How can mental health professionals open their minds to psychosis?

by University of Birmingham

Credit: Pixabay/CC0 Public Domain

Effective clinical care for patients with psychosis means understanding the "lived experience" of their delusions, say researchers at the Universities of Birmingham, York and Melbourne.

31 may 2022--By understanding the intricacies of feelings, attitudes, and experiences that are interlinked with delusions, clinicians will be better able to build trust and genuine engagement with patients.

In a new study, published today in The Lancet Psychiatry, researchers collated and reviewed first-hand accounts of the experience of delusions from patients with psychosis in mental health settings. In their review, the team used a new methodological approach informed by philosophy to combine and synthesize all the available qualitative evidence. The team then developed a new model to better understand how delusions emerge and are shaped by different contexts from multiple levels of explanation.

The authors examined the experiences of more than 370 patients, described in 24 different scientific studies and found a number of themes that were common across all the studies.

For most participants, for example, delusions were not just a symptom of illness or an irrational belief. Delusions often were the most compelling way that the person could make sense of their life, in the context of a radical alteration of reality and intense emotions. While the experience could be hostile, sparking fear or panic, individuals could also experience awe or wonder, or deep meaning in their delusions.

When reality is altered in this way, individuals can struggle to make sense of their own identity, experiencing self-doubt or a loss of control or, conversely, the feeling that they are someone special, or with a unique purpose. In the latter case, the delusional experience seemed to provide a sense of coherence, purpose and belonging at a time of intense life stress and can therefore be interpreted as temporarily adaptive or beneficial.

"These experiences are complex and nuanced," said lead author Dr. Rosa Ritunnano, consultant psychiatrist and researcher at the University of Birmingham's Institute for Mental Health and the University of Melbourne. "When we train clinicians in treating psychosis, we need to ensure they are going beyond 'correcting' a dysfunction or 'curing' a symptom. Instead, by trying to understand how the delusion is shaped by the patient's emotions, life experiences and socio-cultural contexts, we can devise treatment and support that is more relevant to the individual."

The approach has particular resonance for situations in which a patient may be detained without their consent with the aim of protecting themselves from harm. The number of patients detained in this way has been steadily rising for several years, with particular ethnic groups and those with learning disabilities being particularly impacted in this process.

"One of the main issues is that all too often, the patient's voice is lost within the process of trying to help them," says Dr. Clara Humpston, one of the senior authors on the paper. "Carers, clinicians and family members all have a challenging task in learning how to listen. That means accepting that there may not be a shared view of reality, but the patient's experience is still true and valid, and ought not to be silenced."

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More information: Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis, The Lancet Psychiatry (2022). DOI: 10.1016/S2215-0366(22)00104-3

Provided by University of Birmingham 

 

Older people reluctant to seek help for mental health concerns

by Edith Cowan University

Credit: CC0 Public Domain

A new Edith Cowan University (ECU) study has found that more than 40 per cent of older Australians living with chronic disease would be unlikely to seek help for mental health conditions even if they needed it.

14 aug 2021--Ph.D. candidate Claire Adams investigated help-seeking intentions for mental health services by older Western Australians' living with chronic conditions such as cardiovascular disease, respiratory disease including asthma, and type 2 diabetes.

The study involved 108 people aged 65 years and older living with chronic disease. Participants were asked about their attitudes and beliefs towards seeking help for mental health concerns, and information on their past engagement with mental health services, quality of life, physical and mental health.

Ms Adams found that 41 per cent of older adults with chronic disease did not intend to seek help for their mental health, even if they needed to.

"One in seven Australians is aged over 65. But while we're living longer, we're not necessarily living better or happier," Ms Adams said.

"While it's encouraging that most participants (59 per cent) did say they would seek help if they needed it, a high proportion did not, which is concerning given our aging population."

Internal beliefs are key

Ms Adams said the strongest predictor of whether people would access mental health support was their own beliefs about whether speaking with their doctor was likely to be personally beneficial.

"If people believed that speaking to their doctor would be useful, they were more likely to be willing to seek help, whereas people who were sceptical about the benefits were less likely to seek help," Ms Adams said.

Society's influence and physical capability also factors

Participants were also asked about how they thought society would view them seeking help for mental health, and whether that would influence their decision.

"If they believed that family and friends would not support them it was likely to prevent them from wanting to speak out about their mental health," Ms Adams said.

"Another barrier was whether they believed they were physically incapable of accessing services."

Ms Adams said mental health challenges were becoming increasingly prevalent in Australia, and around the world.

"We know that older people with chronic disease are at risk of mental health decline, so it's important that they engage with support services early to reduce severe mental health problems and improve their quality of life," she said.

"This study demonstrates that attitudinal change is required to increase help-seeking in older people with chronic disease."

To address this issue Ms Adams has developed an intervention to promote help-seeking for mental health problems among older adults with chronic disease. It is currently being tested across Australia.

The paper 'Help-seeking for mental health problems among older adults with chronic disease: an application of theory of planned behaviour' is published in the Australian Journal of Psychology.

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More information: Claire Adams et al, Help-seeking for mental health problems among older adults with chronic disease: an application of the theory of planned behaviour, Australian Journal of Psychology (2021). DOI: 10.1080/00049530.2021.1952850

World's largest evidence review: Nutritional supplements for mental health

by Western Sydney University

Credit: CC0 Public Domain

We've all heard that 'food is good for your mood'. Now a new study into mental health and nutrient supplementation has taken a leap forward by establishing the gold standard for which nutrients are proven to assist in the management of a range of mental health disorders.

17 sept 2019--As well as an established relationship between poor diet and mental illness, there is now a vast body of research examining the benefit of nutrient supplementation in people with mental disorders.

To unpack this research, an international team of scientists led by Sydney's NICM Health Research Institute, Western Sydney University examined the 'best of the best' available evidence. The aim was to provide a clear overview of the benefit of specific nutrient supplements—including dosage, target symptoms, safety and tolerability—across different mental disorders.

The world's largest review (a meta-synthesis) of top-tier evidence, published online today in World Psychiatry, examined 33 meta-analyses of randomised control trials (RCTs) and data from 10,951 people with mental health disorders including depression, stress and anxiety disorders, bipolar disorder, personality disorders, schizophrenia and attention-deficit/hyperactivity disorder (ADHD).

Although the majority of nutritional supplements assessed did not significantly improve mental health, the researchers found strong evidence that certain supplements are an effective additional treatment for some mental disorders, supportive of conventional treatment.

All nutrient supplements were found to be safe when recommended dosages and prescriptive instructions were adhered to and there was no evidence of serious adverse effects or contraindications with psychiatric medications.

Summary of results:

• The strongest evidence was found for omega-3 supplements (a polyunsaturated fatty acid) as an add-on treatment for major depression—reducing symptoms of depression beyond the effects of antidepressants alone.
• There was some evidence to suggest that omega-3 supplements may also have small benefits for ADHD.
• There was emerging evidence for the amino acid N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia.
• Special types of folate supplements may be effective as add-on treatments for major depression and schizophrenia, however folic acid was ineffective.
• There was no strong evidence for omega-3 for schizophrenia or other mental health conditions.
• There is currently a lack of compelling evidence supporting the use of vitamins (such as E, C, or D) and minerals (zinc and magnesium) for any mental disorder.

Lead author of the study, Dr. Joseph Firth, Senior Research Fellow at NICM Health Research Institute, Western Sydney University and Honorary Research Fellow at The University of Manchester said the findings should be used to produce more evidence-based guidance on the usage of nutrient-based treatments for various mental health conditions.

"While there has been a longstanding interest in the use of nutrient supplements in the treatment of mental illness, the topic is often quite polarising, and surrounded by either over-hyped claims or undue cynicism," Dr. Firth said.

"In this most recent research, we have brought together the data from dozens and dozens of clinical trials conducted all over the world, in over 10,000 individuals treated for mental illness.

"This mass of data has allowed us to investigate the benefits and safety of various different nutrients for mental health conditions—on a larger scale than what has ever been possible before."

Senior author on the study, NICM Health Research Institute's Professor Jerome Sarris said as the role of nutrition in mental health is becoming increasingly acknowledged, it was vital that an evidence-based approach be adopted.

"Future research should aim to determine which individuals might benefit most from evidence-based supplements and to better understand the underlying mechanisms so we can adopt a targeted approach to supplement use in mental health treatment." Professor Sarris said.

"The role of the gut microbiome in mental health is a rapidly emerging field of research, however more research is needed into the role of 'psychobiotics' in mental health treatment."

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More information: Joseph Firth et al, The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials, World Psychiatry (2019). DOI: 10.1002/wps.20672

Provided by Western Sydney University 

WHO mental health guidelines could better capture 'lived experience'

by University of East Anglia

Mental health patients want mental health diagnostic descriptions to better reflect what it feels like to live with their conditions in the World Health Organisation's global manual of diagnoses—according to a new Lancet Psychiatry report.

10 july 2019--The study, by UK and US researchers at Norfolk and Suffolk NHS Foundation Trust (NSFT), the University of East Anglia, and Columbia University, in collaboration with the WHO Department of Mental Health and Substance Abuse, is the first to report feedback from service users on such a major mental health diagnosis guideline.

The WHO's International Classification of Diseases (ICD) is used by 194 countries and is the most influential and widely used classification guide, with around 55,000 unique codes for injuries, diseases and causes of death.

Researchers looked at the latest revision (ICD-11), which will come into effect in 2022, and focused on its chapter on mental, behavioural and neurodevelopmental disorders.

Researchers asked patients with schizophrenia, bipolar disorder, depression, anxiety and personality disorders in the UK, US and India to compare the WHO descriptions of their diagnoses with their own experiences.

Lead researcher Dr. Corinna Hackman, from UEA's Norwich Medical School and NSFT, said: "The ICD is the most widely used system to diagnose people with mental health conditions globally. It is extremely influential in framing our understanding of mental illness, and the policy and provision of mental health services.

"Despite this, service users' perspectives have not been included in previous versions of the ICD.

"We wanted to gain feedback from service users internationally on how the WHO intends to classify mental health conditions, and in particular—whether their diagnostic descriptions resonate with the lived experiences of patients.

"We found that the WHO diagnosis descriptions didn't always resonate with people's lived mental health experiences. In particular, the descriptions focused on external symptoms, things that can be seen on the outside, rather than the internal, felt-experience.

"Our findings suggest that this may have potential unintended consequences for service users of feeling alienated and misunderstood.

"People with bipolar disorder for example thought that the WHO description only reflected negative aspects of the condition, and identified increased levels of creativity, associated with mania, as a positive aspect.

"People with schizophrenia said that the WHO diagnosis wording didn't cover things like difficulties relating to, and communicating with, other people including feelings of isolation and alienation from other people.

"In some cases the wording was confusing or objectionable—for example the use of the word 'retardation' for depression.

"This research offers a unique insight into the views of service users and it really represents an overdue watershed moment in mental health diagnosis," she added.

Participants also compared the WHO's classification wording with alternate lay translations created by the research team.

Research collaborator Dr. Caitlin Notley, also from UEA's Norwich Medical School, said: "Participants reported that the lay summaries were much more clear, accessible and easier to understand—and consequently they felt that they resonated much better with their own lived experience.

"What we have shown is that patients would benefit from a version of the WHO disease classification system that is easier to understand and includes more information about the felt-experience.

"We hope that the changes we are recommending would also help clinicians better understand and empathise with the felt experience of service users."

The study was undertaken by NSFT, UEA and the London School of Hygiene and Tropical Medicine, in collaboration with Columbia University, NYC, a peer-led service in New Jersey and the All India Institute of Medical Sciences, New Delhi.

It is hoped that the findings will help inform further ICD-11 revisions.

The findings were translated into coproduced recommendations for the WHO, which has established a process of review and consideration of incorporation into revisions of the clinical descriptions and diagnostic guideline for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders.

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More information: 'Perspectives on the International Classification of Diseases, 11th Revision (ICD-11); an international qualitative study to Understand and improve mental health Diagnosis using expertise by Experience: INCLUDE Study' is published in The Lancet Psychiatry on Monday, July 8, 2019.

Provided by University of East Anglia 

Relationships key to mental health recovery, says study

Mental health service users saw the relationships with their care coordinators as being central to their recovery and felt that care plans were largely irrelevant, according to mental health researchers at City University London.

12 feb 2016--The study, published in Health Services & Delivery Research, also found that care coordinators saw care plans as a useful record but also as an inflexible administrative burden that restricted time with service users.
The researchers hope that the research will help improve cumbersome and time consuming care planning processes while enabling mental health workers more time to create meaningful therapeutic relationships, which are currently valued but limited by the focus on bureaucracy.
The study also found that risk remains a significant concern for mental health workers but appeared to be rarely discussed with service users or their carers.
Care planning and coordination is at the heart of effective mental health service delivery and is increasingly required to be personalised and focused on recovery, yet there has been little research conducted that explores these key aspects.
To find out more about how community mental health care was planned and coordinated, the City University London team – in collaboration with Cardiff University and Swansea University - conducted a cross-national comparative study involving six NHS sites in England and Wales that included a survey of 449 service users and 205 care coordinators. They also conducted interviews with 117 managers, practitioners, service users and carers. As part of the process, service users were employed as researchers and advisors.
Speaking about the research, Alan Simpson, Professor of Collaborative Mental Health Nursing in the School of Health Sciences, said:
"Our study has highlighted two very important issues around the delivery of mental health care. Firstly, our study showed that while workers are acutely aware of the need to assess and manage risk, this is rarely discussed openly with service users or their families. This is a missed opportunity to learn from the patient's and family's perspective and to share responsibility in this important area.
"Secondly, there is clearly an issue between how service users see their relationship with care coordinators, and how this is managed. While managers and clinicians clearly see care plans as vital records of care, service users instead said that regular contact and therapeutic relationships with staff help them most in their recovery and time consuming care plans are rarely used.
"The challenge now is for us to work with clinicians and service users to test out new ways of working that maximise therapeutic contact, support collaborative working around risk and reduce the time spent completing lengthy care plan documentation that is rarely used."


Provided by City University London

Smartphone app may revolutionize mental health treatment

Mental illness accounts for 90 percent of all reported suicides and places the largest burden of any disease on social and economic infrastructures worldwide, according to the World Health Organization. There is a dire need for support services to assist clinicians in the evaluation and treatment of those suffering from mental illness.

02 july 2014--New technology developed by researchers at Tel Aviv University is poised to transform the way in which patients with mental illnesses are monitored and treated by clinicians. Dr. Uri Nevo, research team engineer Keren Sela, and scientists from TAU's Faculty of Engineering and Sagol School of Neuroscience have developed a new smartphone-based system that detects changes in patients' behavioral patterns, and then transmits them to professionals in real time. It has the potential to greatly improve the response time and efficacy of clinical psychiatrists. By facilitating patient observation through smartphones, the technology also affords patients much-needed independence from hospitals, clinicians—and even family members.

Research on the application was presented in March at the Israel Society for Biological Psychiatry's annual conference. The project won funding from the Israeli Ministry of Economy and was recently chosen as one of four finalist start-up initiatives featured at Israel's leading Entrepreneurship and Innovation 8200 Accelerator Program. The team is currently in talks with other medical centers in Israel and overseas to expand clinical trials.

Using tools already "in the hand"

"The diagnosis of mental health disease is based only on behavioral patterns," said Dr. Nevo. "In some cases, a patient is discharged from the hospital into a vacuum, with no idea how to monitor his or her new state of mind. Because most people own smartphones today, we thought, 'Why not harness the smartphone, a reservoir of daily activities, to monitor behavioral patterns?'

"Bipolar disorder, for example, starts with a manic episode," said Dr. Nevo. "A patient who usually makes five or ten calls a day might suddenly start making dozens of calls a day. How much they talk, text, how many places they visit, when they go to bed and for how long—these are all indicators of mental health and provide important insights to clinicians who want to catch a disorder before it is full blown."

Researchers conducted two Helsinki-approved clinical trials with the cooperation and direction of leading psychiatrists from Geha Mental Health Center and Be'er Ya'acov Mental Health Center. In the trials, the application was installed on the smartphones of 20 patients suffering from bipolar, unipolar/depressive, or schizo-affective disorders, as well as on the phones of 20 healthy participants. Over the course of six months, the app acquired data from patients' phones and sent the information to distant computers, where advanced algorithms analyzed the data to detect changes in patients' sleep, communication, mobility, and vocal patterns. The researchers further developed a visualization system that displayed the summarized information to psychiatrists, providing them with instant insight into the behavioral trends of their patients.

Preserving patient privacy

According to Dr. Nevo, a patient using the app has full control over who has access to the behavioral patterns recorded and analyzed by it. "We take great care to protect the patient's privacy," said Dr. Nevo. "The content of calls and texts is completely ignored and never acquired or recorded, and any identifying parameters of the patient or of his contacts, are irreversibly masked and are obviously not used."

Psychiatrists in the trials reported that the system has already positively affected their interaction with patients, offering a useful objective "window" into the patient's daily routine. One patient who was involved in the clinical trial for only a brief period recently suffered a hospitalization. "If I had kept the app on my phone, you would have immediately noticed the unusual number of phone calls I was making, and this hospitalization could have been prevented," he told his psychiatrist.

"We have a way to go until such a system will be proven effective and adopted by the psychiatric community," said Dr. Nevo. "However, psychiatrists, as well as U.S. federal policymakers in the field, agree that such tools are necessary to improve psychiatric practice."

Provided by Tel Aviv University

Fewer friends, lower self-esteem can lead to distorted perceptions of life challenges

Being with friends can make climbing a hill feel less daunting.

18 sept 2012—People who have fewer social resources, such as friends and family, literally see challenging objects and events in a more exaggerated way than do people who feel emotionally supported, according to research by Kent Harber, associate professor of psychology at Rutgers-Newark.

"Those with fewer friends, with lower self-esteem and with less opportunity to disclose their emotions tend to visually amplify threats," Harber said. "Their perceptions are exaggerated, and disturbing things appear higher, closer, of greater duration or more intense than they actually are."

According to Harber's thesis – a theory known as the Resources and Perception Model (RPM) – psychosocial resources can prevent this amplification, leading to more accurate perception. In a study published in the The Journal of Experimental Social Psychology, Harber and colleagues from the University of Virginia enlisted passersby who were alone or with a friend and asked them to estimate the angle of a steep hill on the U.Va campus. "Those with friends saw the hill as less steep, and the longer they knew their friend or the closer they felt toward their friend the less steep the hill appeared to them," Harber said.

His latest study, published in the journal Emotion, tested whether the resource of self-worth affected distance perception to a live tarantula. Subjects were first asked to recall one of the following: a personal success, a neutral chore or a personal failure. Next, they used a reel to pull a clear plastic cart toward their face and estimate how far away it was from them. For some people, the cart contained a harmless cat toy; but for others it contained a live tarantula.

"As expected, feeling good, neutral or bad about oneself had no effect on distance to the cat toy but did affect distance to the tarantula," Harber said. "Those who felt bad about themselves saw the tarantula as looming closer than it was; those who felt good about themselves were strikingly accurate."  

Another study tested how high a ledge appeared depending on one's frame of mind. Researchers brought subjects to the fifth floor of a building and estimate how high up they were. One group could put their hands the railing, while the other was prevented in doing so by paper handcuffs. For those who could hold onto the rail, self-esteem had no effect on height perception.

"They were all pretty accurate in their height estimates," Harber said. But self-esteem did matter for the subjects who couldn't hold the railing; the hand-cuffed subjects with high esteem did as well as did subjects who could hold the handrail.

"Those with high levels of self-worth could 'get a grip' internally," Harber said.  But handcuffed subjects who lacked self-esteem "had neither an external nor an internal resource. They saw the distance to floor as much greater than did all other subjects,"  Harber said.

Why would our mind's eye play these tricks on us?  According to Harber,  the distortions can be useful.  "When we lack resources, the potential costs of engaging with hazards are greater and we need to adjust our behavior accordingly.  Our psyches might be nudging us toward caution by exaggerating the visual aspect of challenging things, when our resources are low."   

But for people who chronically lack resources, there may be a serious downside.  "Those who are isolated, who often lack self-worth, or who are in other ways bereft of resources might live in a more threatening world where mole hills look like mountains." 

The remedy, suggests Harber, is not to be super-popular or in a perpetually happy mood (in fact, mood has little influence on his studies).  Rather, it's about having a sufficient number of good friends and a core level of self-acceptance.  "It's not about seeing the world through rose-colored glasses," Harber says. "It's about having the resources to see things clearly, as they are."

More information: doi: 10.1037/a0023995

Provided by Rutgers University

Leading U.S. Expert Offers Ten Warning Signs And Symptoms Of Mental Health Problems In Elderly

04 aug 2009--As people age, the potential exists for those years to be the most rewarding and fulfilling time of their lives. However, major illness, retirement, the death of a spouse, and a shrinking circle of friends all may, in some cases, contribute to increased levels of stress and depression in the elderly. For that reason the chief of geropsychiatry for the Los Angeles Jewish Home - the largest single-source provider of senior residential housing in the western United States - is offering seniors and their loved ones 10 warning signs that may trigger the need for assistance with mental health issues.

"Though many seniors have developed positive coping skills and emotional maturity, others may experience Alzheimer's disease, addictions, anxiety disorders and depression," said Dr. Nitin Nanda of the Home. "Deteriorating physical health can quickly change a happy retirement into a period of confusion, fear and chronic pain. When disabilities occur later in life, individuals who were involved in working, socializing and traveling may suddenly face lower incomes, reduced mobility, and dependence on caregivers and assistive devices. These changes can have a dramatic effect on seniors' mental and emotional well-being."

As a result of this growing need in the country the Home has unveiled the Auerbach Behavioral Health Unit dedicated to treating depression and other acute psychiatric needs in seniors. The 10-bed voluntary unit incorporates the Jewish Home's nationally acclaimed model of comprehensive, high-quality treatment by attending to the needs of the whole person - mind, body and sprit.

Here are Dr. Nanda's ten signs that show a senior you care about might need help:

1. Depressed mood or sadness lasting more than two weeks.

2. Feelings of worthlessness, inappropriate guilt, hopelessness, helplessness.

3. Decreased ability to think, concentrate or make decisions.

4. Repeated thoughts of death or suicide, suicide attempts.

5. Social withdrawal, change in activity level, loss of interest in hobbies. Irritability, quarrelsomeness.

6. Loss or increase in appetite or weight change.

7. Sleep changes such as insomnia or sleeping more than usual.

8. Change in appearance or standard of dress.

9. Aches, pains and other physical problems that cannot otherwise be explained.

10. Alcohol, drug abuse and/or misuse.

"Depression and other types of mental health issues can be sensitively and successfully treated," Dr. Nanda said. "However, it is critical to recognize the need in a timely way and be aware of the various signs." Dr. Nanda said if a problem is suspected, an individual should:

-- Talk with your physician, explain how you feel, and describe what is not normal for you. Have a list of all medications and vitamin, mineral and herbal supplements.

-- Talk to a trusted friend, family member or spiritual advisor.

-- Don't be shy or embarrassed. Explain how you feel. Remind your doctors and pharmacist about your medical history.

-- Ask for instructions in writing.

Founded in 1912, the world-renowned Los Angeles Jewish Home is one of the foremost multi-level senior-living communities in the United States and the largest single-source provider of senior housing in Los Angeles. In total, the Home annually serves more than 1,700 seniors through its extraordinary continuum of services. Each year, more than 1,200 women and men are cared for in-residence on two village campuses, with services including independent-living "Neighborhood Home" accommodations, residential care, skilled nursing care, short-term rehabilitative care, acute psychiatric care, and Alzheimer's disease and dementia care. Another 500 seniors are served through the Home's community-based programs, which includes Skirball Hospice and community clinics. The Home is a nonprofit organization that relies upon donations from individuals, corporations and foundations to continue its remarkable work.

Source: Los Angeles Jewish Home

Tidying the House Soothes Mental Distress

By Crystal Phend
LONDON, April 10 2008-- As little as 20 minutes of physical activity a week, even if it's just routine housework, may be enough to provide mental health benefits, researchers found.
Note that higher intensity, more frequent exercise held more benefits but low intensity activity still provided some protection against psychological distress.
Note, too, that the cross-sectional nature of the study prevents determination of causality and the results could be explained by reverse causality or confounding from unmeasured variables.
Working around the house or garden for as little as 20 minutes once to three times a week reduced the odds of psychological distress by 24%, reported Mark Hamer, Ph.D., of the University College London, and colleagues in the British Journal of Sports Medicine.
However, more activity at a higher intensity improved the effect in a dose response manner with the strongest effects observed for sports (OR 0.67, 95% CI 0.54 to 0.82), they found in the population-based study.
Physical activity has been linked to depression, dementia, and cognitive decline, but how much and what type is best for mental health remained unclear, the researchers said.
So, they examined self-reported participation in all types of physical activity and current mental health among a nationally representative sample of 19,842 men and women 16 and older in the Scottish Health Surveys in 1995, 1998, and 2003.
Participants completed a 12-item General Health Questionnaire to provide details on psychological distress and trained interviewers elicited information on potentially confounding factors such as disease history and health behaviors.
Overall, 3,200 men and women were classified as having psychological distress. About 32% of them did not participate in any physical activity aside from housework or gardening or had one session a week that lasted at least 20 minutes.
All types of activity independently reduced the odds of psychological distress after adjustment for illness, smoking and marital status, gender, age, socioeconomic status, body mass index, and other types of exercise.
Increasing overall activity reduced the likelihood of having a psychological distress score of four points or higher on the General Health Questionnaire (P<0.001 for trend). The findings were:
33% reduction for activity sessions more than 3.5 to five times a week (OR 0.67, 95% CI 0.61 to 0.75).
33% reduction for activity sessions more than five to 6.75 times a week (OR 0.67, 95% CI 0.59 to 0.76).
41% reduction for activity sessions more than 6.75 times a week (OR 0.59, 95% CI 0.52 to 0.66).
For domestic activity -- housework and gardening -- as little as 20 minutes once a week to three times a week was associated with 24% lower odds of psychological distress (OR 0.76, 95% CI 0.69 to 0.84). Four or more such sessions per week were associated with a similar 16% improvement (OR 0.84, 95% CI 0.72 to 0.98).
Walking was associated with a 13% improvement in the likelihood of psychological distress whether once to three times a week or four or more times a week (OR 0.87, 95% CI 0.78 to 0.97 and 0.79 to 0.95, respectively).
Sports activities yielded the greatest benefits and was the only individual activity looked at that had a dose-response association in which greater participation reduced the likelihood of psychological distress (P<0.001 for trend).
Sports may have additional benefits through a "psychological component, such as fostering social support networks and developing mastery and better coping abilities," the researchers said.
The benefits of physical activity in general could be by reducing biological stress reactivity, "given that heightened responsiveness to daily stressors is a risk factor for psychological morbidity," they said. Exercise might also improve biological risk factors such as dyslipidemia, glucose intolerance, inflammation, and vascular dysfunction, "which have been related to mental health disorders such as depression and dementia."
The researchers cautioned, though, that the cross-sectional study could not prove causality and could have been affected by confounding from comorbidities that cause functional impairment or unmeasured variables.
The Scottish Health Survey was funded by the Scottish Executive. The researchers reported receiving grant funding from the British Heart Foundation and the National Institute for Health Research. The researchers reported no conflicts of interest.
Primary source: British Journal of Sports MedicineSource reference:Hamer M, et al "Dose-response relationship between physical activity and mental health: The Scottish Health Survey" Br J Sports Med 2008.

Aging: Mental Health Overlooked in Care of Elderly Patients

By ERIC NAGOURNEY
Depression and other mental illnesses are common among the elderly, and when they get treatment, it usually comes from their primary care doctors. But a new study suggests that those doctors may devote too little time to talking about those ailments.
When researchers reviewed videotapes of 385 appointments with elderly patients in three separate areas, they found the median time spent discussing mental health was just two minutes.
The study, which appeared in the December issue of The Journal of the American Geriatrics Society, was led by Ming Tai-Seale of the School of Rural Public Health at Texas A&M.
More than half the patients whose survey responses suggested they were depressed never spoke with their doctors at all about their emotional state. The subject came up in about a fifth of the visits over all.
But even when patients let their doctors know about their problems, the study found, the responses were often ineffective or worse.

Lancet Launches Campaign to Strengthen Global Mental Health Services

Marlene Busko

September 12, 2007 — The Lancet begins its campaign to strengthen mental healthcare with the September 8 publication of the first 2 articles of a 6-part series on global mental health. The first article focuses on the way mental health affects physical health, and the second article looks at scarcity of resources and inequality and inefficiencies in mental healthcare delivery.
Editor: "We Urge Partners to Join in to Strengthen Mental Health"
In the next 2 years leading up to a global summit on mental health in 2009, the journal plans to direct attention to the neglect and stigmatization of mental illness, to provide a call to action, and to track and monitor progress, Richard Horton, MD, editor of the Lancet, explains in a Comment.
"Despite the great attention Western countries pay to the mind and human consciousness in philosophy and the arts, disturbances of mental health remain not only neglected but also deeply stigmatized across our societies," he writes.
He elaborates that institutions such as the World Health Organization and the World Bank, foundations such as the Gates Foundation, and research funding bodies such as the US National Institutes of Health share a duty to make mental health a strategic and financial priority, but, for the most part, these institutions have done far too little, and many low-income countries are "crying out for help."
He concludes his comment with a call to action: "We urge partners to join in the broad new social movement we are launching to strengthen mental health."
Mental Illness Increases Risk of Physical Illnesses
In the first article in the series, "No health without mental health," Prof. Martin Prince, from King's College London, in the United Kingdom, and colleagues explain that an estimated 14% of the global burden of disease is due to neuropsychiatric disorders, mostly depression, alcohol- and substance-use disorders, and psychoses. However the contribution of mental disorders to physical illness is inadequately appreciated, so the actual global burden of mental disorders is probably higher than this, they observe.
The group reviews the evidence for links between mental health and cardiovascular disease, diabetes, HIV/AIDS, tuberculosis, malaria, maternal and child health, and accidents and injuries.
They report that more research is needed, particularly on the potential for mental health interventions to improve physical health outcomes, and they point out that relatively little of this type of research has been carried out in low- and middle-income countries.
They urge for greater attention to mental health during the planning and delivery of healthcare. "Mental health awareness needs to be integrated into all elements of health and social policy, health-system planning, and delivery of primary and secondary care," they write.
Scarcity, Inequities, and Inefficiencies
In the second article in the series, "Resources for mental health," Shekhar Saxena, MD, from the World Health Organization, in Geneva, Switzerland, and colleagues report that not only are resources for mental health scarce, this is compounded by inequities and inefficiencies in the delivery of mental healthcare.
As a result, people who need care get none. "The treatment gap — the proportion of those who need but do not receive care — is too high for some mental disorders," they write, explaining that as many as 1 in 3 people with schizophrenia and 1 in 2 with other mental disorders do not receive any treatment. The WHO has reported that the treatment gap for serious disorders is 35% to 50% for developed countries and 76% to 85% for low- and middle-income countries.
Shortages of healthcare professionals have been shown to be the main limiting factor in delivering mental healthcare in most low- and middle-income countries, the group writes.
Inequities in care delivery are widespread, the group continues. Mental disorders and need for care is highest for women, young people, poor people, those with the least education, and those living in rural areas — the same people with low access to care, they note. Stigma further constrains the use of scarce resources.
The authors report that inefficiencies in the use of resources include the fact that whereas community-based care has been shown to be more cost-effective, most mental health systems still allocate most of their budgets to mental hospitals.
"Scarcity of available resources, inequities in their distribution, and inefficiencies in their use pose the 3 main obstacles to better mental health, especially in low-income and middle-income countries," the group summarizes, adding that innovative, concerted, and sustained efforts are needed to remove these obstacles and achieve better mental health.
Lancet. 2007;370:806 Abstract, 859-877 Abstract, 878-889. Abstract

Poorer nations asked to aid mentally ill

By MARIA CHENG, AP Medical WriterTue Sep 4, 5:19 AM ET
War, poverty and diseases such as AIDS are adding to mental health problems in poorer countries, which are generally ill-equipped to respond to depression, schizophrenia and other such ailments, according to health officials.
Experts say that has to change.
On Tuesday, health officials called for new strategies and more money to treat the mentally ill in the developing world in a special issue of the British medical journal, The Lancet. Unless mental health treatment becomes widely available, the futures of poor countries will be handicapped, the writers argue.
Among the simple solutions offered: training lay people to spot mental illness in their community. The ill people and their families can then be referred for treatment. India has already introduced such a program for schizophrenia in certain provinces.
"We're thinking outside the box. We're not thinking of more mental health specialists," said Dr. Vikram Patel, a professor of international mental health at London's School of Hygiene and Tropical Medicine and co-author of several of the papers in The Lancet.
Nirmala Srinivasan, head of Action For Mental Illness, a lobby group based in Bangalore, India, said only a small percentage of Indians who suffer from some form of mental illness — schizophrenia, depression, obsessive compulsive disorder, anxiety — get proper treatment.
"The main reason is that people can't access treatment," Srinivasan told The Associated Press, adding that "there is no treatment available" in rural areas.
Dr. N. Vijaya, head of the Institute of Mental Health, a 1,600-bed facility with programs for 400-500 more outpatients in the southern Indian city of Chennai, said awareness of mental health was increasing in India — leading more people to seek treatment.
She said nearly a third of her facility's patients have been "wandering mentally ill" rescued from the streets by police and private aid groups.
"Social workers help us in contacting their families later," she said.
In Brazil, mental health care rivaling that in developed nations is available for those who can afford it. The Lancet said Brazil's mental health care system has improved in the past several decades, but gaps remain.
Mentally ill adults in the teeming cities of Brazil, Latin America's largest nation, are frequently seen begging on street corners and sleeping under highway overpasses. In destitute rural communities, families living in poverty cope the best they can with mentally ill relatives, but often can't afford medication or special care.
In some poorer countries, people turn to chains or cages to restrain those with mental illness.
In African countries, doctors and nurses are often too overwhelmed with illnesses such as AIDS and malaria to care for those with mental health problems.
But mental health advocates argue that because psychiatric problems such as depression and psychoses often lead to physical problems, investing in treating mental illness could prevent other diseases. That can in turn aid the overall economy.
Treating mental illness can't be solved simply by sending in foreign doctors, experts said. Counseling for mental health problems must come from someone who speaks the language and understands the local culture.
In countries such as Zambia, where mental illness is believed to be a sign of witchcraft or being possessed by the devil, people who are sick are reluctant to seek help. When they do, or when others alert the authorities, they are often locked up in institutions.
"You can't just parachute into a system and expect to solve their complex mental health problems," said Cornelius Williams, who helps treat emotionally scarred former child soldiers in Uganda for UNICEF.
Dr. Richard Horton, The Lancet's editor, wrote in an accompanying commentary that the World Health Organization has not done enough to support nations' mental health needs. Although the agency pledged in 2001 to bring "new hope" to treating the mentally ill, "WHO has not backed its words with resources," Horton said.
WHO officials declined to comment.

For Fear of Flying, Therapy Takes to the Skies

By TIM MURPHY
For most of the 100 or so sleepy-eyed people boarding the U.S. Airways shuttle to Logan Airport in Boston from La Guardia in New York on a recent hazy Saturday morning, the 35-minute flight could not have been a bigger nonevent. But that was not the case for about 20 passengers clustered nervously near the gate. Many clutched puzzle books and bags of sour candy as though they held talismans. Some made nervous jokes, others sobbed quietly.
“I have pills with me just in case of an emergency,” said a teenage girl who planned to distract herself on the flight with celebrity magazines.
Mariasol Flouty, a 44-year-old software developer from White Plains, held fast to her Sudoku book. “I had plane-crash nightmares,” she confessed. “I woke up very tense.”
No one was more terrified than Beth Brenner, a 45-year-old mother of two teenagers from Somers, N. Y. “I was hysterical last night,” she said, “but my son said, ‘You’re going to be O.K.’ ” Ms. Brenner was crying quietly on the shoulder of a counselor and staying close to her designated seatmate, Richard Bracken, a retired pilot who had flown for American Airlines for 30 years. “I’m trying to be a father figure here,” Mr. Bracken said.
Several studies have found that up to 40 percent of people have some degree of anxiety about flying, said Dr. Lucas van Gerwen, an aviation psychologist and professional pilot in the Netherlands and an organizer of an international fear-of-flying conference, sponsored by the International Civil Aviation Organization, that took place in early June in Montreal.
According to the National Institute of Mental Health, the percentage of Americans who have a fear of flying so intense that it qualifies as a phobia or anxiety disorder and keeps them off airplanes is closer to 6.5 percent. Those most paralyzed by their flying fear — called aviophobia — sometimes turn to programs like the one at Westchester County Airport in New York, run for 10 years by the Anxiety and Phobia Treatment Center at White Plains Hospital. The program culminates with the graduation flight to Logan from La Guardia.
“We have people who haven’t flown for 5, 10, 15 years,” said Dr. Martin Seif, a psychologist in Greenwich, Conn., who created the program, called Freedom to Fly. He himself used to be so scared of flying, he said, that he once arrived late at a conference in Atlanta because he insisted on taking a train, which got stuck in the snow.
People who suffer from phobias inhabit a world apart. “Anxiety is an altered state of consciousness,” Dr. Seif said.
An anxiety or panic attack is often acutely physical, marked by sweating, numbness in the hands and feet, and a pounding heart, leading sufferers to think they are having a heart attack. In such an episode, “the images in your mind feel like they can really happen,” Dr. Seif said.
Exposure-therapy programs like Dr. Seif’s, in which participants face their fear in small doses by meeting at an airport and boarding a stationary plane several times before taking an actual flight, have declined since the World Trade Center attacks of Sept. 11, 2001, as airport security has tightened, said several fear-of-flying experts.
As a result, virtual-reality programs — high-tech simulations of the flight experience involving a helmet with built-in audiovisual components — have replaced many more traditional treatment programs like Dr. Seif’s.
According to Dr. Barbara Rothbaum of Emory University in Atlanta, who has studied virtual-reality treatments for fear of flying, the success rate is comparable. Dr. Seif said his program’s success rate, defined as those who take the flight to Boston and back, was at least 90 percent. That is comparable to the success rate for similar programs, according to Jerilyn Ross, president and chief executive of the Anxiety Disorders Association of America.
The Sept. 11 attacks also shifted the equation for aviophobes in more subtle ways. With polls immediately after the attacks showing a spike in people who said they were anxious about or unwilling to fly, true aviophobes “grabbed that as a reason for not flying anymore at all,” Dr. van Gerwen said.
In fact, when prodded by Dr. Seif during the program’s first session in mid-April, many participants conceded that their phobia was driven not by a rational fear of crashing but by their own anxiety, easily whipped into a frenzy by factors like a plane’s height, its enclosed atmosphere and wind turbulence, which can feel hazardous even to hardy fliers.
Together, Dr. Seif said, they would learn to “stay in the situation and out-bluff anxiety.”
For the next five Mondays, group members practiced just that. They passed through airport security and met in one of the staff classrooms, where the program began with an outpouring of personal stories.
One man, a tall, broad-shouldered 37-year-old finance executive for an airline, divulged that he had not flown in 20 years, since having had a panic attack on board a flight after the death of his grandmother.
He was among several in the group to link the onset of their phobia to a major life change. That factor, Dr. Seif said, along with a genetic predisposition to anxiety disorders, appears to be a major contributor to a fear of flying.
Twice, the group was visited by Mr. Bracken, the veteran pilot, who patiently dispelled a wild array of fears. “When I’m up there, I feel like the wings and tail are going to rip off,” one man said.
Mr. Bracken detailed the protections woven into building, maintaining and inspecting aircraft. He explained that turbulence was what occurred when, say, a plane hit a ripple of air left in the wake of another jet, and assured his listeners that radar kept planes miles away from truly dangerous weather.
Most group members found the explanations calming. Not Ms. Brenner. Told that the chance of a multiple engine failure was next to none, she insisted, “But what would you do if they did?”
Dr. Seif replied, “That’s like asking what if you’re driving down the highway and your brakes go, your airbag’s not working and you’re approaching a big brick wall.”
The last half-hour of every session was spent aboard a stationary jet. The first time, many group members said their anxiety levels were high, raised by the enclosed space and the smell of the cabin. “I feel like I’m going to throw up,” Ms. Brenner said.
But by the week before the actual flight, when airport staff members added another layer of reality by starting the plane’s engine, even she was relatively at ease.
That changed the next Saturday when the group members took their seats in the front of the plane to Boston. Tension filled the cabin. One young woman bolted from her seat, unpersuaded by entreaties to stay from Dr. Seif and others.
Once the flight was in the air, most participants coped well, as Dr. Seif had predicted they would, busying themselves with their magazines and puzzles or organizing an e-mail list so the group could stay in touch.
Ms. Brenner did not fare as well. She was nearly catatonic throughout the flight, clutching Mr. Bracken’s arm on one side and on the other, that of Cecilia Gschwind, 39, a homemaker from Harrison, N.Y.
“Why does it feel like we’re not going up?” Ms. Brenner asked as the plane made its unmistakable ascent. Halfway to Boston, when asked how she was doing, she said, “I’m having a hard time focusing.”
Dr. Seif demanded that she talk with him to distract herself. He was only half-successful.
At Logan, with an hour or so to kill before the flight home, the participants were giddy and celebratory. Many spoke of their plans to fly again within the next few months. One woman, who had not flown in 10 years, said she was finally ready to take her children to Disney World. She lamented the places she had not flown in her 20s but said, “I think my 30s will be good.”
Ms. Brenner, however, slipped away from the group and took a train back to New York, calling Dr. Seif to let him know.
“O.K., goodbye, see you Monday,” he said curtly into a cellphone.
He was softer, though, when the group reconvened Monday for a final session, and he told Ms. Brenner she did the right thing. “It was such a trauma that you needed time to heal,” he said. For her part, Ms. Brenner said she was not ashamed of herself for running — just frustrated. “I thought I was going to feel this huge rush of relief and accomplishment after the flight,” she said. “But I didn’t. I thought, ‘This is not helping.’ I was so unhappy.”
Ms. Brenner is not making any immediate plans to fly again. “I’m going to try to figure out why it’s as bad as it is for me,” she said. “I don’t think it’s about the planes.”