffering – time we changed it


Those with borderline personality disorder have difficulties regulating their emotions. This contributes to angry outbursts, anxiety and depression, and relationships fraught with difficulties. It’s also commonly associated with trauma (such as childhood abuse or neglect).

Many actions of a person with borderline personality disorder (such as self-harm and overdose) are done out of desperation in an attempt to manage difficult and intense emotions.




Read more:
Explainer: what is borderline personality disorder?


Bipolar disorder

While borderline personality disorder and bipolar disorder can look similar (mood problems, impulsive behaviour and suicidal thinking), there are several key differences.

Bipolar disorder is characterised by extreme mood swings – from severe lows (depression) to periods of high activity, energy and euphoria. The different mood states can seem like a personality change, but a return to the “usual self” occurs once mood stabilises.

While depression is part of borderline personality disorder and bipolar disorder, those with bipolar disorder experience significant “up” mood swings. This is known as mania in bipolar I disorder and hypomania (less intense mania) in bipolar II disorder.




Read more:
Explainer: what is bipolar disorder?


Bipolar mood episodes last longer (four days or longer for “ups” and two weeks or longer for “downs”), with periods of wellness in between, and are less likely to be triggered by external events. And bipolar disorder is more likely to run in families, disrupt sleep patterns, and psychotic symptoms (delusions, hallucinations) can occur during mood episodes.

We all have ups and downs, but bipolar disorder is much more than that with extreme, recurrent mood episodes that are not only distressing, but have a significant long-term impact on key areas of a persons’s life. Positively, with the right treatment, good quality of life is entirely possible despite ongoing symptoms.

Schizophrenia

Schizophrenia, meaning “split mind” in Greek, is often confused with dissociative identity disorder. However, the “split” refers not to multiple personalities, but to a “split” from reality. People with schizophrenia may find it difficult to discern whether their perceptions, thoughts, and emotions are based in reality or not.

Hearing voices (auditory hallucinations) is a common symptom, along with seeing, smelling, feeling, or tasting things others can’t. Unusual beliefs (delusions), including some that cannot possibly be true (such as a belief that one has special powers) are also common. So too is disordered thinking, where the person jumps from one topic to another at random, or makes strange associations to things that don’t make sense. They may also exhibit bizarre behaviour including socially inappropriate outbursts or wearing odd clothing that is inappropriate to the circumstances.

Other symptoms of schizophrenia look a lot like depression, such as an inability to experience pleasure, social withdrawal and low motivation. Depressive symptoms are also present in schizophrenia, but are slightly different in that emotion is diminished altogether, rather than a depressed mood per se.




Read more:
Either mad and bad or Jekyll and Hyde: media portrayals of schizophrenia


Mental health conditions don’t come in neat packages

Unlike physical conditions, we don’t have a biological test that can magically tell us what mental condition we’re dealing with. Mental health practitioners are carefully trained to observe symptom patterns: the right diagnosis guides the appropriate treatment.

For example, first-line treatment of schizophrenia and bipolar disorder often focuses on medication. While dissociative identity disorder and borderline personality disorders are treated primarily with psychological therapy.

The ConversationMental health conditions are serious – whether disorders of personality, mood or somewhere in between. Improved understanding and balanced representation of these conditions is needed to shift stigmas and misconceptions in the community.

Kathryn Fletcher, Postdoctoral Research Fellow, Swinburne University of Technology and Kristi-Ann Villagonzalo, Postdoctoral Research Fellow, Swinburne University of Technology

This article was originally published on The Conversation. Read the original article.

What is mindfulness? Nobody really knows, and that’s a problem



File 20170926 13681 67g4et.jpg?ixlib=rb 1.1
The concept of mindfulness differs depending on who you speak to.
Lua Valentia/Unsplash

Nicholas T. Van Dam, University of Melbourne and Nick Haslam, University of Melbourne

You’ve probably heard of mindfulness. These days, it’s everywhere, like many ideas and practices drawn from Buddhist texts that have become part of mainstream Western culture.

But a review published today in the journal Perspectives on Psychological Science shows the hype is ahead of the evidence. Some reviews of studies on mindfulness suggest it may help with psychological problems such as anxiety, depression, and stress. But it’s not clear what type of mindfulness or meditation we need and for what specific problem.

The study, involving a large group of researchers, clinicians and meditators, found a clear-cut definition of mindfulness doesn’t exist. This has potentially serious implications. If vastly different treatments and practices are considered the same, then research evidence for one may be wrongly taken as support for another.

At the same time, if we move the goalposts too far or in the wrong direction, we might lose the potential benefits of mindfulness altogether.

So, what is mindfulness?

Mindfulness receives a bewildering assortment of definitions. Psychologists measure the concept in differing combinations of acceptance, attentiveness, awareness, body focus, curiosity, nonjudgmental attitude, focus on the present, and others.

It’s equally ill-defined as a set of practices. A brief exercise in self-reflection prompted by a smart-phone app on your daily commute may be considered the same as a months-long meditation retreat. Mindfulness can both refer to what Buddhist monks do and what your yoga instructor does for five minutes at the start and end of a class.

To be clear, mindfulness and meditation are not the same thing. There are types of meditation that are mindful, but not all mindfulness involves meditation and not all meditation is mindfulness-based.

Mindfulness mainly refers to the idea of focusing on the present moment, but it’s not quite that simple. It also refers to several forms of meditation practices that aim to develop skills of awareness of the world around you and of your behavioral patterns and habits. In truth, many disagree about its actual purpose and what is and isn’t mindfulness.

Mindfulness can both refer to what Buddhist monks do and what your yoga instructor does for five minutes at the start and end of a class.
from shutterstock.com

What’s it for?

Mindfulness has been applied to just about any problem you can think up – from relationship issues, problems with alcohol or drugs, to enhancing leadership skills. It’s being used by sportsmen to find “clarity” on and off the field and mindfulness programs are being offered at school. You can find it in workplaces, medical clinics, and old age homes.

More than a few popular books have been written touting the benefits of mindfulness and meditation. For example, in a supposedly critical review Altered Traits: Science Reveals How Meditation Changes your Mind, Brain and Body, Daniel Goleman argues one of the four benefits of mindfulness is improved working memory. Yet, a recent review of about 18 studies exploring the effect of mindfulness-based therapies on attention and memory calls into question these ideas.

Another common claim is that mindfulness reduces stress, for which there is limited evidence. Other promises, such as improved mood and attention, better eating habits, improved sleep, and better weight control are not fully supported by the science either.

And while benefits have limited evidence, mindfulness and meditation can sometimes be harmful and can lead to psychosis, mania, loss of personal identity, anxiety, panic, and re-experiencing traumatic memories. Experts have suggested mindfulness is not for everyone, especially those suffering from several serious mental health problems such as schizophrenia or bipolar disorder.

Research on mindfulness

Another problem with mindfulness literature is that it often suffers from poor research methodology. Ways of measuring mindfulness are highly variable, assessing quite different phenomena while using the same label. This lack of equivalence among measures and individuals makes it challenging to generalise from one study to another.

Mindfulness researchers rely too much on questionnaires, which require people to introspect and report on mental states that may be slippery and fleeting. These reports are notoriously vulnerable to biases. For example, people who aspire to mindfulness may report being mindful because they see it as desirable, not because they have actually achieved it.

Evidence calls into question claims that mindfulness can help with memory.
from shutterstock.com

Only a tiny minority of attempts to examine whether these treatments work compare them against another treatment that is known to work – which is the primary means by which clinical science can show added value of new treatments. And a minority of these studies are conducted in regular clinical practices rather than in specialist research contexts.

A recent review of studies, commissioned by the US Agency for Healthcare Research and Quality, found many studies were too poorly conducted to include in the review and that mindfulness treatments were moderately effective, at best, for anxiety, depression, and pain. There was no evidence of efficacy for attention problems, positive mood, substance abuse, eating habits, sleep or weight control.

What should be done?

Mindfulness is definitely a useful concept and a promising set of practices. It may help prevent psychological problems and could be useful as an addition to existing treatments. It may also be helpful for general mental functioning and well-being. But the promise will not be realised if problems are not addressed.

The mindfulness community must agree to key features that are essential to mindfulness and researchers should be clear how their measures and practices include these. Media reports should be equally specific about what states of mind and practices mindfulness includes, rather than using it as a broad term.

Mindfulness might be assessed, not through self-reporting, but in part using more objective neurobiological and behavioural measures, such as breath counting. This is where random tones could be used to “ask” participants if they are focused on the breath (press left button) or if their mind had wandered (press right button).

Researchers studying the efficacy of mindfulness treatments should compare them to credible alternative treatments, whenever possible. Development of new mindfulness approaches should be avoided until we know more about the ones we already have. Scientists and clinicians should use rigorous randomised control trials and work with researchers from outside the mindfulness tradition.

The ConversationAnd lastly, mindfulness researchers and practitioners should acknowledge the reality of occasional negative effects. Just as medications must declare potential side effects, so should mindfulness treatments. Researchers should systematically assess potential side effects when studying mindfulness treatments. Practitioners should be alert to them and not recommend mindfulness treatments as a first approach if safer ones with stronger evidence of efficacy are available.

Nicholas T. Van Dam, Research Fellow in Psychological Sciences, University of Melbourne and Nick Haslam, Professor of Psychology, University of Melbourne

This article was originally published on The Conversation. Read the original article.