Me, my daughter and Sylvia Plath

Piggybacking on the sad story of Sylvia Plath's son's suicide, Christine Stapleton—a blogger at PsychCentral and columnist for the Palm Beach Postwrote something interesting that caught my attention addressing whether suicide can run in genes:

Suicide is not hereditary – at least geneticists have not proved it. However, studies have shown that  children whose mothers committed suicide are 7 times more likely to attempt suicide than children whose mothers do not. That statistic is why I am alive.

Maybe that statistic would help keep me alive too if I have kids.

20% of American children suffer from mental illness

The new SCHIP (State Children’s Health Insurance Program) law that President Obama signed significantly increases health coverage for children, which also includes mental health parity. According to Nancy Shute of U.S. News & World Report, health coverage is expanded to:

“4 million more children beyond the 6 million already covered but also brings mental-health parity to the state programs that provide insurance for children in low-income families, requiring that they get the same access to treatment for bipolar disorder, depression, anxiety, and other serious disorders as they do for physical ailments.”

Then I stumble across this:

Depressed child“Mental-health needs are nowhere near being met,” says Jay E. Berkelhamer, past president of the American Academy of Pediatrics and chief academic officer at Children’s Healthcare of Atlanta. “At least 20 percent of all visits to pediatricians’ offices are related to mental-health problems.

Normally, though, overworked pediatricians may not ask if a child has a mental-health problem—and may not know where to refer him or her if they do. About 20 percent of children and teenagers have a mental-health problem at any given time, or about 8 million to 13 million people. Two thirds of them are not getting the help they need.

That means out of roughly 40-65 million kids, we have 8-13 million who are “mentally ill.” And then about 5-8 million who aren’t getting proper mental help.

Color me cynical but I think 20 percent is a disproportionately high number to classify children as mentally ill. I think the percentage of adults being classified as mentally ill is exorbitant enough, let alone children who are going through stages in their lives where they’re simply developing, encountering mood swings, being disobedient, and perhaps, being — perish the thought! — normal children.

But let’s address something else here: I don’t think it’s impossible for children to suffer from mental illness but the incidence should be significantly lower.

According to Dr. Louis Kraus, the chief of child and adolescent psychiatry at Rush University Medical Center in Chicago, suicide ranks as the sixth-leading cause of death among ages 5-14 — “although rare.” From ages 15-24, it jumps to number three.

The key word in that last paragraph is suicide is “rare.” The rate of mental illness in children should reflect that somehow. While I’m very happy SCHIP includes widespread mental health parity for low-income families, I’m also concerned children will be overdiagnosed with a “mental illness” when they may simply be dealing with the normal challenges of a difficult life.

“I used to care, but now I take a pill for that.” — Author unknown

Philip Dawdy at Furious Seasons has some great posts on the bipolar child paradigm that further explore the murky world of psychiatry pushing psychiatric illnesses and psychotropic drugs on kids. I’d also recommend reading Soulful Sepulcher as Stephany recounts her and her daughter’s experiences in and out of the mental health system.

(pic from save.org)

Loose Screws Mental Health News

I could’ve been a statistic right here in this area.

suicides in PhiladelphiaPhiladelphia now boasts the sharpest increase in suicides in the country. Despite all the homicides in Philadelphia making the news, the 196 people who killed themselves in 2008 were quietly buried in the obit pages (if they made it there at all).

In light of this news, I’ve decided to place a suicide hotline web banner in the upper right-hand corner of my right sidebar. Susan of If You’re Going Through Hell Keep Going has one in her sidebar and I think it’s a wonderful idea. I’ve had a couple of people comment or send me emails about how they feel they’re on the brink of losing it so hopefully the banner — one of the first things to be seen on this page — will draw some attention and prompt someone to call for help. When I was a teen, I called 1.800.SUICIDE. I can’t remember what happened exactly but I called the hotline and someone talked me into why life was still worth living. People who are suicidal don’t really want to die; they want an escape from the pain they’re feeling and they feel the only way to alleviate that pain is through inflicting death upon themselves. I hope someone who is suicidal would be willing to pick up the phone and come to the same realization that I did at the time.


Speaking of suicide, researchers from the World Health Organization and the University of Verona, Italy have discovered that SSRIs (a class of antidepressants) may significantly reduce the risk for suicide in adults. SSRIs — which include such medications as Prozac, Paxil, and Zoloft — are not be confused with SNRIs such as Effexor, Pristiq, and Cymbalta. PsychCentral notes:

SSRIPrevious studies, including a 2007 study by the U.S. Food and Drug Administration (FDA), found the risk of suicide in adults was neutral, elevated in those under 25 and reduced in people older than 65. A subsequent black box warning was added to all antidepressants regarding increased risk of suicidal symptoms in people under 25 years of age.

Basically, this study just means antidepressants help those who are 25 years and older and hurt those 24 years and younger. I’m sure a new study will come out within the next year or so that contradicts this one. Especially since numerous previous studies on SSRIs found the risk of suicide to be neutral in ages 25-65.


Young adultAccording to the Boston Globe, a (really pathetic) new study shows that nearly half of young adults between the ages of 19 to 25 “meet the criteria for at least one psychiatric disorder.”

Whether in college or not, almost half of this country’s 19-to-25-year-olds meet standard criteria for at least one psychiatric disorder, although some of the disorders, such as phobias, are relatively mild, according to a government-funded survey of more than 5,000 young adults, published in December in the Archives of General Psychiatry.

The study, done at Columbia University and called the National Epidemiologic Study on Alcohol and Related Conditions, found more alcohol use disorders among college students, while their noncollege peers were more likely to have a drug use disorder.

But, beyond that, misery is largely an equal-opportunity affliction: Across the social spectrum, young people in America are depressed. They’re anxious. They regularly break one another’s hearts. And, all too often, they don’t get the help they need as they face life’s questions…

According to the 2005-2007 American Community Survey, the population for adults ages 18-24 is gauged to be around 30 million. Therefore if we’re going to take the study at its word, let’s chop the number by half (even though the number is just under half). That will put us at about 15 million young adults. The NIMH, however, estimates 57.7 million adults in the U.S. “suffer from a diagnosable mental disorder.” If this is the case, those 15 million young adults make up nearly 26 percent of the NIMH’s “diagnosable mental disorder” statistic. The inclusion of alcohol and drug addictions might explain why this figure might be a little high.

Happiness Flash!

From Self magazine, May 2001:

Startling suicide news Wealthy people with a history of mental illness are more likely to kill themselves than those is lower income brackets, says a study in the British Medical Journal. Greater stigma about mental health problems may lead to the higher suicide rate among the well-to-do. [emphases not mine]

Do I have bipolar disorder because my father had schizophrenia?

According to researchers at Stockholm's Karolinska Institute, schizophrenia and bipolar disorder may have common genetic causes. Researchers studied 9 million Swedish people during a 30-year period and discovered that "relatives of people with schizophrenia or bipolar disorder had an increased risk of both disorders." The study may also suggest that "the two conditions may simply be different manifestations of the same disease."

The article from Reuters also points out that Seroquel and Zyprexa are used to treat both disorders, which may lead people in the psychiatric industry to further investigate the link between the two illnesses. Here are some interesting discoveries from the study:

 *  First-degree relatives (parents, siblings, or offspring) of people with either schizophrenia or bipolar disorder were at increased risk for both of these conditions.

 * If a sibling had schizophrenia, full siblings were nine times more likely than the general population to have schizophrenia and four times more likely to have bipolar disorder.

 * If a sibling had bipolar disorder, they were eight times more likely to have bipolar disorder and four times more likely to have schizophrenia.

 * Half siblings who shared the same mother were 3.6 times more likely to have schizophrenia if their half sibling had schizophrenia and 4.5 times more likely to have bipolar disorder if their half sibling had bipolar disorder. Half siblings who shared the same father had a 2.7-fold increase in schizophrenia risk and a 2.4-fold increase in bipolar disorder.

 * Adopted children with a biological parent with one of the disorders had a significant increase in risk for the other.

Creepy. My father's schizophrenia didn't begin to manifest itself until he was in his 40s. The same is true for my two other aunts as well. It may be silly but I live in fear that I may have the same problem. I'll eventually get a psychiatric advance directive in place just in case that day ever comes. After seeing three family members with debilitating schizophrenia/paranoia, sometimes it gets to the point where the benefits of being drugged up outweigh the risks.

Mood rating: 6

Emotional depression along with economic recession?

suicide rates compared to employment ratesCNN has a story looking into whether suicides increase as the economy falls into a recession and investors begin to lose thousands of dollars in the stock market. According to a chart by the NIH & Bureau of Labor Statistics, there seems to be a correlation. Here are the latest high-profile suicides that seem to have been prompted by the economic downturn:

  • Steven Good, a chairman and CEO of Sheldon Good & Co., a major U.S. real estate auction company, may have shot himself, according to police.
  • Adolf Merckle, a 74-year-old German billionaire who was ranked the 94th richest person in the world by Forbes magazine, killed himself by walking in front of a train. According to the CNN article, “in recent months his empire had been near collapse.”
  • Rene-Thierry Magon de la Villehuchet, a 65-year-old French investor, killed himself after losing $1.4 billion in the Ponzi scheme that Bernard Madoff ran.
  • Kirk Stephenson, 47-year-old English financier  and COO of Olivant Ltd., jumped in front of a train in September (the real climax in the economic collapse).

The Centers for Disease Control and Prevention (CDC) estimates more than 32,000 people commit suicide each year but public health experts expect an increase upwards to an additional 1200 suicides because of the economic climate. Here are a few more stats that are worth reading:

  • Calls to the National Suicide Prevention Hotline went from 412,768 in 2007 up to 540,041 in 2008.
  • Unemployed people are two to four times more likely to kill themselves than those who are employed.

I have to admit, I found that following paragraph interesting:

So what about these wealthy and powerful men who have recently killed themselves? Mental health experts say it’s impossible to say why they did it, but they say that people who kill themselves have an underlying psychological issue, such as depression or bipolar disorder, so it’s not only about the money.

So I pose a question: Do all those who commit suicide have a mental illness? Or is it possible to kill oneself without being mentally ill?

Loose Screws Mental Health News: Suicide slide

A National Institute for Mental Health in England report reveals particular progress in cutting suicides among young men.

The three-year average was 8.3 suicides per 100,000 population in 2004-06, down from 8.5 in the previous three years.

The article was brief and unclear which leaves me wondering what England is doing right.

“Sure, Grandpa gets a little cranky and blue sometimes, but he’d never
do anything stupid”, you might think. Wrong.  Elderly people account
for 13% of the US population, but make up nearly 24% of completed
suicides. Older men are the most at risk with a rate of 29 per 100,000
people.

Does this sound like anyone you know?

More than you know, Dr. Chiaramonte. More than you know.

According to the 2007 Small Arms Survey, the United States had about 90 firearms per 100 people – the highest ratio in the world – followed by Yemen, Finland, Switzerland and Iraq.

Over half of all suicides in the United States – 52% – were committed with firearms in 2005, according to the most recent CDC data available.

Gun control: good or bad? Discuss amongst yourselves.

Loose Screws Mental Health News

The mastermind behind Stavzor is Noven Pharmaceuticals (in conjunction with Banner Pharmacaps Inc.). The new “small, easy-to-swallow soft gel capsule” is available in three strengths: 125, 250, and 500 mgs. The pills are are “up to 40% smaller than han Depakote® and Depakote ER® tablets at the 500 mg dosage strength.” From Noven’s PR:

Stavzor is approved for the treatment of manic episodes associated with bipolar disorder, as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures, and for prophylaxis of migraine headaches.

The drug will hit the market in mid to late August.

The hotline receives an average 250 calls each day from veterans that have fought in Iraq, Vietnam, and Afghanistan.

The issue of soldiers with mental illness has recently come to light with studies showing that 1 in 5 soldiers returning from Iraq and Afghanistan have shown symptoms of post-traumatic stress disorder. The issue of the high suicides rate has been a high priority of the VA since mental health director Ira Katz tried to hide the significant number of suicides committed by veterans.

The National Suicide Prevention Lifeline is available 24 hours a day by calling 800-273-TALK (8255); veterans should press “1” after being connected.

“We have seen a 60 per cent increase in demand for our child anxiety classes in the past six months,” said [Dr. Kimberley O’Brien, of the Quirky Kids Clinic at Woollahra in Sydney].

It sounds more like the article is speaking of children who are exposed to constant physical and emotional abuse. If that’s the case, shouldn’t there rather be an increase in parenting properly classes?

Pick a number: 20 or 9,000,000

20 people annually or 9,000,000 people annually.

Golden Gate BridgeThose are the numbers that the Golden Gate Bridge (GGB) Board of Directors will need to choose between in October.

GGB officials are considering a proposal to erect suicide barriers on the bridge. Public forums were held on Tuesday and Wednesday to gauge public reaction to the five options designed to deter suicides. The cost of erecting one of the barriers is estimated between $40–50 million.

Bridge officials have been culling comments about the barriers at the forums and through the site Golden Gate Bridge Suicide Deterrent Barrier. As of Wednesday, July 23, the San Francisco Chronicle reports:

[O]f the more than 900 tallied so far, an overwhelming 75 percent of the respondents said they prefer that no barrier be built at all. But a small, passionate group of proponents – many of them family
members of people who jumped to their deaths from the bridge – insist a barrier is needed. Any barrier.

“Overwhelming 75 percent” prefer no barrier? That’s not good.

Opponents of the barriers say it will ruin the aesthetic view of the bridge for the yearly estimated 9 million visitors.

I stumbled upon a blog, Bookworm Room, yesterday that brought the issue to my attention. This blogger likely represents the sentiment of the “overwhelming 75 percent.”

Read the rest of this entry »

Gun Ownership = Suicide?

Liz Spikol on The Trouble With Spikol linked to an article in the Chicago Tribune in which author Steve Chapman discusses whether buying a gun is a suicidal act.  Chapman argues "not really." Is it?

The Act and Follow-through of Suicide: Wrap-Up

I’ve always found it annoying when people say a suicide attempt is
"a cry for help." And the best one — "She’s just looking for
attention." I ran into that quite a bit in high school.

While a suicidal person may not realize it (I certainly didn’t), a suicide attempt is a cry for help. It’s  an action that says "I’ve come to my breaking point. I’ve run out of options
and I don’t know what else to do. My problems are too much for me to
handle and the only way out of them is to die." Suicide is the action
which stem from thoughts that likely were never verbalized.

The majority of people who commit or attempt suicide aren’t just
seeking to die "just because."

…[T]wo doctors who are among the most often-cited experts on suicide…readily acknowledged the high degree of impulsivity associated with [jumping], but also considered that impulsivity as simply another symptom of mental illness. “Of all the hundreds of jumping suicides I’ve looked at,” one told me, “I’ve yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn’t happen. There’s almost always the presence of mental illness somewhere.”

They feel as though they truly have "run
out of options" and ending their life is the least favorite backup
plan. The common thread that runs through all suicides is hopelessness.

So to wrap this series up, is it possible to prevent someone  from committing or attempting suicide?

Read the rest of this entry »

The Act and Follow-through of Suicide: Part IV

Compilation of Statistics Regarding Suicide

Scott Anderson in his NYT article weaves the grim statistics of suicide in and out of his story. Here’s the morbid list:

General

  • mental illnessThe nation’s suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.
  • In 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.
  • The National Institute of Mental Health says that 90 percent of all suicide “completers” display some form of diagnosable mental disorder.

Demographics

  • Both elderly men living in Western states and white male adolescents from divorced families are at elevated risk.

Premeditation vs. Passion

  • [T]he person who best fits the classic definition of “being suicidal” might actually be safer than one acting in the heat of the moment — at least 40 times safer in the case of someone opting for an overdose of pills over shooting himself.
  • In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.
  • “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total. By the early 1970s, the amount of carbon monoxide
    running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

Read the rest of this entry »

The Act and Follow-through of Suicide: Part III

Premeditation vs. Passion

Author Scott Anderson in his NYT magazine article, "The Urge to End It All," notes:

Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide.

Read the rest of this entry »

The Act and Follow-through of Suicide: Part II

The British Coal-Gas Story

According to Scott Anderson’s NYT article, the little-known British coal-gas story — even among mental health professionals — is a good example of how suicides can be prevented if one takes away the means:

Coal-gas ovenFor generations, the people of Britain heated their homes and fueled their stoves with coal gas. While plentiful and cheap, coal-derived gas could also be deadly; in its unburned form, it released very high levels of carbon monoxide, and an open valve or a leak in a closed space could induce asphyxiation in a matter of minutes. This extreme toxicity also made it a preferred method of suicide. “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total.

Those numbers began dropping over the next decade as the British government embarked on a program to phase out coal gas in favor of the much cleaner natural gas. By the early 1970s, the amount of carbon monoxide running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

Experts seems to insist that committing suicide is proof of an underlying mental illness. Suicide that stems from impulsivity, among these experts, is also considered part of a mental illness. Anderson subtly argues against this, and I find myself agreeing with him:

How can this be? After all, if the impulse to suicide is primarily rooted in mental illness and that illness goes untreated, how does merely closing off one means of self-destruction have any lasting effect? At least a partial answer is that many of those Britons who asphyxiated themselves did so impulsively. In a moment of deep despair or rage or sadness, they turned to what was easy and quick and deadly — “the execution chamber in everyone’s kitchen,” as one psychologist described it — and that instrument allowed little time for second thoughts. Remove it, and the process slowed down; it allowed time for the dark passion to pass.

Would this mean that if people had less access to suicidal means that promoted “ease, speed, and certainty of death” (ESCOD), a number of suicides could be averted? It appears so. Anderson continues to make a case using the Ellington Bridge in Northwest Washington as an example:

Read the rest of this entry »

The Act and Follow-through of Suicide: Part I

“What was immediately apparent was that none of them had truly wanted to die. They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution.”Dr. David Rosen, psychiatrist and Jungian psychoanalyst

A recent article in New York Times magazine suggests that those who exhibit suicidal behavior or have had unsuccessful attempts are least likely to die by way of suicide.

The author, Scott Anderson, delves into the psyche of what drives a person to commit suicide. And he attempts to answer the "what" question by evaluating the "how."

Read the rest of this entry »

The Purple Elephant in the Room

“Every minute, a suicide is attempted.” — everyminute.org

“With over 30,000 people dying by suicide each year in the United States, averaging 82 per day, there are almost twice as many suicides as homicides each year.” — stopasuicide.org

gun82 per day. Despite the fond memories the “Thompson” family will always have of Bob’s grandfather — whom we’ll call Grandpa — he is now logged as a suicide statistic:

  • Suicide per minute
  • Suicide per hour
  • Suicide per day
  • Suicide per year
  • Suicide in the town
  • Suicide in the state
  • Suicide in the nation
  • Suicide in the world
  • Suicide by age (elderly)
  • Suicide by gender
  • Suicide by firearm

The list likely goes on.

Suicide is the purple elephant in the room that no one likes to talk about. It’s never a pleasant subject, especially when it’s by someone you know. The pain of losing someone by suicide seems to surpass the pain of all other kinds of death. There’s something about suicide in which we feel that the deceased had control.

  • “It didn’t have to be that way.”
  • “If he’d just gotten help.”

Read the rest of this entry »

Thoughts on Bipolar Overawareness Week: Part III

In all seriousness, I have wondered about the BPD diagnosis but in my mind, have somewhat fallen short. I don’t think my symptoms are strong enough to be plastered with a BPD label.

To conclude my several-post rambling, I should answer the question that I initially posed. Do I think bipolar disorder is overdiagnosed?

No.

Many of my fellow bloggers will likely disagree with me. Zimmerman’s study at Rhode Island Hospital took into account whether those “diagnosed” with bipolar disorder had a family history of the diagnosis in the family. Maybe I’ve turned to the dark side. Just because I don’t have a family history of bipolar doesn’t mean that I can’t suffer
from the disorder. However, I have a family history of schizophrenia: one father and two aunts. Does this put me at a higher risk for schizophrenia? Definitely. Does this mean I could suffer from bp and have the schizo gene pass me by? You bet. I don’t think that I need a first-degree relative to suffer from bp to make me a classic diagnosis for bp.

For instance, when it comes to my physical appearance, I’m the only one on both sides of the family who suffers from severe eczema to the point where my dermatologist suggested a punch biopsy. Does that mean that I need to have a family history of eczema to obtain the malady? Not necessarily. Why is bipolar disorder any different?

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Calls for VA's top official to resign

I’d been meaning to talk about this story but it’s progressed faster than my typing hands can keep up.

An e-mail sent around at the Veterans Health Administration among Dr. Ira Katz, the VA mental health director, and other officials, discussed the issue of hiding the number of suicides committed by veterans from the public—an estimated five out 18 of them being under VA care. Now, a number of senators (and bloggers) are calling for Katz’s resignation.

Read the rest of this entry »

Response to "Mental Health Blogs Going Bye-Bye?"

From one of Furious Seasons’s latest posts:

Mental Health Blogs Going Bye-Bye?

As I noted earlier, there’s a spate of mental health blogs that are going on hiatus of some kind. Now, it’s my sad duty to report that Gianna Kali’s Bipolar Blast blog is going on an indefinite hiatus as well. You can read her post "Quitting?" for the details. Bottom line: all those years of very high doses of psych meds seem to have injured her body. I cannot even begin to send her enough good wishes. I cannot even begin to express my disgust with some of the bad doctors she ran into over the years.

Also, the Psych Survivor blog, written by a man I only know as Mark, was taken down a few weeks ago, and from what I gather he is in the hospital with heart problems. His was/is a good and strident voice on these issues we all care about and his work is missed.

All of this kind of makes me feel glum, since the two people above had been at the blogging game for well over a year and I sensed that they’d both be around long-term. These are people I care about and it sucks that they won’t be the presence they once were.

Why is it that mental health blogs are so difficult to do and keep going? Why is it so hard for them to find the substantial audiences they deserve? The Internet is crowded with blogs about politics, technology, gadgets, gossip and parenting and many of these seem to do quite well and have huge audiences and long lives, despite the fact that many of them are merely echoes of one another. Are readers of blogs that simple-minded that all they need is the latest news and opinion on Apple’s or Microsoft’s latest bit of software or Obama’s or Hillary’s latest gaffe?

You’d think in a country where 10 percent of the population is on anti-depressants and another 5 percent to 10 percent is likely on some other psych med that there would be a substantial audience for these issues (regardless of what one makes of the dominant mental health paradigm), especially given how wildly popular neuroscience is on the Net. It makes me wonder if we all–and here I include myself–have done something wrong in how we analyze these issues (are we too contrarian?) or if we all simply haven’t been crowded out of the big search engines (that’s how most people find mental health information online) because the Net is so over-populated with pharma sites and allied pro-pharma health websites. I can certainly say that the mainstream media–which usually loves writing about characters on the Net who push against life’s many intellectual tides–has given very little attention to sites like this one, despite the fact that sites like mine have been a very real service to many in the media.

Or maybe the mainstream approach to mental health care is right and the public is just trying to tell us something.

What do you think?

I’ll tell you what I think.

Read the rest of this entry »

Mental illness trend on the rise among troops

soldierThe AP is reporting that nearly one in every five soldiers who have been part of the war in Iraq and Afghanistan now suffer from clinical depression and/or post-traumatic stress disorder (PTSD).
The researchers said 18.5 percent of current and former service members contacted in a recent survey reported symptoms of depression or post-traumatic stress. Based on Pentagon data that more than 1.6 million have deployed to the two wars, the researchers calculated that about 300,000 are suffering mental health problems.

“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan,” said Terri Tanielian, the project’s co-leader and a researcher at Rand. “Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation.”

The trend of mental illness on the rise among soldiers isn’t a new story. I’ve written about the problem several times here, here, and here. The real question now is how the problem is being addressed.

Veterans Affairs is responsible for care of service members after they have leave the military. The Defense Department covers active duty and reservist needs.

Col. Loree Sutton, who heads a new Pentagon center on brain injury, said the Rand study will add to the work defense officials are doing. That includes researching best practices used inside the military and out, improving and expanding training and prevention programs, adding mental health staff and trying to change a military culture in which many troops are afraid or embarrassed to get mental health treatment.
“We’ve got to get the word out that seeking help is a sign of strength,” Sutton said.

She said officials have been working to add thousands more mental health professionals to help the uniformed psychiatrists, psychologists and others struggling to meet the wartime demands of troops and their families. Across the services, officials are trying to hire over 1,000 additional staff. Also, companies providing health care by contract to the Pentagon have added over 3,000 in the past year, and the U.S. Public Health Service has provided some 200, she said. Veterans Affairs has added some 3,800 professionals in the past couple of years, officials there said.

It sounds like the VA is doing all they can with what they’ve got at the moment to address this problem. According to the article, the hesitation among troops to seek help is slowly and steadily on the decline. That’s a good sign. However, a few impediments that can block this progress:

  • they worried about the side effects of medication,
  • they believed family and friends could help them with the problem, or
  • they feared seeking care might damage their careers.

Again, I think many of these problems stem from psychological issues and should be heavily addressed by psychologists who are specifically trained help them work through these problems. This is one instance where I would downplay the use of psych drugs and focus primarily on talk (CBT/DBT/counseling) therapy.

Scary statistic

Here's one scary statistic:

In a study, the first of its kind, scientists have found that websites encouraging suicide pop up more frequently in Internet search engines than those which aim to prevent it.

The story, reported by the Times of India, must be speaking of Web sites outside of the U.S. because I sure can't find such a phenomenon on U.S. sites. (Yes, yes, I've previously tried.)

"Lies, damned lies, and statistics":

While one in five sites that popped up on the click of a mouse were dedicated suicide sites, and over 50% of them encouraged, promoted or facilitated suicide. Over 43 of the websites studied contained personal accounts of suicide methods. In contrast, only 13% focused on suicide prevention or offered support, while another 12% actively discouraged suicide.

The article mentions that the three highest ranked sites were pro-suicide. The top four sites gave detailed information on various ways to commit suicide. Most of these pro-suicide hits were found via Google and Yahoo. MSN had the highest hits of prevention and support sites.

As I resist the urge not to investigate the data further, I think of a Web site I was introduced to recently called everyminute.org. According to the site, about 30,000 people commit suicide in the U.S. annually. Suicide also is the second highest cause of death of those in the 25–34 age range. Untreated mental illness tends to play a big role in suicides. This statistic makes me glad that my mental illness is being treated, however, I still struggle with suicidal thoughts (I have lately). The silver lining in this is that I have a higher chance of overcoming my suicidal actions and behavior thanks to my counseling, medication, and self-education via this blog and the blogs of others.

Loose Screws Mental Health News

An article in the NYTimes addresses the issue of diagnosing mental health in developing countries. A startling fact:

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

emoIn India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.

Looks like depression is really more than just a whiny rich American kid who chooses to be upset because he’s got nothing better to do. That’s “emo” for those who aren’t hip-to-the-jive. 😉


On The Elite Agenda, Dr. Fred Baughman mentions Swedish writer Janne Larson who asserts that “over 80 percent of persons killing themselves were treated with psychiatric drugs.” Thank God for FOIA that provides the docs to back this up:

According to data received via a Freedom of Information Act request, more than 80 percent of the 367 suicides had been receiving psychiatric medications. More than half of these were receiving antidepressants, while more than 60 percent were receiving either antidepressants or antipsychotics. There is no mention of this either in the NBHW paper or in major Swedish media reports about the health care suicides.

I guess Sweden isn’t the only country in the world that wants to sweep unfavorable mental health coverage under the rug. By the way, Sweden also is considered to be the seventh happiest country in the world.

While the FDA has recognized that antidepressants can cause an increase in suicidal behavior (as indicated by the “black box warning”), antipsychotics seem to have fallen under the radar. In fact in 2002, Clozaril was approved to combat suicidal behavior in schizophrenic patients. Since then, research has shown that antipsychotics can increase suicidal behavior in schizophrenic patients twenty-fold.

Akathisia – a serious side effect that has occurred for nearly all psych drugs in clinical trials – has been found to be linked to suicidal behavior with not only antidepressants but also in conjunction with antipsychotics.

Finally, Baughman closes with this:

It is important to note that nearly every school shooting that has happened in the United States over the last decade has been conducted by young males who were taking antidepressant drugs. The drugs not only cause suicidal behavior, they also seem to promote extreme violence towards other individuals. In most school shooting cases, the young men committing the violence also committed suicide after killing classmates and teachers. These are classic signs of antidepressant use.

I don’t know if that’s wholly true but it’s a trend I’ve seen with Cho, Kazmierczak, and Eric Harris of Columbine. Since 1996, there have been 55 major school shootings all around the world; 43 of them occurred in the U.S. Makes you wonder how many of these gunmen were on a psychotropic drug – prescribed or not – of some kind.

(Image from Style Hair Magazine)

Do antidepressants provide psychosomatic improvement?

Despite all the hype surrounding antidepressants and their effectiveness, the AP has reported on a new study from the University of Hull in Britain that says antidepressants only help severely depressed people and “work no better than placebos in many patients.”

The drugs used in the study: Prozac (fluoxetine), Effexor (venlafaxine), Paxil/Seroxat (paroxetine), and Serzone (nefazodone).

Irving Kirsch, who headed the study, said: “Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great. This means that depressed people can improve without chemical treatments.” (AP)

This is a pretty controversial finding considering the widespread use of antidepressants among those who have been diagnosed with clinical depression and other forms of mental illness, i.e. anxiety.

According the NIH, depression (the clinical term is major depressive disorder) affects an estimated 14.8 million American adults. CNN cites a study from the U.S. Centers for Disease Control and Prevention that says 2.4 billion drugs were prescribed in 2005; of those, 118 million were antidepressants. I can only imagine as “awareness” of depression increases, the number of prescribed antid’s has increased as well.

Adult use of antidepressants almost tripled between the periods 1988-1994 and 1999-2000.

Between 1995 and 2002, the most recent year for which statistics are available, the use of these drugs rose 48 percent, the CDC reported.

Many psychiatrists see this statistic as good news — a sign that finally Americans feel comfortable asking for help with psychiatric problems. (CNN)

CNN quoted Dr. Kelly Posner, an assistant professor at Columbia University College of Physicians and Surgeons in New York City, who said that “25 percent of adults will have a major depressive episode sometime in their life, as will 8 percent of adolescents.” If 25 percent of adults have a “major depressive episode,” does that mean that those 25 percent will require antidepressants as well? I’m concerned about the relatively high number for adolescents. I’m not a fan of throwing pills at growing children.

In light of the U of Hull study, the first course of treatment regarding depression should be non-medicated therapy of some kind. Whether it be “talk” therapy or cognitive behavior therapy, tackling depression really should first be treated with psychologic therapy. Posner says “25 percent of adults will have a major depressive episode.” Major depressive episode does not equal clinical depression or major depressive disorder, for that matter. A major depressive episode could mean anything: bereavement, loss of employment, or a difficult situation without an immediate resolution. I am strongly against prescribing antidepressants to help people cope with “normal” life events. People feel as though that their grief is too much to bear so they go to the doctor in the hopes that an antidepressant will help “dull” their emotions. I can only hope that a doctor will be able to differentiate between true clinical depression and a difficult situation that could be helped without the use of psychiatric medication.

P.S. I looked up Dr. Posner’s conflicts of interest and they were “TBD.” I would feel better had it listed “no conflicts of interest to disclose.”

Mental Health Problems Among Soldiers and Veterans

I stumbled upon rawstory.com where I read about a report that CBS released detailing that suicide among veterans is double that of non-veterans. The Department of Veteran Affairs (VA) estimates that 5,000 veterans will commit suicide this year. Actually, the wording verbatim is "5000 suicides among veterans can be expected this year. It's sad that we've come to the point where we expect veterans to just kill themselves.

The Red State blog highlighted a notable quote from the story:

It found that veterans were more than twice as likely to commit suicide in 2005 than non-vets. (Veterans committed suicide at the rate of between 18.7 to 20.8 per 100,000, compared to other Americans, who did so at the rate of 8.9 per 100,000.)

One age group stood out. Veterans aged 20 through 24, those who have served during the war on terror. They had the highest suicide rate among all veterans, estimated between two and four times higher than civilians the same age. (The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be between 22.9 and 31.9 per 100,000.)
I'll reiterate the obvious that everyone's been stating: Something needs to be done.
In general, the rate for veterans needs to significantly decrease, but I find the rate of suicide in the 20-24 age group alarming.
What's the disconnect between that age range as opposed to the other age ranges?
The issue here that needs to be addressed is psychological effects from the war resulting in post-traumatic stress disorder (PTSD).
While I'm sure that psychiatric assistance may come into play for some veterans, all veterans should receive counseling and therapy.
We'll see how the VA handles this information going forward.

In a related matter, USA Today published an article, based on an Army study in the Journal of the American Medical Association, detailing how duty in Iraq affects Army and National Guard soldiers.

The mental toll of fighting in Iraq affects 20% of active-duty soldiers and 42% of National Guard troops and reservists, according to an Army study, which also found that most mental health problems didn't surface until months after troops returned home.

Army psychiatrists examined the results of routine health screenings administered to nearly 90,000 soldiers – active-duty, National Guard and reservists – returning from Iraq in 2005 and 2006. They found about 25,000 suffering mental health problems, ranging from post-traumatic stress disorder (PTSD) and depression to substance abuse and family conflict, according to the study published Wednesday in the Journal of the American Medical Association.

The study also found that mental health problems did not surface as the soldiers left Iraq, but rather, that they appeared about three to six months after a tour of duty. Considering that soldiers are no longer in an unfamiliar area where their top concern is their safety, the appearance of mental health issues upon returning to the U.S. should be of no surprise.

One problem uncovered by the study was the Army's difficulty in treating alcohol abuse. Out of nearly 7,000 soldiers who admitted a drinking problem, 29 signed up for rehabilitation services. The authors blamed this on a policy that requires commanders be notified when a soldier enrolls in alcohol-abuse treatment programs.

I cannot provide any suggestions on how to change a tradition of pretentiousness in the Army: A solider pretending that nothing is wrong while turmoil rages inside his mind. Soldiers are expected and trained to be strong, to not be afraid, and to face their fears. Many of them when on active duty exemplify that attitude. However, working as a soldier is just that – it's work. Just like accountants or editors who are trained in their field, soldiers are trained in their jobs. When a soldier returns from duty, he is a normal human being like the accountant that clocks out at 5 in the evening. Perhaps that analogy might explain how a  soldier struggles with these problems when he is "off the clock," so to speak.

The emergence of mental health issues among soldiers – not just PTSD but also forms of abuse: drug, alcohol, violent – shows that the military needs to engage in preemptive action to combat these problems before they arise. (The puns were not intended, but I thought they were somewhat clever.)

Saturday Stats

"A recent study in the Journal of the American Medical Association (JAMA) concluded that the frequency of severe and fatal reactions to prescribed drugs in the United States is ‘extremely high.’ More than 100,000 people per year are estimated to die in hospitals from drug reactions, implicating medications as one of the nation’s top killers. Depending on the specific estimate, drug reactions in hospitals may constitute either the fourth or the sixth leading cause of death behind heart disease, cancer, and stroke." — Breggin & Cohen, "Your Drug May Be Your Problem"

Saturday Stats

"Rates of mania caused by antidepressants frequently reach or surpass 1 percent of patients." — Breggin & Cohen, "Your Drug May Be Your Problem"

Saturday Stats

"Studies show that at least 75 percent of the antidepressant effect is a placebo effect — the positive response that people have to any treatment that they hope or think will work. But the remaining 25 percent of the positive result may be caused by the ‘active placebo’ effect — which is related to the fact that the antidepressants, unlike placebos, have noticeable side effects that convince the subjects that they are getting ‘strong’ or ‘real’ medicine." — Breggin & Cohen, "Your Drug May Be Your Problem"

Mentally ill? Expect to die sooner

In the midst of the Virginia Tech shootings and the Rebecca Riley case, the media have finally shone a spotlight on mental illness. Some good, some bad (see TAC’s lock ’em and throw away the key).

Marilyn Elias’ article in USAToday, "Mental illness linked to short life," points to obesity and antipsychotics as two of the main factors. (They’re inextricably linked.)

"Obesity is a serious problem. These patients often get little exercise, and many take a newer type of anti-psychotic, on the market for 18 years, that can cause drastic weight gains, promoting diabetes and heart disease, Parks says. He thinks these drugs are contributing to deaths from cardiovascular disease.

Recent studies question the advantage of the newer drugs. "Many could be switched to safer medicines," Parks says. Schizophrenics are thought to have a higher risk for diabetes already, he says."

The article specifically mentions that people with mental illness tend to die at the age of 51 as opposed to the national average of 76. The odds of dying are as follows:

  • 3.4 for heart disease and diabetes, respectively
  • 3.8 for accidents
  • 5.0 for respiratory disease
  • 6.6 for pneumonia and the flu

The staggering fact here is "three out of five" people die from diseases that can either be prevented or easily treated. This combats the widespread myth that the mentally ill die mostly by accidents and suicide.

My hope here is that as the NY Times and USAT pick up on the issues of mental illness, the public can become less callous to those who are – ahem – "crazy" and try to reach out to them. Despite the TAC’s point of view, most of us are NOT violence and benefit from the help of a caring few.

What a shame that 32 lives had to be taken to spark this discussion.

USAToday has a great list of related articles. I recommend "New antipsychotic drugs carry risks for children."

PERSPECTIVES: One family’s success story
PERSPECTIVES: Mom feels betrayed by doctors, FDA
Adult antipsychotics can worsen troubles
For foster kids, oversight of prescriptions is scarce
A rush to overprescribe?
Opinion: An outraged journalist and father discovers the mental health system is in ‘shambles’
Welcome to the club.

TAC's Irrelevant Statistics

A couple of things:

  • I’m going to go the way of Gianna at Bipolar Blast and admit that my stats weren’t as accurate as I would have liked them to be. (Hey, I did say, "I could be wrong.") My math is about average and stats were never my thing so please, feel free to take a page out of John Grohol’s book at PsychCentral.com and do a kick-ass analysis of studies or stats that interest you. I must say, however, I am quite flattered at helping raise awareness about the TAC’s stupidity. All credit goes to Furious Seasons for picking at them piece by piece first. Cairn, a commenter over at CLPsych, did a better job of analyzing the stats I used. It seems pretty spot on to me.
  • My husband – the better mathematician and also my better half – pointed out something I’m not sure anyone picked up on. (My apologies to anyone who did.) Let’s recap:

USPRA: “Violence is no more prevalent among individuals with mental illness than the general public”
Fact: The CATIE violence study found that patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public (19.1% vs. 2% in the general population).

Have you figured out what it is yet? Well, the TAC took the USPRA’s broad statement about violence among people with mental illness and applied data about violence among schizophrenics only. The data the TAC used is irrelevant because it doesn’t even apply. The percentages that the TAC used to combat the USPRA’s statement isn’t even an accurate because, well, the USPRA wasn’t talking about schizophrenics; they were talking about the mentally ill in general. So all my stats in my last post are pretty much moot at this revelation because of TAC’s skewed application of the CATIE violence study statistics.

"There are three kinds of lies: lies, damned lies,
and statistics."
~ Mark Twain

A classic case of twisting the words of someone who supposedly shot the messenger

The subject title is long, but – I think – apropos.

The Treatment Advocacy Center’s post, “A classic case of shooting the messenger,” has been bothering me all day. I’ve been wanting to do further research on their claim that “patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public.” Funny thing is, I didn’t have to look far.

The TAC links to a summary of the CATIE violence study and surprisingly, it contradicts the TAC’s post. I couldn’t help but chuckle once I realized I could easily debunk their claims from what they considered supporting evidence.

USPRA: “Violence is no more prevalent among individuals with mental illness than the general public”
Fact: The CATIE violence study found that patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public (19.1% vs. 2% in the general population).

MY TAKE:Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia. Of the 1,140 participants in this analysis, 80.9 percent reported no violence, while 3.6 percent reported engaging in serious violence in the past six months. Serious violence was defined as assault resulting in injury, use of a lethal weapon, or sexual assault. During the same period, 15.5 percent of participants reported engaging in minor violence, such as simple assault without injury or weapon. By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period, according to the NIMH-funded Epidemiologic Catchment Area Study.”

This data is a little skewed here. (CLPsych or Philip Dawdy could do a better job at clarifying this for me.) First of all, “about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period.” How many people does this constitute? The sentence doesn’t specify ‘without schizophrenia’; it says “without psychiatric disorder.” That means Americans who do not suffer at any given time from depression, bipolar disorder, psychosis, anxiety, schizophrenia, obsessive-compulsive disorder, postpartum depression, and the list goes on and on. Can anyone compile complete data of Americans who suffer from a psychiatric disorder? (Why do I have the funny feeling that Americans without psychiatric disorders are becoming the minority?)

In the January 1994 issue of the Archives of General Psychiatry, results of the National Comorbidity Study were released. Diagnoses from the DSM-III were applied to the participants ranging from ages 15-54. The study found that 50 percent of participants reported “one lifetime disorder” and 30 percent said they had “at least one 12-month disorder.”

That was January 1994. The American population has grown significantly since then, so I have a hunch that there's an increase in diagnosing people with psychiatric illnesses. But like I said, that’s, uh, just a hunch. (Keep in mind that the study does not include children ranging from ages 4-14 who are likely to receive ADHD and/or bipolar diagnoses.)

Humor me: Let’s take the NC study’s findings and apply it to the current estimated U.S. population (assuming that the percentage of those with a lifetime disorder has remained the same). Out of nearly 300 million Americans (July ’06 estimate), that means about 150 million Americans have at least some form of a psychiatric disorder. If 1 percent of the general population suffers from schizophrenia, that comes out to 3 million people. If we apply CATIE’s violence percentages, TAC’s right; 19.1 percent of schizophrenic patients engage in violent behavior of any kind. However, the CATIE study also says that two percent of the general population without psychiatric disorder engages in violent behavior. That means out of the remaining 150 million, 2 percent of that would be —*drumroll please* — 3 million Americans! Maybe it’s just me, but doesn’t seem 10 times likely. I could always be wrong.

Read the rest of this entry »

Saturday Stats

"Two-thirds of people ‘with psychiatric disorders’ often wait two to five years or more before seeking treatment." — Breggin & Cohen, "Your Drug May Be Your Problem"

Saturday Stats

"Using a low-end rate of 1 percent, Maxmend and War (1995, p. 33) estimate that 1,000-4,000 deaths occur in America each year as a result of MNS, neuroleptic maglinant syndrome, a reaction caused by neuroleptic drugs." — Breggin & Cohen, "Your Drug May Be Your Problem"

Saturday Stats

65 percent of American adults who need behavioral health care services yet do not receive the services they require, according to the U.S. Surgeon General. Eighty percent of children also do not get the needed services. — Metro (newspaper)/NC

Saturday Stats

"Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm." – National Center for Injury Prevention and Control

Saturday Stats

"In 2001, firearms were used in 54% of youth suicides." – National Center for Injury Prevention and Control

Saturday Stats

"Suicide is the eighth leading cause of death for all U.S. men." – National Center for Injury Prevention and Control

Saturday Stats

"In 2001, 5,393 Americans over age 65 committed suicide. Of those, 85% were men and 15% were women." – National Center for Injury Prevention and Control

Saturday Stats

"American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group." – National Center for Injury Prevention and Control

Saturday Stats

"Women report attempting suicide during their lifetime about three times as often as men." – National Center for Injury Prevention and Control

Saturday Stats

"In 2001, 55% of suicides were committed with a firearm," – National Center for Injury Prevention and Control

Saturday Stats

"Males are four times more likely to die from suicide than females." – National Center for Injury Prevention and Control

Saturday Stats

"Of the nearly 35 million Americans age 65 and older, an estimated 2
million have a depressive illness (major depressive disorder, dysthymic
disorder, or bipolar disorder) and another 5 million may have
"subsyndromal depression," or depressive symptoms that fall short of
meeting full diagnostic criteria for a disorder." – National Institute of Mental Health

Saturday Stats

"Fewer than half of those suffering from depression seek treatment." – National Mental Health Association

Saturday Stats

"Suicide took the lives of 30,622 people in 2001." – National Center for Injury Prevention and Control

Saturday Stats

"Firearms were used in 73% of suicides committed by adults over the age of 65 in 2001." – National Center for Injury Prevention and Control

Saturday Stats

"Suicide rates in the United States are lowest in the winter and highest in the spring." – National Center for Injury Prevention and Control

Saturday Stats

"Suicide rates are generally higher than the national average in the western states and lower in the eastern and midwestern states." – National Center for Injury Prevention and Control

Saturday Stats

"Clinical depression is one of the most common mental illnesses, affecting more than 19 million Americans each year. This includes major depressive disorder, manic depression and dysthymia, a milder, longer-lasting form of depression." – National Mental Health Association

Docs don't prescribe enough antid's

MSNBC antidepressants

What? Doctors don’t prescribe enough drugs? You have GOT to be kidding me. [I didn’t watch the report (work blocks access to this kind of stuff), but it’s probably way off regardless.] On a semi-rant, though, if 22 million Americans are suffering from clinical depression at any given day, do all 22 million REALLY need to be on antid’s? Seriously. It’s like pharma companies are in the poor house and need this NBC report to boost sales. (Ugh, who paid Today for this “free” ad spot?) (article source: Uncomfortably Numb)

Saturday Stats

"Comprising only 13 percent of the U.S. population, individuals age 65 and older accounted for 18 percent of all suicide deaths in 2000. Among the highest rates (when categorized by gender and race) were white men age 85 and older: 59 deaths per 100,000 persons in 2000, more than five times the national U.S. rate of 10.6 per 100,000." – National Institute of Mental Health

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