Category: Suicide

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Ketamine Depression Treatment Poses Unknown Risks

00Decision-Making, Depression, Education, Featured news, Health, Psychopharmacology, Suicide November, 18

Source: SnaPsi at flickr, Creative Commons

New evidence that ketamine, an anesthetic medication, might be effective in treating depression is leading to increased research on the drug. What’s significant is the rapid relief in symptoms seen in some patients. After just one dose of ketamine, their depression can decline within three days, much quicker than with conventional anti-depressants.

This finding is particularly meaningful for people at risk for suicide. Ketamine may provide an option for physicians to quickly treat acutely suicidal patients by creating a window of opportunity to begin long-term behavioral and pharmacological therapies. If a patient’s symptoms are relieved even for a short time, it may be long enough to intervene.

Recent excitement also surfaced when researchers from New York’s Mount Sinai School of Medicine demonstrated the drug’s ability to alleviate treatment resistant depression (TRD). TRD occurs when feelings of intense sadness, loss of energy, and inability to experience pleasure persist even after multiple attempts at treatment. In the study, a shocking nine out of 10 patients with TRD experienced significantly reduced symptoms after their first dose of ketamine.

Despite this finding, questions remain about the drug’s long-term efficacy, as well as its side effects.

Anthony (name changed) has first-hand experience with ketamine to treat TRD. In a Reddit thread and interview with the Trauma and Mental Health Report, he explained that, prior to receiving ketamine treatment, he had tried numerous anti-depressants. After spending weeks or months on each drug to no avail, his doctor would switch him to a new drug in hopes of finding one that worked, but nothing did. Anthony began researching alternative treatments himself. He explained:

“When you try so many drugs—SSRIs, SNRIs, TCAS, antipsychotics, lithium, depakote—you are pretty open to anything that will help.”

He discovered ketamine and was enticed by the prospect of its therapeutic benefits:

“Before ketamine, I was in a hole. This was as depressed as I had ever been. I was suicidal. I called my mom and dad. They rescued me, letting me live in their basement. There, I began researching ketamine until I knew almost every study. I convinced my doctor to let me try it.”

But ketamine is only approved for use as an anesthetic by the U.S. Food and Drug Administration (FDA). This provision means that any patient who receives ketamine treatment for depression must have it prescribed as an “off-label” treatment. In other words, the doctor prescribes the drug for a non-FDA-approved use.

Choosing to participate in an unapproved treatment may expose a patient to more risks than they are aware of. FDA approval for ketamine use in anesthesia indicates that one time treatments are not harmful, but it is uncertain whether repeated treatments are safe. And, the long-term effects are not known.

Not surprisingly, the off-label prescription of ketamine has been criticized. A study by Melvyn Zhang at the Institute of Mental Health in Singapore and colleagues cited multiple problems with ketamine treatment for depression. A major criticism was that current information is based on inadequately short periods of observation. These observations indicate depression relapse rates as high as 73% one month after treatment ends.

Nevertheless, after deciding he was scared, but prepared to do anything to overcome his depression, Anthony began intravenous (IV) ketamine treatment in his doctor’s office:

“[When taking the drug] I feel completely disconnected from my body. I cannot move. I feel partly elated, and partly terrified. Reality becomes distant. I have no awareness of my body; only my mind exists. In this space, I can see my own struggle with depression. I recognize in this strange way that the depression isn’t real, not a part of me. I realize that I am surrounded by people who love me. Slowly, I come back to the chair I’m in, back to the doctor’s office. Somehow, I already feel better.”

After his initial treatment, Anthony said that his thoughts of suicide disappeared. He remembers feeling clear-headed, not high or euphoric. He felt normal again. This realization was so profound, he was moved to tears:

“After the initial five treatments, I was having moments when it felt like all my symptoms of depression were gone. But they would always eventually return. I was prescribed a nasal spray about a month after my last IV treatment. That worked for a while.”

Unfortunately, these benefits had serious contraindications. Anthony experienced lingering feelings of being disconnected from his body and from reality. Another study investigating ketamine use for TRD found that three out of 10 participants experienced dissociative symptoms from the drug.

These side effects have yet to be fully understood. Although Anthony believes that the treatment saved him, it also opened the door for other mental-health problems:

“Looking back, I would do it over again, as ketamine literally pulled me from suicidal thoughts. But, in my opinion, ketamine opened the door for the feelings of disconnection. And they are a huge struggle for me every day now.”

With alarmingly high post-treatment relapse rates, little knowledge of long-term safety, and worrisome side effects, ketamine has yet to be proven as a lasting treatment for depression.

– Stefano Costa, Contributing Writer. The Trauma and Mental Health Report

-Chief Editor: Robert T Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Should Those with Mental Illness Have the Right to Die?

00Chronic Pain, Decision-Making, Featured news, Health, Resilience, Suicide September, 18

Source: KingaBritschgi at DeviantArt/Creative Commons

On June 17, 2016, Canada joined a handful of countries and several U.S. states in enacting assisted suicide legislation. Medical Assistance in Dying (MAID), also known as euthanasia, was passed into Canadian law as Bill C-14 in an effort to provide relief from unbearable suffering to those whose death is reasonably foreseeable.

Although having the choice to die brings relief to many individuals and their families, Bill C-14 does not cover those who wish to end their life due to an unendurable mental illness.

Being denied a legal right to assisted death for significant mental illness was the plight of 27-year-old Adam Maier-Clayton. Since childhood, Maier-Clayton suffered from unrelenting psychological disorders that robbed him of sustaining a reasonable quality of life. In an essay published in The Globe and Mail, he detailed the unrelenting pain his psychological disorder caused him:

“I’m not suicidal in the sense that I hate myself and I want to leave. I think this world is beautiful, but this amount of pain is intolerable… Some people are confined to lives of truly horrifying amounts of suffering that no amount of treatment can stop.”

Maier-Clayton lobbied the Canadian federal government to change the criteria that would allow people with severe mental illness to qualify for medical assistance in dying. His bid was not successful. Sadly, in April 2017, he took his own life.

Currently, the law in Canada excludes access to MAID for people suffering from psychological issues alone. For right-to-die supporter, author, and journalist Sandra Martin, this position is disrespectful to the severely mentally ill. In an article written for The Globe and Mail, Martin argued for what she believes is the best interest of the patient:

“We can’t leave it to vote-wary politicians and risk-averse medical associations to campaign for an equitable MAID law….We can’t wait for another constitutional challenge to recognize that not all suffering is physical. That struggle is Maier-Clayton’s legacy—and fighting for it might make a difference to you or somebody you love.”

Not having an available, safe, and medically supervised solution to dying does not prevent death. According to Dying With Dignity Canada, the absence of a legal and feasible option pushes individuals into making agonizing and expensive decisions. They must either take their own life or travel abroad to countries where assisted suicide is legal.

Despite the pressure to change MAID, lawmakers are taking a cautious approach to considering future regulation on right-to-die policies involving psychological disorders. Many mental health professionals and organizations meet this unhurried approach favourably, as they feel it is necessary to protect potentially vulnerable members of society who may recover.

The Centre for Addiction and Mental Health (CAMH) supports the Canadian government’s decision to painstakingly consider the implications of MAID for psychiatric patients. CAMH stated:

“CAMH recognizes that people with mental illness can experience intolerable psychological suffering as a result of their illness, but there is always the hope of recovery. In those rare cases where a mental illness may be determined to be irremediable, safeguards must be in place to make sure that an individual truly has the capacity to consent to MAID.”

On February 8, 2017, in a panel discussion jointly hosted by the University of Toronto Faculty of Law and CAMH, mental health professionals converged to dissect this multifaceted debate. In addition to the vast legal issues, they discussed the enormous ethical dilemmas inherent in right-to-die policies. Panel member Scott Kim, Senior Investigator at the National Institute of Health, summarized some of the ethical, moral, and legal issues at play, and cautioned against enacting policy without the appropriate research on euthanasia available. Kim emphasized the risk of human error in the medical profession in making this type of decision:

“Euthanasia is permanent….Even the most sophisticated psychiatrist does not have too much data to go on except their own experience and impressions to make these prognostic determinations.”

Kim goes on to point out that wanting to die is often part of the mental illness manifestation itself, and with correct and consistent treatment, the desire to end one’s life may abate.

MAID currently requires a medical practitioner to support a patient’s resolve to die. The magnitude of such a permanent decision lies not only with the patient, but also with the medical professional. In an occupation that is obligated to ‘do no harm’, supporting the death of someone with a non-terminal illness, despite an intolerable life, appears contradictory.

Tarek Rajii, panel member and Chief of Geriatric Psychiatry at CAMH, has worked with patients that he knows may never recover. However, based on the current research available, Rajii remains hesitant about MAID for mental illness:

“We don’t know who will die suffering. We don’t know how to identify that person….If we are considering MAID as a form of treatment intervention, when there is very limited evidence, as a medical profession, do we introduce an intervention without enough evidence, that we don’t [fully] understand?”

With making the decision to end a life of psychological suffering, mistakes are not an option. There is no room for error; there is no reversal. And yet, how much suffering can one person endure? Ultimately, we are left with the realization that, despite the pain from devastating mental illness, hope for recovery cannot be ruled out.

– Kimberley Moore, Contributing Writer, “The Trauma and Mental Health Report”

“-Chief Editor: Robert T. Muller, The trauma and Mental Health Report”

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Solitary Confinement Is Torture

00Ethics and Morality, Featured news, Health, Politics, Psychopathy, Punishment, Suicide May, 18

Source: The Euskadi 11 at flickr, Creative Commons

Sixteen-year-old Kalief Browder spent three years in New York’s notorious Rikers Island prison, awaiting trial for robbery. Two of those years were spent in solitary confinement. Browder’s case was eventually dismissed and, after surviving four suicide attempts during incarceration, he was released. Suffering from depression and paranoia from his years in isolation, Browder died by suicide in June of 2015.

Former U.S. President Barack Obama referenced Browder’s story in an opinion piece he wrote for the Washington Post, explaining his decision to ban solitary confinement for juveniles in all federal prisons, and calling for greater restrictions on its use as a punitive measure. New York had already ended the use of isolation for prisoners 16 and 17 years old, but in October 2016, the age restriction was extended to age 21 and younger.

In 2015, Canada’s Prime Minister Justin Trudeau moved to ban the use of long-term solitary confinement by placing a 15 consecutive-day limit on its use—as of writing, this ban had not come into effect. His decision was motivated in part by the death of Ashley Smith, a young offender who had spent more than 1,000 days in isolation. At the age of 19, while being held in solitary, Smith died by hanging herself. A coroner’s inquest ruled her death a homicide, indicating that other people’s actions were factors in her death.

Reforms are moving in the right direction, but results of a 2011 United Nations (UN) report raise the question—should isolation be permitted under any circumstances? UN Special Rapporteur Juan E. Mendez said in this report:

“Solitary confinement, [as a punishment] cannot be justified for any reason, precisely because it imposes severe mental pain and suffering beyond any reasonable retribution for criminal behaviour and thus constitutes an act defined [as] … torture.”

Nevertheless, according to the National Conference of State Legislatures, many American states impose no restrictions on the use of solitary confinement, even for juveniles. In Canada, there is currently no limit on how much time a prisoner can spend in solitary confinement. And, if adopted, the limits proposed by Trudeau will only affect federal prisons.

According to an American National Survey by the Association of State Correctional Administrators at Yale, “between 80,000 and 100,000 people were in isolation in prisons as of the fall of 2014.” In Canada, The Globe and Mail reports, “1,800 Canadian inmates are held in segregation on any given day.”

According to Mendez, the adverse health effects of this type of imprisonment are numerous, and include ‘prison psychosis,’ which can lead to anxiety, depression, irritability, cognitive disorders, hallucinations, paranoia, and self-inflicted injuries. Mendez concluded that “solitary confinement for more than 15 days…constitutes cruel and inhuman, or degrading treatment, or even torture”—well below the time Browder and Smith spent in isolation.

The adverse effects of solitary confinement on mental health have a long history of documentation. David H. Cloud, head of the Vera Institute of Justice’s Reform for Healthy Communities Initiative, stated:

“Nearly every scientific inquiry into the effects of solitary confinement over the past 150 years has concluded that subjecting an individual to more than 10 days of involuntary segregation results in a distinct set of emotional, cognitive, social, and physical pathologies.”

These findings prompted Kenneth Appelbaum from the Center for Health Policy and Research at the University of Massachusetts Medical School to write an article calling for American psychiatry to join the fight against the use of solitary confinement.

Many prison administrators disagree. In an interview with the Boston Globe, the Massachusetts Commissioner of Correction defended the use of solitary, explaining:

“We have to be realistic when we’re running these prisons. Segregation is a necessary tool in a prison environment.”

An article by Corrections One, an online news outlet for the correctional field, explains that segregation keeps jails safer by removing violent and dangerous inmates from the prison population, in the same way that imprisonment removes dangerous people from society. Segregation, the article states, is primarily used on prisoners that pose a risk of harm to themselves or others.

Speaking with the Canadian Broadcasting Company (CBC), Lisa Kerr, law professor at Queen’s University in Southern Ontario, reported that:

“Prison administrators have long been convinced that they cannot manage their institutions without easy, limitless recourse to segregation.”

Watch-dog groups point out that other countries apply the use of solitary confinement more selectively and with greater oversight than is used in North American prisons. In the U.K., while solitary is still in practice, the number of prisoners subjected to this form of punishment is much lower. Even more progressive are correctional institutions in Norway, where prison reform has moved away from punitive approaches and has placed rehabilitation and reintegration as a key focus during incarceration.

Eliminating the use of solitary confinement for juveniles is a promising first step towards abolishing the practice entirely. While supporters of solitary may not feel there are effective alternative punishments, human rights advocates continue to fight for prison reform. Looking at solutions used in other countries, perhaps more effective and humane incarceration methods can be realized, and the current paradigm of punishment may shift.

–Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report. 

Copyright Robert T. Muller. 

This article was originally published on Psychology Today

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Online Programs Confront Suicide in Indigenous Communities

00Depression, Featured news, Health, Resilience, Suicide, Therapy December, 17

Source: Nicole Mason at unsplash, Creative Commons

In 2016, a wave of suicides occurred in Canada’s indigenous populations. Communities in northern Saskatchewan, in particular, witnessed several youth suicides. In October of that year, five girls between 10 and 14 died by suicide in the span of a few weeks. The situation intensified when news broke later that month that a 13-year-old girl was the latest to take her life: a total of six young girls in the province.

Indigenous communities have a long and painful history of mental health issues. Persistent poverty, discrimination, and systemic racism have been cited as key factors in the growing mental health crisis these people face today. Indigenous communities are found in remote, less populated areas, making it difficult for them to get adequate care.

Suicide is the leading cause of death for indigenous peoples—indigenous youth being an acutely vulnerable population. Unsurprisingly, there has been a public outcry for intervention. To reach these remote areas, both activists and researchers are turning to technology to alleviate the growing suicide epidemic.

The We Matter Campaign, an initiative by brother-sister duo Kelvin and Tunchai Redvers, began in October 2016. The campaign consists of videos from members of the indigenous community sharing personal stories of survival and hope. The Redvers’ website hosts a variety of work from indigenous youth—visual art and poetry, in addition to the videos, which are the main focus. Individuals with diverse experiences have shared their stories, from high school students to residential school survivors to members of parliament.

One especially moving story comes from comedian Don Burnstick, who discloses:

“I ended up on a chair with a rope around my neck, and I was going to hang myself. …I imagine if I would have done that, I would have ended up another statistic; a cross on the ground in my res. None of this life would have happened for me. I was very grateful that I got off that chair, took the rope off and looked at suicide and said ‘I’m not going to do it. I don’t care how much pain I’m in. I’m not going to do it. You’re not going to get me.’”

By hosting a multi-media campaign on platforms like Facebook and Twitter, as well as their own website, the Redvers harness technology and social media to reach otherwise isolated populations.

Kelvin and Tunchai Redvers spoke to the Trauma and Mental Health Report about their initiative. When asked how it started, Kelvin emphasizes the role of the internet: “It seemed like something so simple, yet we hadn’t seen anyone do it yet… 3 a.m. is when life seems so bleak and you feel most alone. Since our campaign is online and available at all hours, it could really help during those dark moments.”

Tunchai further highlights the important role technology plays in their approach: “Our campaign is online, and it lives online—to all remote corners, to those who might not reach out for help. It’s less overwhelming that way, less intimidating.”

Researchers, too, are harnessing the power of technology to help indigenous youth populations. Sally Merry and colleagues at Auckland University have developed a video game called SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts). SPARX is a fantasy role-playing game designed to teach coping skills based on the principles of cognitive behavioural therapy. SPARX teaches five behaviours to help young people address stress or depression: problem solving; being active; dealing with negative thoughts; improving social skills; and learning relaxation techniques.

Anecdotal findings in Auckland show that adolescents using SPARX report feeling happy that their peers don’t know they are depressed, and that they can deal with their mental health concerns on their own. That same study found youth reporting decreased feelings of hopelessness and better emotion regulation. One user explains, “It gives you the courage to sort out your problems, face your problems, and may even enable you to take another step and talk to someone.”

SPARX has been used to treat depressed youth in a variety of cultural contexts, including indigenous youth. After successful results with the New Zealand Māori population, the approach is being tried in Canada. Given that individuals of the Inuit community in Nunavut are 11 times more likely than the national average to commit suicide, researchers from York University are working to adapt SPARX for the Inuit context (SPARX-N).

This technology is enabling new routes to helping marginalized, indigenous populations that live in inaccessible areas. Although tangible outcomes remain to be seen, technology-based solutions offer hope toward helping heal a long history of trauma. Above all, the founders of the We Matter Campaign emphasize the strength and resilience of indigenous communities. Tunchai says: “There are a lot of issues out there, but also so much creativity, love, and hope.”

–Fernanda de la Mora, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Online Programs Confront Suicide in Indigenous Communities

30Depression, Featured news, Health, Resilience, Suicide, Therapy December, 17

Source: Nicole Mason at unsplash, Creative Commons

In 2016, a wave of suicides occurred in Canada’s indigenous populations. Communities in northern Saskatchewan particularly witnessed several youth suicides. In October of that year, five girls between 10 and 14 died by suicide in the span of a few weeks. The situation intensified when news broke later that month that a 13-year-old girl was the latest to take her life: a total of six young girls in the province.

Indigenous communities have a long and painful history of mental health issues. Persistent poverty, discrimination, and systemic racism have been cited as key factors in the growing mental health crisis these people face today. Indigenous communities are found in remote, less populated areas, making it difficult for them to get adequate care.

Suicide is the leading cause of death for indigenous peoples—indigenous youth being an acutely vulnerable population. Unsurprisingly, there has been a public outcry for intervention. To reach these remote areas, both activists and researchers are turning to technology to alleviate the growing suicide epidemic.

The We Matter Campaign, an initiative by brother-sister duo Kelvin and Tunchai Redvers, began in October 2016. The campaign consists of videos from members of the indigenous community sharing personal stories of survival and hope. The Redvers’ website hosts a variety of work from indigenous youth—visual art and poetry, in addition to the videos, which are the main focus. Individuals with diverse experiences have shared their stories, from high school students, to residential school survivors, to members of parliament.

One especially moving story comes from comedian Don Burnstick, who discloses:

“I ended up on a chair with a rope around my neck, and I was going to hang myself. …I imagine if I would have done that, I would have ended up another statistic; a cross on the ground in my res. None of this life would have happened for me. I was very grateful that I got off that chair, took the rope off and looked at suicide and said ‘I’m not going to do it. I don’t care how much pain I’m in. I’m not going to do it. You’re not going to get me.’”

By hosting a multi-media campaign on platforms like Facebook and Twitter, as well as their own website, the Redvers harness technology and social media to reach otherwise isolated populations.

Kelvin and Tunchai Redvers spoke to the Trauma and Mental Health Report about their initiative. When asked how it started, Kelvin emphasizes the role of the internet:

“It seemed like something so simple, yet we hadn’t seen anyone do it yet. 3AM is when life seems so bleak and you feel most alone. Since our campaign is online and available at all hours, it could really help during those dark moments.”

Tunchai further highlights the important role technology plays in their approach:

“Our campaign is online, and it lives online—to all remote corners, to those who might not reach out for help. It’s less overwhelming that way, less intimidating.”

Researchers, too, are harnessing the power of technology to help indigenous youth populations. Sally Merry and colleagues at Auckland University have developed a video game called SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts). Referred to as the first “scientifically-proven ‘gamified’ online therapy for depressed people,”SPARX is a fantasy role-playing game designed to teach coping skills based on the principles of cognitive behavioural therapy. SPARX teaches five behaviours to help young people address stress or depression: problem solving; being active; dealing with negative thoughts; improving social skills; and learning relaxation techniques.

Anecdotal findings of SPARX in Auckland show that adolescents using it report feeling happy that their peers don’t know they are depressed, and that they can deal with their mental health concerns on their own. That same study found youth reporting decreased feelings of hopelessness and better emotion regulation. One user explains:

“It gives you the courage to sort out your problems, face your problems, and may even enable you to take another step and talk to someone.”

SPARX has been used to treat depressed youth in a variety of cultural contexts, including indigenous youth. After successful results with the New Zealand Māori population, the approach is being tried in Canada. Given that individuals of the Inuit community in Nunavut are 11 times more likely than the national average to commit suicide, researchers from York University are working to adapt SPARX for the Inuit context (SPARX-N).

This technology is enabling new routes to helping marginalized, indigenous populations that live in inaccessible areas. Although tangible outcomes remain to be seen, technology-based solutions offer hope toward helping heal a long history of trauma. Above all, the founders of the We Matter Campaign emphasize the strength and resilience of indigenous communities. Tunchai says:

“There are a lot of issues out there, but also so much creativity, love, and hope.”

–Fernanda de la Mora, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Climate Change Affecting Farmers' Mental Health

00Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from an insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A report from the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts by the farmers. Failure of a crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behavior, including greater isolation due to a growing distance between farms, increased competition, and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

This article was originally published on Psychology Today

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Climate Change Affecting Farmer’s Mental Health

60Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A reportfrom the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts in the farmers. Failure of crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behaviour, including greater isolation due to a growing distance between farms, increased competition and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

60Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

00Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

feature-470x260-6f0917207c860c121e20580c44412ffc2a08e57a

When a Sibling Dies by Suicide

00Depression, Family Dynamics, Featured news, Grief, Health, Suicide October, 17

Source: Clair Graubner and Clair Graubner at flicker, Creative Commons

“As far back as I can remember, Michael was always good at being silly. He could make me laugh harder than anyone. He was very creative, and always had a good ear for music.”

In an interview with the Trauma and Mental Health Report, Samantha (names changed for anonymity) shared her experiences living through the suicide of her older brother, Michael, when she was sixteen years old.

Michael’s battle with mental illness began as a teen. He struggled with low self-esteem and clinical depression, and consequently self-medicated.

“After my parentsdivorce, his mental health took a turn for the worse. He was always getting stoned and was generally depressed… After he took LSD with his friend, he was never the same. He was in a psychotic, suicidal state from the drug, so my parents took him to a mental hospital one night… He stayed in the hospital for a week, and was moved to a rehab facility to learn coping skills to become less dependent on marijuana. He was in an extremely dark place during his stay there, and came home in September to start school. He committed suicide on October 15, 2007.”

Samantha’s experience is not uncommon. Suicide is the second leading cause of death for young people aged 15 to 34. And according to a report published by the National Institute of Mental Health, depression and substance abuse (often in combination with other mental disorders) are common risk factors for suicide.

“Words could never express how I felt when I found out. I fell to the ground in absolute hysterics. It’s such an out-of-body memory for me… to go from having an older brother and having visions of our future together, to then in a second having all of that taken away from you.”

Samantha also experienced dissociative thoughts after her brother’s suicide.

“I remember thinking that maybe we were being ‘punk’d’, and that this was all part of a twisted social experiment to show the devastating effects suicide has on a family. That probably lasted a year or so in order to protect my brain from feeling too deeply and to help me focus on other things, like getting into college.”

Samantha began using marijuana and alcohol regularly to numb feelings of anger and loss. Her transition to college was challenging—she had difficulty balancing school work with partying, and often felt isolated.

“I felt like I couldn’t relate to most of my peers, and was extremely lonely. I was always getting high by myself, and reflecting on the past. While all of this was going on, my dad got remarried and had a baby during my freshman year of college. It was really hard for me to watch him start a new family while I was still grieving the loss of our old family.”

Samantha’s decision to self-medicate to deal with her unresolved grief is common among adolescents who lack strong social support.

“I think about Michael every day… but finally I have the relationships and living environment to really dig deep and process what I’ve been through. Yoga and meditation have also played a huge part in my healing process, as well as hula hoop dancing.”

In fact, yoga and meditation can help the healing process. Research by psychology professor Stefan Hofmann and colleagues at Boston University describes the benefits of mindfulness meditation for anxiety and mood symptoms. In their meta-analysis of 39 research studies, individuals who practiced mindfulness meditation experienced reduced anxiety, grief, and depressive symptoms.

Everyone grieves in their own way, and moving on doesn’t have to mean leaving the loved one’s memory behind. As for Samantha: “Michael continues to live on with all of those who knew him.”

–Lauren Goldberg, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today