Veterans with specific mental health disorders—depression , psychosis and bipolar disorder—had an increased risk of heart attack, stroke and death from cardiovascular disease, according to new research published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
The link between mental illness and cardiovascular disease is well established. However, there has been little research and data on which mental health conditions pose the highest risk for cardiovascular disease.
In this study, researchers assessed veterans at risk for major heart disease and stroke events and death associated with depression, anxiety, PTSD, psychosis and bipolar disorder. The analysis included data from more than 1.6 million veterans ages 45 to 80 who received care in the Department of Veterans Affairs healthcare system from 2010-2014. About 45% of the men and 63% of the women had been diagnosed with a mental health disorder.
When controlling for age, cardiovascular risk factors such as blood pressure and cholesterol, other mental health conditions and psychiatric medications, both men and women with various mental health diagnoses except post-traumatic stress disorder had a higher risk of cardiovascular events and death over five years. Additional findings from this study:
In particular, among men, depression, anxiety, psychosis and bipolar disorder were associated with an increased risk of death from cardiovascular disease. And, depression, psychosis and bipolar disorder were also linked to cardiovascular events such as heart attack and stroke.
Among women, depression, psychosis and bipolar disorder posed a higher cardiovascular disease risk. Psychosis and bipolar disorder also increased the risk of death.
A diagnosis of psychosis, such as schizophrenia, among both men and women posed the strongest risk for heart attack, stroke and death from cardiovascular disease.
A PTSD diagnosis among men in the study was associated with a lower risk of cardiovascular disease compared to the study population as a whole. This finding differed from some previous studies.
According to the study authors, this is the largest-scale assessment of the associations among different psychiatric conditions and major cardiovascular outcomes. Researchers state that these findings have implications for estimating cardiovascular risk among patients and determining who might benefit from interventions such as cholesterol-lowering medications and blood pressure treatment.
This study was not designed to assess why veterans with mental health conditions have heightened cardiovascular risk, although the authors raise the possibility that chronic stress due to mental health problems could play a role.
“The bottom line is that when considering a veteran’s health care needs, mental health status, especially for more severe mental illnesses, should be taken into consideration when calculating cardiovascular disease risk and considering the appropriate treatment options,” said Mary C. Vance, M.D., M.Sc., an employee of the Henry M. Jackson Foundation working as assistant professor of psychiatry at the Uniformed Services University School of Medicine and lead author of the study.
The researchers say that although their study population was large, results could differ in a population outside of the Veterans Affairs health system.
For people with severe mental illness, cardiovascular disease risk may be underestimated
Veterans with mental health conditions have higher risk of heart disease, stroke (2019, September 24)
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The statistics about children’s mental health in the UK are shocking. So what can we do to help?
In part one of our exclusive new series, This Morning’s resident psychologist Emma Kenny explains the warning signs parents should look out for….
What has gone wrong with our children’s mental health?
It seems that every day there’s a heartbreaking story hitting the headlines, and official government statistics make for shocking reading.
The number of UK children and teenagers diagnosed with mental health problems is growing.
Self-harm rates have tripled during the past five years and teenage suicide has risen in England and Wales by 67% since 2010.
Time and time again, all the evidence suggests that young people in the UK are more unhappy than ever.
But why is this? And what can we do to help?
What is going on?
Mental health affects all children and young people to some degree. For example, many struggle with anxiety and low mood.
On top of this, exam-related stress, relationship issues, family breakdown or personal insecurities will cause most children to feel unhappy, depressed or anxious at some point in their life.
However, while these feelings are usually short-lived, for some children they can trigger more serious problems.
I feel there has never been a more confusing time for young people. We talk constantly about mental health, and we advise children and teens to be honest about their feelings.
But what actually happens when they do open up?
The truth is that resources for children and young people who are struggling are inadequate, and are usually only offered when mental distress levels are acute.
Instead, there should be help available at every level, from the child who simply acknowledges that they “just don’t feel happy”, to those who are at immediate risk of self-harm.
Look for any out-of-character bad behaviour. As a parent, it’s natural to feel upset if your child starts getting into trouble at school on a regular basis.
However, instead of punishing them, bear in mind this behaviour may be a symptom of the way they feel.
Grounding them, or taking their phone away, will not resolve their difficult feelings so put support strategies in place instead, such as seeing the school counsellor.
Lack of interest
Investigate if your child suddenly loses interest in activities they love. Ask them why they’ve stopped.
If they say the activity is “so last week”, chances are they are simply growing up. However, if they can’t put their finger on what has changed and appear less positive than usual, something may be going on behind the scenes that requires attention.
Fits of anger
Unexplained anger can signify something else is going on. Children and teenagers often become very angry when they are feeling lost, anxious or depressed, because these feelings are overwhelming.
If you find yourself butting heads with your once well-behaved child, take a step back from your own feelings so you can deal with theirs.
When you meet anger with empathy, compassion and reassurance, you often break through and find a confused and scared child behind it.
You will find getting to the heart of the issue easier once they have calmed down.
If your child’s mood seems low for any length of time, talk to them. Explain you feel they may be struggling.
Reassure them you’re on their side and want to help. If they tell you everything is OK, don’t push them.
Instead, tell them you are there for them whenever they need you. Then try again in a couple of days.
The moody teenager myth
Teenagers are known for moody behaviour, but this can be a dangerous stereotype as changes in mood can also be a sign your teen is struggling emotionally.
This is why the most important aspect of any parent-child relationship is communication.
While you may find your child isn’t keen to talk at first, persevering until they see a daily check-in chat as part of your family routine ensures two things.
Firstly, they know you are genuinely interested in their life and, secondly, you are likely to recognise if they are struggling and pick up problems at an early stage.
Other signs that a teenager could be unhappy include if they withdraw to their bedrooms for long periods of time or stop socialising with their friends.
Some teenagers struggle with the hormonal changes that occur during puberty. Slamming doors, screaming blue murder and being highly disrespectful can be mistaken for unacceptable
However, these types of behaviour are often more to do with your child feeling overwhelmed and seeking an outlet for their unmanageable emotions.
Teens often struggle to express their feelings because they don’t fully understand what is making them so unhappy in the first place.
If you think your teen is struggling with explosive moods, they may require some extra advice from a healthcare professional.
How to talk about mental health
Start talking to your children about mental health – what it is, why it is important and what you can do to positively maintain it – as early as you can.
If you make it clear you are comfortable talking about anything and everything to do with mental health, they will see it as something that is entirely natural to discuss with other people.
If you have concerns about your child’s mental health, it’s best to discuss it without having an obvious agenda.
Instead, throw it into conversation when you are walking the dog, cooking, hanging out or in the car.
Simply suggesting that you have noticed they are quieter than usual, or don’t seem quite as positive, is a good way to show you’ve been paying attention.
Sometimes, with the best will in the world, your child will not wish to engage and that’s OK. Remind them that they are loved and that you’re always there for them.
Explain that nothing they could tell you would ever stop them being loved and that even when they feel alone, they are not.
Finally, make it clear that you are always there if they need a chat, a cup of tea or a cuddle.
Back to school blues
Last week, millions of children and teenagers went back to school. And while many will have been excited to start the new academic year, unfortunately that’s not the case for all of them.
School can be a tough place for some children, and it can make the idea of returning after the summer holidays feel terrifying.
One common problem is back-to-school anxiety. Often children are expected to just ‘get on with it’, but this sort of reaction to their concerns can be very damaging.
Anxiety is part of the brain’s self-defence system and whether real or imaginary, anxious children are reacting to a perceived danger. This
is why tough love, punishment or negotiation just won’t work.
Instead, help your child understand why they are feeling anxious and what they can do to help themselves.
- The moment your child starts feeling anxious, tell them to breathe in through their nose, then out again, for three counts. Even very young children can master this relaxation technique, and it instructs the brain to slow down.
- If your child has worked themselves into a state, they have triggered their fight or flight response. This is their body’s way of preparing to escape. A few minutes of vigorous exercise is a good way to get rid of this nervous energy and helps them calm down.
- Organisation can help to reduce nerves. When you feel in charge of your life, you automatically feel better about things. Help your child make a checklist of things they need each day for school. Ensure they are happy with their uniform, and allow them choices about the way they wish to look.
- A good sleep routine is essential to reduce anxiety, and spending time outdoors in nature has also been shown to boost mood.
- Foster an attitude of gratitude by helping your child think of three things they are grateful for each day, and one thing they struggled with but learnt from. This activates positive thinking and encourages the brain to re-frame challenges into valuable experiences.
- For some children, anxiety is a debilitating condition that requires extra support. Should your child refuse to attend school, appear very depressed and withdrawn, or tell you that they are finding school life very tough, see a GP. When it comes to mental health, the earlier you get help, the better the outcome.
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JUST two diet drinks a day raises the risk of dying young by a quarter, a major study reveals.
And lovers of Diet Coke and Pepsi Max see their chances of being killed by a heart attack or stroke rocket by more than half, compared to those who avoid the stuff.
Experts said the “important” European findings – involving more than 450,000 people – were “concerning”.
They urged Brits to ditch soft drinks and switch to water.
The World Health Organisation research found the dangers from guzzling artificially sweetened pop were up to three times greater than regular sugary drinks.
Diet drinks ‘worse’
It suggests switching to sugar-free products – such as Diet Pepsi or Lucozade Zero – could be equally bad for health, if not worse.
The study was carried out by the International Agency for Research on Cancer in France, which is a part of the WHO.
Lead researcher Dr Neil Murphy said: “The striking observation in our study was that we found positive associations for both sugar-sweetened and artificially-sweetened soft drinks with risk of all-cause deaths.
“It would probably be prudent to limit consumption of all soft drinks and replace with a healthier alternative, such as water.”
The take home message is drink water – certainly avoid sugar sweetened beverages and be cautious about artificially sweetened beverages
Professor Mitchell Elkind, incoming president at American Heart Association
The research tracked participants for 16 years – including Brits – and is the largest study of its kind.
It found chances of early death went up by eight per cent for those who consumed sugary drinks twice daily.
But for those glugging two glasses of diet pop each day, the risk went up by 26 per cent.
This group also saw their chance of being killed by cardiovascular disease rise by 52 per cent.
Take home message: ‘Drink water’
The damning findings, published in JAMA Internal Medicine, coincide with the largest gathering on heart experts in the world.
Speaking from the European Society of Cardiology congress in Paris, Professor Mitchell Elkind, incoming president of the American Heart Association urged people to ditch soft drinks.
He said: “This study is important.
“There are concerns about both sugar sweetened beverages and so-called diet beverages.
“There may be a direct impact [of diet drinks] – and other studies have suggested biological mechanisms may include an impact on insulin signalling in the liver.
“The take home message is drink water – certainly avoid sugar sweetened beverages and be cautious about artificially sweetened beverages.”
Not so sweet
Previous research suggests sweeteners may affect blood vessel health, dementia risk and also trigger weight gain.
One theory is that it affects the body’s sugar levels and key hormones, such as insulin.
But others claim unhealthy adults are more likely to turn to diet drinks, which may explain the findings.
Vegetarians and vegans 20 per cent more likely to suffer a stroke, say scientists
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Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “This new research shows that people who regularly drink sweetened soft drinks have a slightly higher overall risk of dying as a result of heart and circulatory diseases.
“Where you can, stick with water and unsweetened tea or coffee, and keep soft drinks as a treat.”
Gavin Partington, Director General at British Soft Drinks Association, said: “Soft drinks are safe to consume as part of a balanced diet.
“According to all leading health authorities in the world, as well as Cancer Research UK and Diabetes UK, low- and no-calorie sweeteners are safe.”
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Even if you are a non-smoker who exercises and has no genetic predisposition to cardiovascular disease, skimping on sleep — or getting too much of it — can boost your risk of heart attack, according to a new University of Colorado Boulder study of nearly a half-million people.
The research, published Sept. 2 in the Journal of the American College of Cardiology, also found that for those at high genetic risk for heart attack, sleeping between 6 and 9 hours nightly can offset that risk.
“This provides some of the strongest proof yet that sleep duration is a key factor when it comes to heart health, and this holds true for everyone,” senior author Celine Vetter, an assistant professor of integrative physiology, says in a statement.
For the study, Vetter and co-authors at the Massachusetts General Hospital and the University of Manchester analyzed the genetic information, self-reported sleep habits and medical records of 461,000 UK Biobank participants age 40 to 69 who had never had a heart attack, then followed them for seven years.
Compared to those who slept 6 to 9 hours per night, those who slept fewer than six hours were 20% more likely to have a heart attack during the study period. Those who slept more than nine hours were 34% more likely.
When the researchers looked only at people with a genetic predisposition to heart disease, they found that sleeping between six and nine hours nightly cut their risk of having a heart attack by 18%.
“It’s kind of a hopeful message, that regardless of what your inherited risk for heart attack is, sleeping a healthy amount may cut that risk just like eating a healthy diet, not smoking, and other lifestyle approaches can,” says lead author Iyas Daghlas, a medical student at Harvard.
Many factors can influence both heart health and sleep, making it even more difficult to determine cause and effect. For the new study, the researchers used the massive UK Biobank dataset and combined observational and genetic research.
After taking into account 30 other factors — including body composition, physical activity, socioeconomic status and mental health — they found that sleep duration, in and of itself, influenced heart attack risk independently of these other factors.
The farther people fell outside the 6 to 9-hour range, the more their risk increased. For instance, people who slept five hours per night had a 52% higher risk of heart attack than those who slept 7 to 8, while those who slept 10 hours nightly were twice as likely to have one.
Using a method called Mendelian randomization, the researchers then looked at participant’s genetic profiles to determine whether those who were genetically predisposed to short sleep were more likely to have heart attacks. Twenty-seven genetic variants have been associated with short sleep.
They saw similar patterns emerge and found that genetically influenced short sleep duration was a risk factor for heart attack.
“This gives us even more confidence that there is a causal relationship here, that it is sleep duration, not something else, influencing heart health,” says Vetter.
The study did not explore the mechanism by which short or long sleep may boost heart attack risk, but previous studies have pointed to a few explanations. Sleeping too little can impact the lining of the arteries, or endothelium, impact bone marrow development of inflammatory cells, but also lead to poor dietary choices and ill-timed eating (which can in turn impact weight and, thus, heart health). Sleeping too much may also boost inflammation in the body, which is also associated with cardiovascular disease.
The authors hope the study will increase awareness about sleep’s heart-health benefits among physicians, public health agencies and the public. “Just as working out and eating healthy can reduce your risk of heart disease, sleep can too,” says Vetter.
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Patients with more sleep problems had more exacerbations, reports MedPage Today.
“Poor sleep was associated with greater future risk of exacerbations, worsened symptoms, and more hospitalizations,” Kaminska told told MedPage Today.
“We ask patients with asthma about sleep symptoms all the time, because we know that poor sleep is a marker for poor asthma control,” she said. “COPD hasn’t really been on many people’s radar, but we should probably be asking patients with COPD about sleep too.”
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Restless legs syndrome (RLS) is associated with a nearly tripled risk of suicide and self-harm, according to a new study led by Penn State researchers.
The researchers found that people with RLS had a 2.7- fold higher risk of suicide or self-harm, even when the researchers controlled for such conditions as depression, insomnia, diabetes and others. The study was published in the Journal of the American Medical Association (JAMA) Network Open.
Xiang Gao, associate professor of nutritional sciences and director of the Nutritional Epidemiology Lab at Penn State, says in a statement that as suicide rates rise in the United States, the findings suggest that physicians should pay special attention to the mental health of patients with RLS.
“Our study suggests that restless legs syndrome isn’t just connected to physical conditions, but to mental health, as well,” Gao says. “And, with RLS being under-diagnosed and suicide rates rising, this connection is going to be more and more important. Clinicians may want to be careful when they’re screening patients both for RLS and suicide risk.”
According to the researchers, RLS affects approximately 5 % of the US population, causing an uncomfortable feeling in a person’s legs resulting in the urge to move them, often during the night. While the exact cause of RLS is unknown, previous research has found an association between RLS and iron deficiency, as well as low levels of dopamine in the brain.
Gao says that while RLS has been linked with a higher chance of mortality in the past, scientists do not know why. Previous research has found associations between RLS and a greater risk for hypertension or heart attack, suggesting a possible cardiovascular component. But, some studies have also found links between RLS and depression and thoughts of suicide.
“I’ve wanted to explore a potential connection between RLS and suicide for more than 10 years, but because both RLS and suicide rates are low from a data perspective, it wasn’t possible,” Gao says. “But, when I moved here to Penn State, I gained access to a data set with more than 200 million people, so it gave us power to finally test this hypothesis.”
The researchers used data from the Truven Health MarketScan national claims from 2006 to 2014, including 24,179 people who had been diagnosed with RLS and 145,194 people who did not have RLS. All participants were free of suicide and self-harm at the baseline of the study.
After analyzing the data, the researchers found that people who had restless leg syndrome had a 270 percent higher chance of suicide or self-harm than people who did not. The risk did not decrease even when the researchers controlled for such factors as depression, sleep disorders and common chronic diseases.
“After controlling for these factors, we still didn’t see the association decrease, meaning RLS could still be an independent variable contributing to suicide and self-harm,” says Muzi Na, Broadhurst Career Development professor for the Study of Health Promotion and Disease Prevention at Penn State. “We still don’t know the exact reason, but our results can help shape future research to learn more about the mechanism.”
In the future, the researchers say additional studies will need to be done to replicate and confirm the findings.
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FRIDAY, Aug. 16, 2019 (HealthDay News) — Transgender college students are two to four times more likely than their classmates to have mental health problems, researchers say.
They analyzed data from more than 1,200 gender-minority students on 71 U.S. campuses who took part in an annual nationwide survey. Gender-minority means their gender identity differs from the sex assigned to them at birth.
About 78% of the students met criteria for one or more mental health problems such as depression, anxiety, eating disorders, self-injury and suicide risk, the survey found.
Besides transgender individuals, gender minorities include people who are gender nonconforming, genderqueer and nonbinary.
Nearly 60% of them screened positive for clinically significant depression, compared to 28% of students whose sex assigned at birth aligns with their current gender identity (cisgender).
“There has never been a more important time for colleges and universities to take action to protect and support trans, genderqueer and nonbinary students on campus,” said lead author Sarah Ketchen Lipson, an assistant professor of health law, policy and management at Boston University.
Researchers also found that transgender men and genderqueer students (those who identify with neither, both or a combination of male and female genders) are particularly vulnerable. That requires further study, Lipson said in a university news release.
Previous research has shown that transgender college students experience near-constant discrimination and harassment and have higher dropout rates. Campus bathrooms and housing are among the most stressful issues for transgender students, who have a sharply higher suicide risk when they lack access to gender-appropriate facilities.
“Reports that more than 40% of transgender people have attempted suicide in their lifetimes suggested, to me, that there is a large and disproportionate burden of disease among [people in the gender minority] that public health research can contribute to addressing,” study co-author Julia Raifman said in the news release. Raifman is also an assistant professor of health law, policy and management at BU.
“Mental health outcomes, as well as negative educational outcomes like dropping out, are preventable,” Lipson said. “The most effective way to prevent them would be, from my perspective, through policy changes. Inclusive policies are necessary to advance equity. And that’s what I really want these data to speak to.”
The study was published Aug. 16 in the American Journal of Preventive Medicine.
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Mental health services are “putting women at risk” by failing to ask them about their experience of domestic abuse, a new report has found.
The study, carried out by Agenda, a charity which campaigns for women and girls at risk, found more than a third of NHS mental health trusts are failing to ask women about domestic abuse in spite of recommended guidelines.
Campaigners argue it is especially important mental health services ask about domestic abuse given the high rates of violence and abuse suffered by those who access them. Some 38 per cent of women who have a mental health problem have experienced domestic abuse.
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The report found there is a postcode lottery in the support mental health services are providing to survivors – with one trust saying they asked just three per cent of patients about domestic abuse.
This is at direct loggerheads with National Institute of Health and Care Excellence (Nice) guidelines which specifically stipulate everyone should be asked.
The findings – based on Freedom of Information requests – show that more than a third of NHS mental health trusts that responded (42 of 58) have no policy on “routine enquiry” about domestic violence and abuse.
Chlo, a domestic abuse survivor who now works for a domestic violence charity, was a teenager when she first started to experience such abuse but failed to receive the help she needed.
She said: “I was in mental health services when it started, but no one talked to me about my relationship or picked up the warning signs.
“It was police that first suggested what I was experiencing was domestic abuse. It hadn’t even occurred to me that’s what it was until then, I didn’t know about emotional abuse or coercive control. After that, I was referred to victim support and eventually, he was convicted.
“I know that for other women experiencing abuse, it doesn’t always happen like that. The peer research showed that despite everything women are resilient and still try to engage with services, but often it’s the services who are ‘hard to reach’ or difficult to engage with, not the women themselves.”
Another survivor said: “No one even bothered, even when I went to hospital when my tooth got knocked out, even then they never even bothered to refer you.”
The report comes as charities, practitioners and other leading experts call for the Domestic Abuse Bill to ensure all public services ask about domestic violence.
Agenda is calling for the government to amend the landmark legislation, which was introduced to parliament last month, to put a duty on all public authorities to make sure staff across the public sector are making trained enquiries into domestic abuse. This must include funding for training for public sector workers, they said.
Jemima Olchawski, chief executive of Agenda, said: “Women who have experienced domestic abuse come into contact with a wide range of services – both while they are facing abuse and in the years that follow.
“Whether it’s a local GP, job centre or mental health service, staff across our public services should be trained to ask about domestic abuse and act appropriately. If not, we are putting women at risk. A change in the law is needed to make sure we’re not missing opportunities to help.”
The latest figures show that out of an estimated two million victims of domestic abuse in the last year, some 1.3 million were women. Research shows 85 per cent of survivors sought help five times on average from professionals in the year before they got effective help to stop the abuse, four out of five victims never call the police, but many will visit their GP as a result of the abuse they are suffering.
Sophie Corlett, of mental health charity Mind, said: “A large proportion of women and girls coming into contact with mental health services either have experienced or are experiencing, abuse. Domestic abuse can significantly increase the likelihood of developing both common mental health problems, such as anxiety and depression and severe and enduring mental health problems such as schizophrenia or bipolar disorder.
“A thorough understanding of a woman’s experience of trauma can hugely improve the quality of mental healthcare that they receive and avoid services inadvertently re-traumatising them. Women must be asked the right questions and properly supported by those charged with their care.”
Baroness Hilary Armstrong, chair of the National Commission on Domestic and Sexual Violence, said she had heard from women across the country about the ”devastating impact” of domestic abuse.
“For far too many, the legacy that trauma leaves is poor mental health, problems with substance use, homelessness, or a criminal record,” she said. “Women told me that services let them down. Time and again the signs of abuse were not picked up by professionals, and too often women were bounced around or even turned away from services.”
The majority (70 per cent) of victims of domestic violence deaths are female. Every week in the UK, two women are murdered by a partner or ex-partner.
In 2013-14, 93 per cent of defendants in domestic violence court cases were male and 84 per cent of victims were female.
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While it might sound like fun to work around pets every day, veterinarians and people who volunteer at animal shelters face particular stressors that can place them at risk for depression, anxiety and even suicide, according to research presented at the annual convention of the American Psychological Association.
“People who work or volunteer with animals are often drawn to it because they see it as a personal calling,” said Angela K. Fournier, PhD, of Bemidji State University, who presented at the meeting. “However, they are faced with animal suffering and death on a routine basis, which can lead to burnout, compassion fatigue and mental health issues.”
Veterinarians in particular are at high risk for death by suicide, according to a study from the Journal of the American Veterinary Medical Association, which found that from 1979 to 2015, veterinarians died by suicide between two to 3.5 times more often than the general U.S. population.
“Talking about veterinarian suicide certainly gets people to pay attention, but it does not tell the whole, nuanced story about what may be contributing to poor well-being in this population,” said Katherine Goldberg, DVM, LMSW, community consultation and intervention specialist at Cornell Health and Founder of Whole Animal Veterinary Geriatrics and Palliative Care Services, who also presented at the meeting. “More research is under way to help better understand why veterinarians might be at an increased risk, but a combination of personality traits, professional demands and the veterinary learning environment all likely contribute.”
Goldberg noted that vets also face economic challenges, as the average veterinary school graduate reported having more than $143,000 of school loan debt while earning a starting salary of just over an average of $73,000 annually in 2016.
“Personal finance concerns are stressful for many veterinarians, especially recent graduates, and at the same time, many clients regularly question the cost of care for their animals and may be suspicious that their vet is trying to ‘push’ services that their pet doesn’t need,” said Goldberg.
Goldberg described a multi-center study that looked at rates of adverse childhood experiences (a term used to describe all types of abuse, neglect and other traumatic experiences) in veterinary students, in an effort to understand what may be causing poor mental health among vets. However, veterinarians were not, on entry to the profession, more predisposed to poor mental health than the general population as a result of adverse childhood experiences, she said.
This indicates that something is happening over the course of veterinary student training or once veterinarians are working to cause poor well-being outcomes. Well-being education should be integrated into the veterinary curriculum, emphasizing resiliency behaviors and cultivating professional partnerships between veterinary medicine and mental health care.”
Katherine Goldberg, DVM, LMSW, community consultation and intervention specialist, Cornell Health and Founder of Whole Animal Veterinary Geriatrics and Palliative Care Services
Substance use among veterinarians is also an understudied area. Veterinary medicine is the only medical profession in the U.S. that does not have a national monitoring program for substance use and mental health issues, she said.
While veterinarians who are dealing with mental health issues may exhibit symptoms common to all populations, such as sadness that interferes with daily activities or changes in appetite, there are a few specific warning signs to watch for in a clinical veterinary setting, according to Goldberg.
“Increased medical errors, absenteeism, client complaints and spending too little or too much time at work” are factors to watch for, she said. “For potential substance use issues, warning signs could include missing drugs or missing prescription pads.”
Goldberg believes there needs to be a paradigm shift in veterinary training to better prepare veterinarians not only for the animal-related aspects of their jobs, but the human elements as well.
“We need core curricular material that focuses on coping with the emotional demands of the profession. Mindfulness, moral stress, ethics literacy, grief and bereavement, mental health first aid and suicide awareness all have a role in veterinary education” she said. “Colleges of veterinary medicine that have embedded mental health professionals are a step ahead of those that do not, and I would like to see this become a requirement for all schools accredited by the Association of American Veterinary Medical Colleges.”
Fournier’s presentation looked at employees and volunteers in animal shelters or rescues, and animal welfare and animal rights activists, who are at risk for compassion fatigue and psychological distress.
“Animal welfare agents, as these people are often called, are exposed to animal abuse, neglect and oppression on a regular basis, as well as routine euthanasia that is common in these settings,” said Fournier.
Over 2.4 million healthy cats and dogs are euthanized each year in the U.S., most often homeless animals in shelters, according to the Humane Society of the United States.
“Shelter workers are then caught in a dilemma because they are charged with caring for an animal and they may ultimately end that animal’s life,” she said. “Research suggests that this causes significant guilt, which can lead to depression, anxiety and insomnia, as well as greater family-work conflict and low job satisfaction.”
Animal welfare agents may also hear gruesome stories of animal abuse or witness the consequences firsthand when they are rehabilitating the animals, which can cause a lot of distress and lead to compassion fatigue, said Fournier.
“Experts suggest that animal welfare agents carry an even heavier burden than those in other helping professions who are susceptible to compassion fatigue because of the issues unique to working with animals, such as euthanasia and caring for living beings who have experienced pain and suffering but cannot articulate their needs and experiences,” said Fournier.
Fournier suggested that psychotherapists who work with animal welfare agents offer patients strategies to reframe negative experiences, identify ways in which they get fulfillment and gratification from the work they do, and establish healthy boundaries between their work and personal lives.
“There are certainly positive and negative aspects of the job and over time or during times of acute stress, it can be difficult to see the positive,” she said. “It may be necessary to help someone focus on the big picture that overall they are making a difference and animals have been saved, rather than ruminating on individual stories of crisis and loss. Self-care is also critical to ensuring the best mental health outcomes for those who work and volunteer with animals.”
American Psychological Association
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ANN ARBOR, Mich. – A new study, published in Annals of Internal Medicine, highlights the need for increased awareness of mental health disorders among adults with cerebral palsy.
“According to the Centers for Disease Control and Prevention, 1 in every 323 children in the United States has been identified as having cerebral palsy,” says Daniel Whitney, Ph.D., an assistant professor of physical medicine and rehabilitation at Michigan Medicine.
“Much of the research regarding cerebral palsy focuses on childhood. However, with modern treatment advances, many of these children grow up to be adults,” says Whitney, the study’s lead author.
“Unfortunately, far less is known about the health and clinical care needed to promote healthy aging throughout the adult lifespan for this patient population.”
Mark Peterson, Ph.D., M.S., FACSM, an associate professor of physical medicine and rehabilitation at Michigan Medicine and the senior author of the study, adds, “For example, how is this patient group’s overall health and quality of life in adulthood? There isn’t much research available to help answer this question and others.”
In the study, Whitney and Peterson focus on mental health in adults with cerebral palsy and find that the patient population experiences an elevated prevalence of mental health disorders.
“And some of these mental health disorders were more pronounced in patients with cerebral palsy that also have comorbid neurodevelopmental disorders, such as intellectual disabilities, autism or epilepsy,” Peterson says. “Which makes sense, as patients with cerebral palsy have an increased risk for secondary chronic conditions during childhood.”
Whitney and Peterson, both members of the University of Michigan Institute for Healthcare Policy and Innovation, examined insurance claims data for adults, both with cerebral palsy and those without the condition, and if the individual had a mental health disorder.
“We found that adults with cerebral palsy had higher age-standardized prevalence of mental health disorders compared to adults without cerebral palsy,” Whitney says.
More specifically, the research team found male adults with cerebral palsy had higher prevalence of schizophrenic disorders (2.8% vs. 0.7%), mood affective disorders (19.5% vs. 8.1%), anxiety disorders (19.5% vs. 11.1%) and disorders of adult personality and behavior (1.2% vs. 0.3%), compared to their male adult counterparts.
“Female patients with cerebral palsy also exhibited similar or higher prevalence of those mental health disorders versus their female counterparts,” Peterson says.
The research team did find one exception.
“We found that adult males with cerebral palsy exhibited higher rates of alcohol and/or opioid-related disorders compared to their male counterparts, whereas women with cerebral palsy did not exhibit higher rates of these disorders compared to their female counterparts,” Peterson says.
Whitney and Peterson agree that the results of this study demonstrate the need for additional focus on the mental health care of adults with cerebral palsy.
“Clinicians caring for adults with cerebral palsy need to be aware of the increased prevalence of mental health disorders in this patient population,” Peterson says.
Whitney agrees, “We hope this study highlights the need for improved mental health screenings and access to mental health services and resources for these patients.”
Additional Michigan Medicine authors of the study include: Seth Warschausky, Ph.D., Sophia Ng, M.P.H., Ph.D., Edward Hurvitz, M.D., and Neil Kamdar, M.A.
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