How much longer before action?

Last week, there appears an article in the San Francisco Chronicle about suicide deaths due to jumping from the Golden Gate Bridge http://blog.sfgate.com/inmarin/2010/01/21/marin-coroner-releases-2009-golden-gate-bridge-suicide-count/. According the Chronicle, last year there were 31 deaths, the year before that there were 34. Over 1,300 people have died by suicide from jumping from the bridge since it was built.

And what is the essence of the story? Apparently the Marin County Coroners Office wants to recommend suicide prevention barriers and this is controversial. And guess what – more studies are apparently recommended.

Now, readers of this blog know how committed I am to research. You also know that I am committed to action. Will putting up an appropriate barrier decrease the rate of successful suicides by jumping from the bridge? Highly likely. Is this a good thing. For sure. So why is it not being done. Who knows?

I remember the hard work that went into getting barriers erected on the Bloor St. Viaduct in Toronto. There the effort was lead by a young man with lived experience of mental illness. I know of the hard work that went into getting a barrier erected on the MacDonald Bridge in Halifax. There the effort was lead by a mother who had lost her son to suicide from the bridge.

It the courageous activity of people like those Toronto and Halifax citizens that seems to be necessary before authorities can act. I am so proud to know and support those leaders and I thank them for everything that they have done and continue to do in this regard. What I don’t get is this. Why is it so hard to do the right thing when it comes to mental health action?

More on the word depression

Today I saw an article about the movie Avatar. This article tells all who read it that this movie is causing people to become depressed and suicidal. What a bunch of journalistic hokum. 

What this likely illustrates is what a topic of a previous blog has been: the inappropriate use of the word “depression”. People do not become clinically depressed after watching a movie; they may however experience a variety of negative feelings (or sometimes positive feelings). We do not call the feeling state that a movie such as Chariots of Fire engenders “mania”. No, on the contrary. We call it; uplifting, joyous, awesome, elevating, etc. Why do we call negative feelings “depression”?

There are so many other words to use. Our language is so rich in words that describe affect. So let’s use some of them: dispirited; demoralized; dysphoric; distressed; disgruntled; disaffected; pathetic; etc. And while we are at it, lets give reporters who may not know how or can not be bothered to write clearly. (or who are using emotive words to sell copy), a clear message that these headlines are of no value in furthering our understanding of the human spirit. Can a movie stir our emotions? Totally! Does it cause mental disorder? No!

--Stan

A mind at sleep is a mind at rest

A recently published study about the relationship between sleep time and depression in teens has many people confused. It was a co-relational study and thus does not confirm causality. So it is not possible to conclude that going to bed late causes depression in adolescents. On the other hand, the study does bring the spotlight back on the well known scientifically but less well appreciated complex relationship between sleep and depression in teens.

We have known for a long time that sleep is disturbed in teen depression. We have also known for a long time that the usual sleep architecture (that is how the different stages of sleep happen during the night) is disturbed in teen depression. We also know that some teens who get depressed show subtle changes in their sleep architecture before they get depressed. Many years ago my research team reported those findings and we also showed that there were abnormalities in hormone secretion at night in depressed teens. And, we know that forced waking early in the morning may improve symptoms in depression. So there is clearly something happening in how the brain controls mood and how it controls sleep.

But, it is simplistic and wrong to assume that setting late bedtimes for teen’s causes depression. This is not the case and it would be foolish to try to tell parents and teens that going to sleep before midnight is protective against depression. However, there is much for us to learn about sleep and depression in teenagers. And there is a growing interest amongst researchers in this area. So stay tuned!

--Stan

Using What Works and NOT Using What Does Not Work

Recently, my research team published a scientific commentary in the Canadian Medical Association Journal dealing with an important mental health concern. We conducted an assessment of the information dealing with psychological debriefing in schools and found that there was no substantive evidence to support the use of that kind of intervention following traumatic events. We also found that the best available evidence in studies of adults showed that these type of interventions were not helpful, and indeed in some studies turned out to be harmful (see: Psychological debriefing in schools, www.cmaj.ca Online publication, January 4, 2010)...

Yet, these interventions have been very popular and used so frequently that they have become commonplace. Who has not heard the news on the radio that grief counselors have been dispatched to a school after a traumatic event?

This raises a very important issue. That is, before we start wide-scale mental health interventions we need to be pretty sure that they work and we need to be really sure that they do not cause harm. If we put programs into place that do not work we are creating a false sense of security and using scare resources; money and people, to no good end. Furthermore, because of our investment in such programs we may be less interested in considering other options – options that may actually work. In other words, what seems like a good idea may not be a good idea and if that gets codified or ingrained in an organization or institution it may have more negative than positive consequences.

So, what is to be done? First, when we do get solid substantive evidence that what we are doing does not really work, is not cost effective, could be done better in a different way or may cause harm – we should stop doing whatever that is that we are doing. Sounds simple but it is not so easy. Usually because there has been a big investment in the initial program and there may even be a big industry and local champions pushing for its continuation. Second, before putting in a program we should demand solid substantive evidence that the program really works and that it causes no harm. Third, if we decide to put programs in without the kind of evidence we need to have, we better make sure that we also provide the kind of independent and unbiased research that is needed to help us determine if the program works or not, if it is cost effective and it does not lead to harm!

We have to do the right thing, not just do something.

--Stan