New Studies Suggest That Depression And Distress Is Not Detected In The Majority Of Patients Seen By Nurses

New research from the University of Leicester reveals that nursing staff have ‘considerable difficulty’ detecting depression and distress in patients.

Two new research studies led by Dr Alex Mitchell, consultant in psycho-oncology at Leicestershire Partnership Trust and honorary senior lecturer at the University of Leicester, highlight the fact that while nurses are at the front line of caring for people, they receive little training in mental health.

The researchers call for the development of short, simple methods to identify mood problems as a way of providing more targeted and appropriate treatment for patients.

Dr Mitchell, of the Department of Cancer Studies and Molecular Medicine at the University of Leicester, said: “In terms of dealing with distress and depression, nursing staff are probably the most important group of health professionals.

“In the NHS 400,000 nurses provide valuable support to those suffering a range a physical and mental illnesses but struggle to detect depression in the early stages. Nurses are often very capable of forming good therapeutic relationships and provide a great deal of psychological support which is highly valued. However their ability to do this is increasingly under-pressure from high workloads and little funding for professional development.

“Our first analysis found that 7000 nurses and nursing assistants often overlooked depression in clinical settings. Nurses working in hospital settings and nursing homes correctly identified about 4 out of 10 people with depression and practice nurses working in primary care correctly identified only one in four people with depression.”

A second study examined the ability of nurses to detect distressed patients and found half were missed until distress became severe.

Dr Mitchell said the research discovered a number of reasons that accounted for this situation: “Factors that appear to be influential include greater empathy, more confidence with mental health and more time spent with patients. However most nursing staff receive little training in mental health and report low experience in this area. It may be unrealistic to expect nurses to remember complex criteria for detection of depression or to apply lengthy screening tools. In the future we may focus more on who has impaired function and who needs help rather than depression alone.”

Dr Mitchell’s team is working on short, simple methods to identify mood problems and these can be freely accessed here.

Note
Mitchell AJ, Kakkadasam V. Ability of nurses to identify depression in primary care, secondary care and nursing homes – A meta-analysis of routine clinical accuracy. International Journal of Nursing Studies (2010) online first and on ScienceDirect doi:10.1016/j.ijnurstu.2010.05.01

Mitchell, A. J., Hussain, N., Grainger, L. and Symonds, P. , Identification of patient-reported distress by clinical nurse specialists in routine oncology practice: a multicentre UK study. Psycho-Oncology, n/a. doi: 10.1002/pon.1815

Source:
University of Leicester

Warning: Racism Is Bad for Your Health

By Elizabeth Page-Gould

Elizabeth Page-Gould explains that the targets of prejudice aren’t the only ones harmed by it.

When we think about the victims of racism, we typically think of the immediate targets of racial prejudice: Those who have suffered at the hand of discrimination and oppression. But new research has identified another, unlikely group of victims: the racists themselves.

In the urban metropolises of the United States and Canada, it is almost impossible to avoid talking to someone of another race. So imagine the toll it would take if every time you did, your body responded with an acute stress reaction: You experience a surge in stress hormones, and your heart pumps harder while your blood vessels constrict, inhibiting the flow of blood to your limbs and brain.

These types of bodily reactions are helpful in truly dangerous situations, but a number of recent studies have found that racially prejudiced people experience them even during benign social interactions with people of different races. This means that just navigating the supermarket, coffee shop, or modern workplace can be stressful for them. And if the racist person then has to go through this every single day, the repeated stress can become a chronic problem, which places them at heightened risk for disease in later life.

Harboring prejudice, it seems, may be bad for your health.

Challenge vs. threat
The human body is incredibly adaptive to stressful situations. But our nervous system reacts very differently to stressful situations we perceive as challenges than to those we see as threats. It’s a distinction that, in the long run, could mean the difference between life and death for people with racial prejudices.

Challenges incite a sequence of physiological responses that send more blood to our muscles and brains, enhancing our physical and cognitive performance. Threats, on the other hand, set off a physiological response that restricts our blood flow and releases the hormone cortisol, which breaks down muscle tissue and halts digestive processes so that the body can quickly muster the energy it needs to confront the threat. Over time, these responses wear down muscles, including the heart, and damage the immune system.

In other words, facing challenges is good for you; facing threats is not. And whether you perceive interracial interactions as a challenge or a threat may be the key to thriving in a multicultural society.

In one study, Wendy Berry Mendes, Jim Blascovich, and their colleagues invited European-American men into the laboratory to engage in social interactions with African-American men or with men of the same race as themselves. The participants were hooked up to equipment that measured the responses of their autonomic nervous system while they played the game Boggle with their white or black partners.

When interacting with African-American partners, the white men tended to respond as to a physiological threat, marked by diminished blood pumped through the heart and constriction of the circulatory system. However, European Americans who had positive experiences with African Americans in the past responded as though the game posed a challenge—increased blood pumped by the heart and dilation of the circulatory system.

This is not an isolated result. In a study with Rodolfo Mendoza-Denton and Linda Tropp, I randomly paired European-American and Latino participants into same-race and cross-race pairs and had them disclose personal information to each other. At the beginning and end of the social interaction, participants provided saliva samples so we could measure their cortisol responses to the social interactions.

More on Are We Born Racist?
Read more about the book, or order your copy
Read Susan Fiske’s essay on the new science of racism
Read Allison Briscoe-Smith’s essay on teaching tolerance to kids

In other words, prejudiced individuals perceived partners of a different race as a physical threat, even though they were in a safe laboratory setting and engaging in a task that was structured to build closeness between the participant pairs. This was true for both Latino and European-American participants who were prejudiced. Imagine these same individuals trying to negotiate a racially diverse street scene or meeting at work.

In another study, Wendy Berry Mendes and her colleagues invited European Americans to take a survey over the Internet, measuring their levels of automatic prejudice against African Americans. These white participants were then invited to a laboratory where either European Americans or African Americans evaluated participants, as if in a job interview.

Again, as in the study I did with my colleagues, cortisol spiked in the relatively racist participants—and at the same time, their bodies released low levels of DHEA-S, a hormone that helps repair tissue damage caused by the taxing “flight or fight” response. In contrast, the more egalitarian participants—those who scored low in automatic prejudice—responded to the interracial interaction with greater increases in DHEA-S than cortisol, which suggests that they saw the evaluation more as a healthy challenge than as a threat.

A healthy society?
The bottom line is clear: Harboring racist feelings in a multicultural society causes daily stress; this kind of stress can lead to chronic problems like cancer, hypertension, and Type II diabetes. But interracial interactions are not inherently stressful. Low-prejudice people show markedly different physiological responses during interracial interactions. In all three of these studies, people who had positive attitudes about people of other races responded to interracial interactions in ways that were happy, healthy, and adaptive.

These positive attitudes can be learned; prejudiced people are not doomed to be that way forever. In my own study with Latino and European-American participants, we randomly assigned racist participants—those who were measurably stressed out by simple cross-race conversations—to complete a series of friendship-building tasks over several weeks with people of a different race. Over the next several weeks, we watched cortisol levels diminish in prejudiced participants, a trend that lasted throughout the friendship meetings. Furthermore, in the 10 days following their final friendship meeting, prejudiced participants who had made a cross-race friend in the lab sought out more daily interracial interactions afterward.

It’s that simple: Building friendships with people of other races seems to eliminate unhealthy stress responses, so that each new interaction can be greeted as a challenge instead of a threat. In a racially diverse society, those who feel comfortable with people of other races are at an advantage over those who do not.

These results have profound implications for the way we design our neighborhoods and institutions; indeed, they suggest that race-mixing policies like affirmative action might be just as good for white people as for people of color. The future health of racist people is not set in stone. If they’re willing to take the first step and reach out to people of other groups in a friendly way, they may learn to thrive in a society that is increasingly diverse

The Vicious Cycle Of Overeating And Obesity

New research provides evidence of the vicious cycle created when an obese individual overeats to compensate for reduced pleasure from food.

Obese individuals have fewer pleasure receptors and overeat to compensate, according to a study by University of Texas at Austin senior research fellow and Oregon Research Institute senior scientist Eric Stice and his colleagues published this week in The Journal of Neuroscience.

Stice shows evidence this overeating may further weaken the responsiveness of the pleasure receptors (“hypofunctioning reward circuitry”), further diminishing the rewards gained from overeating.

Food intake is associated with dopamine release. The degree of pleasure derived from eating correlates with the amount of dopamine released. Evidence shows obese individuals have fewer dopamine (D2) receptors in the brain relative to lean individuals and suggests obese individuals overeat to compensate for this reward deficit.

People with fewer of the dopamine receptors need to take in more of a rewarding substance — such as food or drugs — to get an effect other people get with less.

“Although recent findings suggested that obese individuals may experience less pleasure when eating, and therefore eat more to compensate, this is the first prospective evidence to show that the overeating itself further blunts the award circuitry,” says Stice, a senior scientist at Oregon Research Institute, a non-profit, independent behavioral research center. “The weakened responsivity of the reward circuitry increases the risk for future weight gain in a feed-forward manner. This may explain why obesity typically shows a chronic course and is resistant to treatment.”

Using Functional Magnetic Resonance Imaging (fMRI), Stice’s team measured the extent to which a certain area of the brain (the dorsal striatum) was activated in response to the individual’s consumption of a taste of chocolate milkshake (versus a tasteless solution). Researchers tracked participants’ changes in body mass index over six months.

Results indicated those participants who gained weight showed significantly less activation in response to the milkshake intake at six-month follow-up relative to their baseline scan and relative to women who did not gain weight.

“This is a novel contribution to the literature because, to our knowledge, this is the first prospective fMRI study to investigate change in striatal response to food consumption as a function of weight change,” said Stice. “These results will be important when developing programs to prevent and treat obesity.”

The research was conducted at the The University of Oregon brain imaging center.

Stice has been studying eating disorders and obesity for 20 years. This research has produced several prevention programs that reliably reduce risk for onset of eating disorders and obesity.
Source:
Kathryn Madden
University of Texas at Austin

Men Battling The Skinny Jean and Eating Disorders

Despite the number of men with eating disorders continuing to rise, men with eating disorders feel invisible and unable to seek professional help, according to research by the South London and Maudsley NHS Foundation Trust (SLaM).

SLaM Clinical Psychologist Dr Victoria Mountford and her co-researchers at Canterbury Christ Church University, found that men with eating disorders felt alone and worried about the stigma surrounding male eating disorders.

It is now estimated that at least 10 per cent of binge eaters, anorexics and bulimia sufferers are male. Interestingly, rates of eating disorders among men are on the rise, whereas rates among women have remained largely the same over the last 10 years.

The stigma around males and body image means males find it even harder to acknowledge they have an eating disorder and seek help. Males showing signs of eating disorders are less likely to be recognized and diagnosed by professionals including GPs and psychiatrists.

To coincide with London Fashion Week, SLaM has contributed a piece on the rise of eating disorders among men to Nutrition Rocks, a lifestyle and celebrity website that aims to improve nutrition and body image among young people.

This London Fashion Week, media attention has zeroed-in on the so-called ‘size zero debate’. Models and eating disorders, and the unrealistic body image promoted by the fashion industry, is nothing new.

What is different is that the fashion industry’s obsession with body weight is no longer confined to women. Men, and in particular male models, are increasingly aspiring to unrealistic, unobtainable and unhealthy body shapes.

The article cites the research of Dr Mountford and colleagues, who spent a great deal of time talking to men suffering eating and body image problems.

“They told me they felt male eating disorders were an invisible issue and that eating disorders were thought to only affect women. They felt very alone with their eating disorders and worried about how people would react if they found out,” Dr Mountford explained.

“The men we spoke to had found it difficult to admit to themselves and others that their eating behaviors were problematic and that they needed some support. This meant that many of the men waited a considerable amount of time before seeking help.”

Hala El-Shafie, Specialist Dietician and co-founder of Nutrition Rocks, agreed with Dr Mountford’s research.

“The greatest challenge surrounding body image issues and eating disorders in men, is that men historically find it difficult to share and discuss emotional issues they may be facing. Sadly, disordered eating behaviour and distorted body image is becoming increasingly prevalent in males,” Hala said.

“However, without greater awareness of the problem, many men will continue to suffer in silence and shame, and the underlying stresses that often precede disordered eating will continue to go undetected. Greater awareness of how men can access help and support is needed. This is not just a women’s issue.”

Notes
– Dr Victoria Mountford is a clinical psychologist in SLaM’s Eating Disorders Inpatient Service. Internationally renowned for its research and treatment development, the service offers assessment, treatment and management of people with anorexia nervosa, bulimia, binge eating and other eating problems. Care is tailored to individual needs, and outpatient, daycare and inpatient treatment is offered.

– For more information on SLaM’s Eating Disorders Service visit here.

Nutrition Rocks aims to offer people easy and practical advice on living a healthier lifestyle whilst providing accurate tips in nutrition and well being. Together with celebrity interviews, Nutrition Rocks features real life stories to encourage and inspire alongside no nonsense information around food, nutrition, beauty, fashion and fitness.

Source: South London and Maudsley NHS Foundation Trust (SLaM)
Copyright: Medical News Today
This article was originally published at:
http://www.medicalnewstoday.com/articles/202112.php

The Price of Popularity: Drug and Alcohol Consumption

The consumption of drugs and alcohol by teenagers is not just about rebellion or emotional troubles. It’s about being one of the cool kids, according to a study by led by researchers at the Université de Montréal.

“Our study highlights a correlation between popularity and consumption,” says Jean-Sébastien Fallu, lead researcher and professor at the Université de Montréal’s School of Psycho-education. “The teenagers we studied were well-accepted, very sensitive to social codes, and understood the compromises that it takes to be popular.”

Link between popularity, friends and consumption

The study, which is to be published during the next year as part of a collective work, was conducted on more than 500 French- speaking students at three separate moments of their lives: at ages 10 to 11, 12 to 13 and 14 to15. It took into consideration the popularity of the child and their friends and tracked their consumption of alcohol, marijuana and hard drugs.

The findings showed an increase in consumption, as the child got older regardless of their popularity level. However, the more popular a child and their friends were, the greater this consumption was. There was a two-fold between increase between ages 10 and 15 for the most popular kids who also had very popular friends. However, this trend did not apply to popular kids whose friends were not as popular.

Maintaining popularity

The results suggest that popular teenagers are more at risk if their friends are also considered popular. “Teenagers don’t consume to belong to the group or to increase their popularity level, they do it to remain well-liked,” says Fallu. “It’s more about keeping their status than increasing it.”

Teenagers who aren’t considered popular are obviously also at risk of other deviant behaviors. However, other studies have shown that they are more inclined to develop violent behaviors than consume alcohol or drugs.

This research was made possible by grants from the Social Science and Humanities Research Council of Canada, the National Health Research and Development Program, and the Fonds Québécois de Recherche sur la Société et la Culture.

Fallu conducted the study with the help of Frank Vitaro, Stéphane Cantin and doctoral student, Frédéric Brière of the Université de Montréal School of Psychoeducation as well as colleagues at the University of Oslo.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Montreal, via EurekAlert!, a service of AAAS.