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Two major mental health trends, with one unifying theme

Two articles jumped out at me over this weekend. The first was this extremely long and in-depth look at a major suicide study done decades ago, which showed that even the occasional letter from a therapist can get someone through a crisis and significantly reduce suicide rates. The second touches on the topic you’ve all heard me discuss many times before: The rise of depression and suicide in young adults, and the potential role that smart phones may play.

The commonality here is obvious: The importance of relationships in stopping a mental health crisis and maintaining happy lives.

The Huffington Post article tracks the work of Dr. Jerome Motto, who engaged in a massive suicide study. His team tracked tracked mentally ill patients and found that sending letters to them could dramatically reduce suicide attempts, a study that, according to the article, has been backed up by other, similar studies, including this one by Gregory Carter:

Gregory Carter, who ran a psychiatry service in New South Wales, Australia, orchestrated a study in which Motto’s words were typed onto a postcard illustrated with a cartoon dog clutching an envelope in its mouth. The notes were sent eight times over the course of 12 months to patients who were among the hardest to treat. The majority had histories of trauma, including rape and molestation. Some had made repeated suicide attempts. But Carter found there was a 50 percent reduction in attempts by those who received the postcards. When he checked in on the study’s participants five years later, the letters’ effects were still strong. And the cost per patient was a little over $11.

Meanwhile, the USA Today article I noted above places at least some of the blame of the rise in depression among teenagers and young adults on cell phones:

San Diego State University psychologist Jean Twenge sees a direct link between how much time teens spend on smartphones and troubling signs of mental health distress.

In her 2017 book “iGen,” she cited national health surveys and other statistics to argue that a generation of teens have turned to smartphones as their preferred social outlet, and teens who spend the most time on their screens are more likely to be unhappy.

“What you get is a fundamental shift in how teens spend their leisure time,” Twenge told USA TODAY. “They are spending less time sleeping, less time with their friends face to face. … It is not something that happened to their parents. It is not something that happens as a world event.”

There’s a common connection here, and it’s pretty obvious: People – all of us – need each other.

The simple fact is this: iPhones and social media are build on the premise of building a further connection between people, and while that’s certainly possible, I’d argue that they really just keep us apart. I’m just as guilty of this as anyone else, but when we use our phones instead of talking to people face to face, we’re not building anything. It may increase our surface knowledge of someone’s life, but it’s not a substitute for a real interaction. It’s like heaving sugar for dinner instead of a healthy meal – it may fill you up, but there’s nutritious about what you are eating, and eventually, it rots you from the inside.

The article about sending letters to suicidal people backs up this point, in my opinion. People can, apparently, be brought back from the brink by hearing from someone who truly cares. I will not presume to imagine what is going through the mind of someone who is at the point of a suicide attempt. But from what I’ve read – and what I’ve experienced when I was close to that point – suicide isn’t really about dying, per se. It’s about someone wanting to stop their pain. To know that they have a reason to hope. So, if you get an authentic person sending a real message – hey, how are you doing, I’m thinking about you and I care about you – can that fill a void? Can that bring a person back from the edge? Dr. Motto’s research, and that of others, would certainly seem to imply that the answer to that question is yes.

It seems to me that these two articles detailing the rise in suicide and depression have someone in common – humans are losing their innate ability to connect with others, and doing so can solve many of our mental health issues.

As always, I welcome your thoughts. Let us know your thoughts in the comments below!

Depression rates by state, and what one state is doing about it

USA Today has run a fascinating and eye opening article on the state by state depression rates throughout the country.

First, here’s the basics (sorry, tried to get this as an infographic but having trouble getting the link to load):

Depression By State.png

 

The bluer the state, the higher the rate of depression. Leading the pack, sadly, is Utah, which has 3,977.6 cases of depression for every 100,000 people. At the bottom is New Jersey, with 2,353.3 cases. My state, Pennsylvania, is in the lower half of the country, with depression rates of 2,881.8.

The USA Today article largely focuses on the very high rates of depression in the Mountain West region of the country, which, as you can see, are very high. The article discusses the damning role of stigma, lack of access to health care, the rural natural of many of these states and high levels of gun ownership, which, unfortunately, often lead to suicide.

The article blames much of the rise of depression in this region on its self-reliant culture, particularly in terms of how it affects men. That’s one of the reasons why articles like this are so important: They can hep shatter the stigma which surrounds depression, and particularly by using personal stories of men who have suffered and sought help.

To Utah’s credit, they have done a variety of things to address their rising rates of depression and heavy rates of suicide. This includes:

  • Development of a smartphone app which can provide counseling.
  • Requiring students to take classes on life skills, mental health and substance abuse.
  • Creation of a suicide prevention research coordinator.

The App is widely known within mental health circles and has saved lives. The requirement that student take courses in life skills is interesting, particularly if it teaches things like resilience and coping skills. I know – it seems difficult to imagine that classes are now needed in this area – but the world has changed. It has evolved. And these classes are now, apparently, painfully, necessary.

This article makes a broader point: Depression, suicide and mental illness are rising. We, in the public policy arena, must address these changes for our society to have any hope of evolving and surviving. The world seems to have become a darker place. We have to be the ones who give it light.

Your smartphone can tell if you’re depressed

person using phonwYou know how I’ve written about how social media and phones can cause depression? Well, it turns out, your phone can also tell if you are depressed.

The study, from the University of Stanford, shows that face and speech software on your phone can detect depression based on your facial expressions and speech patterns:

The researchers fed video footage of depressed and non-depressed people into a machine-learning model that was trained to learn from a combination of signals: facial expressions, voice tone, and spoken words. The data was collected from interviews in which a patient spoke to an avatar controlled by a physician.

In testing, it was able to detect whether someone was depressed more than 80% of the time. The research was led by Fei-Fei Li, a prominent AI expert who recently returned to Stanford from Google.

The article did caution that, due to the way the study was conducted, the therapeutic applications aren’t clear. According to David Sontag, an assistant professor at MIT:

…that the training data was gathered during an interview with a real clinician, albeit one behind an avatar, so it isn’t clear if the diagnosis could be entirely automated. “The line of work is interesting,” he says,“but it’s not yet clear to me how it’ll be used clinically.”

I have two thoughts about this type of treatment. First, this is fascinating – and this type of technology be helpful in terms of closing the gap between those who have access to treatment and those who don’t. In addition to studies like the one above, Stanford has also developed apps which can be used to treat depression – and which apparently work. I’ve touched on this topic in previous entries as well: Apps which treat depression can work.

In other words, apps and automated programs can help to treat depression. That’s fascinating to me – I never would have believed that depression could be treated without a live, human person, but apparently it can work.

On the other hand, there are some rather frightening potential applications of this sort of treatment. First is privacy: I am sure that any app working right now is operating with the strictest of privacy measures and data safeguards, but as we have seen repeatedly, data hacks and breaches occur with relative consistency. This has some very serious implications for something like text therapy or therapy which occurs over a device, because it begs the question: What data is recorded, and how could it potentially be accessed? I mean, I’m pretty open about the fact that I receive treatment, but even I wouldn’t want the items I discuss with my therapist broadcasted to the whole word. Is that possible with these apps? I don’t know, and it may not be. But there are real privacy and technological concerns which must be addressed when it comes to therapy delivered electronically.

Second: Can someone be diagnosed against their will? I don’t think so. Not yet, anyway. Later down the line, programs like the one discussed above may also have issues with consent. It seems to me that the Stanford program is not yet ready to be used in a public or even therapeutic setting. But, when it is, will people be able to use it on others without their consent? That…that’s kind of a scary thought.

These are questions which are only somewhat hypothetical. Technology is clearly advancing, and I can only hope privacy and ethical safeguards can advance with it.

Let us know your thoughts in the comments below!

Symptoms of depression in others

I’ve written a lot about how to deal with depression if you’re the one suffering, but there’s one topic that I realized I haven’t touched on a ton: How can you recognize when someone you know or love is depressed? That can be a challenge: The symptoms may be subtle, or they may be screamingly obvious. But recognizing that someone is suffering is the first step towards getting them the help that they may need.

So, what are the signs of depression in someone else? There’s the obvious: They seem down. They express negative emotions or feelings about themselves. But spotting depression isn’t always that easy, sadly. Here’s a few thoughts on how you can keep an eye out for when someone is down:

  • Lack of energy: The person you know or love just doesn’t seem to want to do anything anymore.
  • Social withdrawal: They don’t want to spend time with their friends, go to work or do anything other than lie in bed/stay at home and watch TV.
  • Changes in appetite: This can go either way – someone suddenly stops eating or is eating all the time.
  • Tired and/or lacking energy: Okay, yeah, we’re all busy and constantly sleepy, but if someone is complaining to you about wanting to do nothing but sleep – or not being able to get any sleep – that’s a problem.
  • Reckless behavior: People with depression will often do anything to escape their own heads. This may involve behavior which unnecessarily puts them in some sort of risk. That may involve increased use of alcohol or drugs or other dangerous activities.
  • Attention problems: People with depression may have a hard time focusing on work or school. If you see your friend having a bigger problem than usual paying attention, that may be a sign that they are in trouble.

Two additional things about the symptoms noted above. First, there has to be a baseline. Someone may seem like they are withdrawing from the world when the truth is that they are just a homebody – you have to have something to judge their behavior against, and it has to represent a change from the norm.

Second, these changes can be subtle. People with depression are often good – too good – at hiding their symptoms (trust me). This is for a variety of reasons – they don’t want to be a burden, they think it’s just “all in their head,” etc. As a friend or a loved one, this can make your life difficult, but it requires you to keep an eye out for behavior. This is particularly important when someone you know has been depressed in the past, or is likely to slip into a depressive spell again. My poor wife has a series of symptoms which she is constantly on the lookout for, and if you have someone you love who has suffered, you know exactly what I am talking about.

As always, I welcome your thoughts and comments! Anything I missed here? Please let us know in the comments below!

Suicide rates are on the rise

Bad news, per a press release from the American Foundation for Suicide Prevention. The CDC has released it’s 2017 mortality report on suicide and found that 47,173 Americans killed themselves – an increase of 3.7% over the 44,965 Americans who killed themselves in 2016.

The suicide rate is at a 50 year peak, an astonishingly high number, and one which is actually contributing to a decrease in the life expectancy of the average American. Suicide is the currently 10th leading cause of death in America.

The American Foundation for Suicide Prevention says that five things need to change in order to comprehensively address suicide reduction:

  1. Cultural attitudes about help seeking and overall awareness about mental health conditions.
  2. Access to affordable mental health care.
  3. Training for primary care physicians to screen for mental health and suicide risks.
  4. Reducing access to lethal means of suicide.
  5. Better data collection.

I’d add this, based on other research that I’d seen: We need a stronger social safety net. This means that we need a more activist government that can provide a social and financial backstop for people who are in need of it. Studies have shown that suicide rates are lower in areas where there is a stronger social safety net, but that connection seems to be particularly strong when there is good access to health care and housing assistance.

This is a harder one to advocate for, to be honest, and I think there are two reasons behind that.

First, the concept of a “stronger social safety net” is broader and more abstract. The five points noted above are relatively clear-cut, and the connection between them and suicide reduction is clear. I think that connection is weaker when it comes to improving the social safety net, but it doesn’t mean that the two aren’t connected.

Second – and maybe this is just in my head – is a political concern: A stronger social safety net requires more government intervention and funding. That, of course, is a much broader and more political statement, one which slants more towards the progressive end of the ideological spectrum. And that gets difficult for non-partisan organizations which typically fight for stronger mental health services.

I think that’s a long term challenge for the mental health community. Again, I’m a Democrat and pretty progressive, so I’m biased, but I do think that the research bears this out: A more progressive political orientation is better for individuals with mental health challenges and to reduce the scourge of suicide.

That is NOT to say that Republicans or conservatives don’t care about mental health or suicide reduction – nothing could be further from the truth, and I have very proudly worked with Republicans and conservatives on mental health and suicide reduction legislation. But, it is a challenge. The simple truth is that making improvements in these areas requires more government intervention.

Anyway, as always, I’m curious to hear your thoughts – do you agree or disagree with me? Let us know in the comments below!

An in-depth look at worldwide suicide

The Economist has an absolutely fascinating and thought provoking look at suicide trends across the world. The most interesting item in the article is the graph above, which shows two things. First, suicide worldwide is declining. Second, the United States is the exception – we’re the only place in the western world where suicide is increasing, which is terribly upsetting.

The article is well worth reading, but it is a long one. I’ll try to summarize some of the trends it notes.

First, and most importantly: Suicide rates are down 38% from 1994. That’s fantastic news. But, of course, those decreases haven’t occurred evenly across all subgroups.

In China and India, significantly less women are killing themselves. This is attributed to public policy changes – and changes in culture – which have given women more freedom and independence. As gender norms have changed, women have gained more control over their lives, thus leading to lowered suicide rates. In other words, gender equality can save lives.

Increased urbanization is helping with this as well, as rural suicide rates are higher than urban ones – a trend which seems to be relatively constant across the word.

In Russia, cultural and political changes contributed to massive spike in suicides among middle aged men. That number, though still high when compared to the rest of the world, is now at half of its peak in the 1990s. This is attributable to a few things. First, the article notes that men have learned how to live in Russia’s new society and economy, having more success at getting a job and earning a living. Unemployment and economic upheaval leads to suicide, so as more men get jobs, they are less likely to kill themselves, and this is a constant across the world, in all cultures.

Additionally, studies have noted that suicide rates are tied with health care access. In countries where the unemployed still had access to health care, suicide rates did not increase during recessions – something that was not true in countries where health care was harder to come by.

Alcohol is also linked to suicide – alcohol consumption and suicide rates move together, though the article was unclear about whether or not one caused the other or a third factor moved both.

Suicide rates are higher among the elderly than they are the young or middle-aged population. As health care and poverty improves among this group, suicide rates fall.

The article also notes that means reduction – be it with guns, poison or gas – can have a major effect on suicides. The impulse to kill oneself is often fleeting, and reducing access to deadly weapons can absolutely reduce suicides.

What are the broad, global conclusions of this article? The one thing that I get out of it – more than anything else – is that public policy can have a major, major impact on suicide. Efforts to enhance economic security, increase access to health care, spread economic freedom and enhance gender equality plays a big role in reducing suicides. These are important factors which must be taken into account for any mental health conversation.

Does social media cause depression?

Despite being a complete social media addict (sigh), I’ve written repeatedly about the negative impacts that social media can have on your mental health. However, one of the key, unanswered questions has always been this: Is the relationship casual? That is, does social media use cause loneliness, does loneliness cause an increase in social media use, or is a third item related to both?

New research indicates that the relationship IS casual: Social media use does, in fact, make you more lonely.

This comes from a new study, courtesy of Melissa Hunt, the associate director of clinical training at the University of Pennsylvania’s Psychology Department.

In her study, Hunt took two groups of college students. In the first, students were asked to use social media as they usually did (about an hour a day). The second group was asked to limit it’s social media use to ten minutes per site.

The results, per Hunt: “The main finding of the paper is that limiting your use of Facebook, Snapchat and Instagram to 30 minutes total or less per day results in reductions in depression and loneliness, especially for people who were moderately depressed to start with.”

Yikes.

Yikes yikes yikes.

This is the first study, to my knowledge, which directly shows that social media is a CAUSE of depression, not just correlated with it. However, I can’t say I’m particularly surprised by this. We know that excessive use of social media can create a variety of negative impacts on someone’s life, including cyberbullying, negative body image and more. However, this is the first time that there has been a direct casual link established between depression and social media.

What do we do? Well, that’s easy: Use social media less. Seriously. It’s good for you to do that anyway, even if this study isn’t accurate (though I intuitively think it is).

More research is needed, but I firmly believe that this study will be the first of many, many which show the devastating impacts which social media is having on our society and our culture. And it’s hard for me to say: Like many of you, I find myself completely addicted to social media. But it’s an addiction which needs to break.

 

The danger of Benzodiazepians

If you’ve suffered from any sort of mental health disorder, odds are good you are familiar with Benzodiazepians (aka Benzos). Benzos are a class of drugs which are used to treat anxiety and a slew of other conditions, including insomnia, seizures and more. In the short-term, they can be very helpful in getting people through panic attacks. Personally, I’ve used them in the past for rip-roaring anxiety attacks, and they can be helpful in getting through the worst of these condition. When taken in conjunction with therapy or other long-term medication strategies, they are a useful tool in treating mental illness.

Use of benzos has dramatically increased. From 1996-2013, the amount of adults prescribed benzos increased 67%, going from 8.1 million to 13.5 million. Those increases are also seen among individuals who have been prescribed opioids – and that has led to overdose issues.

According to government research, over 30% of opioid overdoses also involve benzos:

Line graph showing causes of death from opioids, benzodiazepines and opioids, and opioids without benzodiazepines between 1999 and 2015

 

Meanwhile, overdose deaths from Benzos have shown frightening increases of late:

Number of Deaths Involving Benzodiazepines

There is also evidence of late that shows that Benzo prescriptions for those with PTSD may increase suicide risk, and that use of Benzos may be tied to an increased risk of Alzheimer’s.

So, am I telling you to throw away your Benzos? No, no, and hell no. When used under a doctors care, and responsibly, Benzo medication can be an important part of any therapeutic regimen. Candidly, when my anxiety was at it’s peak, I walked around with tranquilizers as a “just in case.” Knowing I had those to fall back on gave me the confidence to continue my daily routine in terms of my school, work and social life. If I hadn’t had those, I would have had major difficulties functioning. Eventually, modifications to my regular medication and therapy helped me address my anxiety issues, ones which (thankfully) have not come back.

Benzos can be helpful – you just need to be careful in how you use them!

PS: GO VOTE TOMORROW!

How to stay hopeful in a world filled with darkness

This week:

I spent most of Saturday crying on and off. It’s almost impossible not to. You keep reading and hearing how the world is coming apart at the seems, how things are getting so much worse, how toxic the political environment is.

Everything does seem hopeless. I get that. But it isn’t. While world events are overwhelming, and the darkness does often seem to be closing in, now, more than ever, those of us who are capable of having and expressing hope have an obligation to do so.

If world events seem overwhelming to you, here are a few ways you can try and draw some hope.

First: Concentrate on the good in the world, not the evil.

As it happened, the day of the Pittsburgh shootings, my family and I were going to an open house at a local Mosque. I did this Facebook live video while I was there:

The conclusion is this: Evil is loud. Good is soft. But there is still more good than evil. In the aftermath of the Pittsburgh shootings, hundreds rallied for peace. Pittsburgh blood banks put out a call for help after the shootings and were overwhelmed with donors. First responders did their job that day, heroically running into the Temple, and likely saving lives while doing so, even while four of their own were injured.

The world may seem broken, but that’s because evil screams and gets more attention. Don’t concentrate on that. There is so much good in this place. You don’t even have to look very hard.

Second: Find what you can control, and do something about it.

One of the hardest lessons for me in government and politics has been learning the limits of governmental power. And no, I don’t mean that in the sense of wanting government to be able to do more. I mean acknowledging that there are simply some things beyond our control. You get into government and politics because you want to help people, and then you realize that you can’t save everyone.

What all of us can do, however, is make a difference in certain areas, and that’s what I am referring to. What are you good at? What are you passionate about? Concentrate on that, not on all the evil in the world. Find where you can make a positive, tangible difference in someone’s life. For me, that’s been mental health and other areas of government and pubic policy I am passionate about. For you, that will almost certainly be something different, but find what it is and go for it.

Don’t give into the hopelessness. Find where you can make a difference, and make it.

Third: It’s okay to unplug and take care of yourself.

You can’t do good without taking care of yourself. Unplug for a few hours or a day or two. It’s okay. Don’t feel guilty. And if that guilt becomes overwhelming, remember: You’re no good to anyone if you burn out.

Fourth: Draw solace from the fact that there are millions of others like you.

I’ll refer you back to the blog entry I wrote a few weeks ago: Millions upon millions of Americans are deeply worried about the world in which we live. That doesn’t change the world, no. But it does create a base of people who agree with you – that things are scary, and that we have to work to make the world a better place.

Finally: Remember the arc of history.

Despite it all, humanity has made more progress in more areas than any of us could have ever dreamed. Progress is not inevitable. It zigs and zags. But, with the concentrated effort of a dedicated world, it does come. Concentrate on that, focus your efforts on the forward momentum of humanity, and we will be okay.

Using Facebook to diagnosis depression

I came across this article in Medical News Today, which reviews a study done in the medical journal Proceedings of the National Academy of Sciences. To make a long story short, the study reviews Facebook data and medical records, analyzing information posted by the more than 100 people who had been diagnosed with depression.

While there is ample evidence that social media can be a cause of depression (I have written about the topic before), this is the first time that I have ever seen published information which notes that social media can be used as a diagnosis tool for depression. That has some pretty interesting implications.

First, the study itself. Here’s one of the most important parts:

The scientists fed the information into an algorithm. In total, Eichstaedt [author of teh study] and colleagues analyzed 524,292 Facebook status updates from both people who had a history of depression and from those who did not.

By modeling conversations on 200 topics, the researchers determined a range of so-called depression-associated language markers, which depicted emotional and cognitive cues, including “sadness, loneliness, hostility, rumination, and increased self-reference” — that is an increased use of first-person pronouns, such as “I” or “me.”

The researchers found that the linguistic markers could predict depression with “significant” accuracy up to 3 months before the person receives a formal diagnosis.

Here’s a look at what words can be used to predict depression (none of this will be a surprise):

F4.large

Also notable is that more self-referential language is found more often in people with depression. That’s not really a surprise, as depression and narcissism are often linked.

To be perfectly honest, none of the above should be very surprising. Extended use of terms that indicate pain, distress or rumination would obviously indicate someone who is in a crisis. What is interesting, however, is that you can actually use these terms on social media to predictably and reliably diagnosis depression. That, to me, is fascinating. It is yet another tool in the toolbox for diagnosis depression, and as numerous studies have shown, depression remains massively under diagnosed, with some estimates showing that up to 2/3 of all individuals with depression are undiagnosed.