Wednesday, January 27, 2016

Health professionals can take the fight against stigma into their own back yards

Today is Bell Lets Talk day - in which tweets with #BellLetsTalk lead to a donation from Bell to support its stigma-fighting efforts. There is lots of support for the fight against stigma - usually targeting public stigma (negative attitudes help by the general population). Health professionals almost always have good intentions, but they are not immune from stigma. A recent study (report available here) identified 6 key ingredients of efforts to fight stigma among health professionals: (1) the anti-stigma intervention should include a personal testimony from a trained speaker who has lived experience of mental illness, (2) there should be multiple forms or points of social contact (for example, a live speaker and a video presentation, multiple speakers, etc.), (3) the program should focus on behaviour change by teaching skills that help health care providers with concrete skills to help them avoid stigmatization, (4) that the program should challenge stigmatizing myths, (5) the program facilitator should be enthusiastic and have a person-centred approach (as opposed to pathology-first) and (6) the program should emphasize recovery as a key part of its messaging. Often, health organizations and institutions plan their own anti-stigma interventions "from the ground up" but they should carefully consider these key ingredients. Programs that incorporate all of them have better outcomes. 

Tuesday, January 26, 2016

Benzodiazepine use in Canada

Benzodiazepines are sometimes used in the symptomatic management of major depression - usually targeting symptoms such as anxiety and sleep problems. Unfortunately, with any use of these medications for longer than a few weeks there can be development of tolerance, such that rebound anxiety and insomnia may occur on discontinuation, making it difficult to stop them. For this, other reasons, the prevalence of use of these drugs has been persistently high over the past several decades, as discussed in a paper by Kassam et al., available here. In the February edition of the  Canadian Journal of Psychiatry, we compare two mental health surveys conducted in Canada - one in 2002 and one in 2012. One of the positive changes over this ten year period is a decline in the frequency of benzodiazepine use in the general population, down to 1.5% whereas this was previously about 3%. While this is good news, it is possible that the use of benzodiazepines has merely been replaced to some extent by the use of sedating antipsychotics such as quetiapine, where an increase in the frequency of use was observed.

Sunday, January 24, 2016

Blended learning for Community Health Workers and Health Professionals in Afghanistan

Funded by Grand Challenges Canada, Tech4Life in partnership with some Canadian academics through the University of Calgary have been developing blended learning materials for front-line mental health workers in Afghanistan. They use the open-source learning platform Moodle and have also employed some innovative strategies such as providing memory cards with the course materials to the learners. They have recently reported positive outcomes from the evaluation of their modules on Depression - and more detail should soon be forthcoming in the peer-reviewed literature.

Sunday, January 17, 2016

The "Blue Monday" phenomenon - not just stupid anymore, this is getting destructive

It is not really any secret any more than "blue monday" is a fake. This was an idea that was apparently developed as a component of a marketing scheme for a travel company (the story can be found on Wikipedia, here). It comes with a ridiculous formula that adds, subtracts, multiplies, divides (it even has exponents!) various things that intuition suggests might make the first few weeks of the new year unpleasant. It might be funny except that in spite of all reason it continues to be mistaken for legitimate science - most recently our own CBC has decided to conflate this idea with the the concept of seasonal affective disorder, look at this story. This one is not as bad as some media outlets, who seem to be completely sucked in, see here for example. Apparently, there is even a saint that you can pray to for assistance. This might all be humorous (for a fun discussion, check here), except that there are number of downsides. Pseudoscience has the potential to discredit actual science and the "Blue Monday" concept has the potential to stigmatize and trivialize actual depression, as recently pointed out in a blog by George Woolfrey. As Tom Chivers says, here, "can't we all just drop it now?" Sensible as that suggestion may be, I doubt it.

Wednesday, January 13, 2016

Depression is much more common in the winter in Canada

Discussions about winter depression in this country tend to gravitate towards the concept of Seasonal Affective Disorder (SAD). SAD is not officially recognized as a disorder in DSM-5, but is instead a subtype of Major Depressive and Bipolar Disorders. The way in which the sub-type is defined in the manual is based on episodes having a characteristic time of onset and resolution. They are not required to occur in the winter and they are not even required (in the case of Bipolar I disorder) to be depressive episodes. Most studies of this condition have used instruments that assess seasonal variation in mood, not depressive episodes. But it is important to know whether there is actually more major depression in the winter months. We've recently looked at this question in national datasets and the results are striking (click here). The paper is published in the journal Epidemiology and Psychiatric Sciences. There is a 70% higher odds of depression in the winter months compared to the summer months. This presents a real problem for the health system(s) in Canada to deal with, since it implies a need for greater availability of services in the winter months - and I know of no efforts to deliver seasonal services for depression.

Tuesday, January 12, 2016

Is depression more common in women? Yes, but...

It is commonly asserted that major depression is more common in women than in men - with (roughly speaking) a 2:1 ratio in the prevalence. However, what is often forgotten is that this sex difference is age-dependent. It does not seem to exist prior to puberty. This raises the question of what happens later in life as people get older. We have recently examined this question using data collected from approximately half a million people in Canadian national surveys conducted over the past two decades. The results confirm this strong age dependency - the sex difference is largest in the youngest age group examined by these surveys (15 - 24 years) and subsequently gets smaller with age. By the elderly end of the age range the difference is gone completely. The abstract from this study is available through this link. Prior researchers have hypothesized the sex difference would disappear around the age of menopause, but this does not appear to be the case. Rather, the biggest difference is in the 15-24 age group and it gets progressively smaller with time. It is important to note that in addition to being more common in women throughout much of the age range, major depression is more common in the younger end of the adult age range. As such, it is not so much that men "catch up" with women as that the prevalence diminishes with age at a more rapid rate in women. It is fascinating to wonder what the reasons might be, and whether these are biological, psychological or social (or all of these) in nature.