Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour

Objectives:

To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use.

Methods:

Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices.

Results:

The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours.

Conclusions:

Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.     

Compensatory Usage of the Internet: The Case of Mukbang Watching on YouTube

ObjectiveAccumulating empirical research has emphasized that a wide range of online activities–such as using social networking sites–can be performed in order to compensate unattained needs or to cope with negative affect and psychopathological symptoms. Although the correlates of problematic social networking use have been extensively investigated, less is known about problematic YouTube use (PYU), an umbrella term grouping a number of different activities (e.g., viewing of online video games, watching specific YouTube channels). Furthermore, nothing is known concerning increasingly popular and distinct YouTube-related activities such as mukbang watching (i.e., watching livestream “eating broadcasts” where someone eats various foods in front of the camera while interacting with viewers). The aim of the present study was to examine the mediating role of problematic mukbang watching (PMW) on the relationships between depression and loneliness with PYU. MethodsAn online survey that comprised assessment tools for aforementioned variables was administered to 217 mukbang viewers (mean age=20.58 years, range 18–33 years). ResultsResults indicated that PMW was positively related to loneliness and PYU. Depression was positively and directly associated with PYU but was not associated with PMW.ConclusionFurther research is required to better understand the psychological processes underlying problematic mukbang watching and its association with other mental health conditions (e.g., addictive disorders, eating disorders).     

Trace Amines and Cocaine Abuse

Cocaine addiction remains a clinical challenge with no effective pharmacotherapy available. Trace amine associated receptor (TAAR) 1 represents a promising drug target for the modulation of dopaminergic system and stimulant abuse. This Viewpoint discusses the emerging data which strongly suggest that TAAR 1 functions as a molecular “brake” that controls the addiction-related effects of cocaine and could be a novel drug target for the development of efficacious pharmacotherapy to treat cocaine addiction.     

Paternal childcare at 6 months and risk of maternal psychological distress at 1 year after delivery: The Japan Environment and Children’s Study (JECS)

BackgroundPaternal childcare is reported to benefit maternal mental health, but specific childcare behaviors have not been comprehensively determined. This study sought to identify paternal childcare behaviors associated with maternal mental health by adjusting for other covariates associated with maternal mental health and examining childcare behaviors.MethodsThis study investigated whether seven types of paternal childcare behaviors at 6 months after delivery were associated with maternal psychological distress at 1 year after delivery, which was assessed using the Kessler Psychological Distress Scale (K6). After exclusions from a dataset of 103,062 pregnancies obtained in the Japan Environment and Children’s Study, we evaluated data from 75,607 mothers.ResultsMore than 70% of fathers were always or sometimes involved in “playing at home,” “playing outdoors,” “changing diapers,” and “bathing,” 60%–70% in “helping with feeding” and “dressing,” and 45.9% in “putting the child to bed.” All paternal childcare behaviors showed some beneficial association with less maternal psychological distress, both moderate (K6 score 5–12) and severe (K6 score ≥ 13) distress. Playing at home was the most beneficial association identified (adjusted odds ratio [aOR] 0.66, 95% confidence interval [CI] 0.56–0.76 for moderate psychological distress; aOR 0.36, 95% CI 0.28–0.48 for severe psychological distress).ConclusionsThese seven types of paternal childcare behaviors may help lessen maternal psychological distress. Emphasis should be given to building education systems and working environments that promote paternal childcare.     

Racism and mental health and the role of mental health professionals

The concept of “race” and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be “the others,” who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of “the other” on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of “race” is genetically incorrect. Therefore, the implicit racism that underlies many established “scientific” paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.     

Intermittent Drug Techniques for Schizophrenia

Intermittent drug techniques refer to the “use of medication only during periods of incipient relapse or symptom exacerbation rather than continuously.” The aim is to reduce the risk of adverse effects of antipsychotics by “reducing long-term medication exposure for patients who are receiving maintenance treatment while limiting risk of relapse,” with a further goal of improving social functioning resulting from the reduction of antipsychotic-induced side effects. We reviewed the effects of different intermittent drug techniques compared with maintenance treatment in people with schizophrenia or related disorders. We searched The Cochrane Schizophrenia Group Trials Register (April 2012) and supplemented this by contacting relevant study authors and manually searching reference lists. All relevant randomized controlled trials (RCTs) were included.Of 241 records retrieved by the search, 17 trials were included. Homogenous data demonstrated that instances of relapse were significantly higher in people receiving any intermittent drug treatment in the long term (n=436, 7 RCTs, RR=2.46, 95% CI=1.70– to 3.54). Intermittent treatment was shown to be more effective than placebo, however, and demonstrated that significantly less people receiving intermittent antipsychotics experienced full relapse by medium term (n=290, 2 RCTs, RR=0.37, 95% CI=0.24–0.58). Intermittent antipsychotic treatment is not as effective as continuous, maintained antipsychotic therapy for preventing relapse in people with schizophrenia. It does seem, however, significantly better than no treatment.Key words: schizophrenia, intermittent, meta-analysis     

A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario,Canada: An Exploratory Analysis

BackgroundYouth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges.ObjectiveThis hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges.MethodA total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics.ResultsThere was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories.ConclusionsWhile mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.     

Executive cognitive functions and impulsivity as correlates of risk taking and problem behavior in preadolescents

Initiation of drug use and other risky behavior in preadolescence is associated with poor developmental outcomes. In this research, we examine models that ascribe the trajectory to (a) weak executive cognitive function (ECF), (b) early manifestation of externalizing problems, or (c) heightened levels of trait impulsivity. We test the explanatory power of these factors in a structural equation model with a community sample of 387 preadolescents ages 10–12 years. Participants were tested with a computerized battery of tasks to assess three facets of ECF (working memory, cognitive control, and reward processing) as well as with an audio assisted computerized self-interview to obtain reports of impulsivity and risk behaviors (use of cigarettes and alcohol as well as engaging in fighting and gambling for money) and a self-administered questionnaire to assess externalizing and internalizing problems. The best fitting model explained both early risk taking and externalizing symptoms as the result of individual differences in impulsivity. Although no ECF was directly related to risk taking, working memory and one measure of reward processing performance (reversal learning) were inversely related to impulsivity. The results are discussed in regard to theories of early risk taking with particular focus on the potential relation between ECF and impulsive behavior tendencies and the implications for early intervention to prevent the dysfunctional trajectory associated with early risk behavior.     

A retrospective examination of antisocial and risk-taking behaviours

Engagement in antisocial and risk-taking behaviours is a recurring issue that has been associated with a range of negative outcomes for the individual, community, and society. This research explored factors that influenced engagement and co-occurring behaviours. Responses (n?=?393) from an Australian sample who completed the Antisocial Engagement Questionnaire showed that the majority of the behaviours of interest were associated, indicating that engagement in one behaviour was associated with engagement in additional antisocial and risk-taking behaviours. Engagement in antisocial behaviours was also associated with increased substance consumption. An investigation into the associations between 15 substance-related behaviours found that use of one substance was associated with the use of additional substances. The findings have implications for understanding the development of an antisocial lifestyle, the associations between behaviours, the findings build on research relating to behaviour prediction and will assist clinicians working with at-risk individuals and intervention design.     

Adolescents and benzodiazepines: prescribed use, self-medication and intoxication

In a longitudinal study of 1230 people aged 13-18 years from the Greater Oslo Area, the past-year prevalence of anxiolytic or hypnotic use was 10%, which is higher than previously reported. The majority gave therapeutic reasons as a motive for using these drugs. However, most of the use was unprescribed. The parents, and especially the mother, were the most important suppliers. A minority gave intoxication as a motive for using these drugs. In this group, the suppliers were mainly peers and the illegal market. Neither the unprescribed nor the prescribed therapeutic use show any association with use of drugs such as alcohol and cannabis. There is, however, a strong association between the unprescribed use of benzodiazepines by young people and by their parents. This suggests a pattern of learning and role modelling, which must be regarded as problematic for public health policy. Those who use the drugs to become intoxicated have particularly poor mental health, and they use many other drugs as well. This group probably runs a special risk of developing more serious drug abuse.     

Antipsychotics Use Is Associated With Greater Adherence to Cardiometabolic Medications in Patients With Schizophrenia: Results From a Nationwide,Within-subject Design Study

BackgroundPeople with schizophrenia/schizoaffective disorder (schizophrenia) die early, largely due to cardiovascular-related mortality. Antipsychotics are associated with lower mortality. We aimed to explore whether antipsychotic use can reduce discontinuation of medications for cardiovascular risk factors and diseases (“cardiometacolic drugs”), using a within-study design controlling for subject-related factors.MethodsPersons diagnosed with schizophrenia between 1972 and 2014, aged <65 years at cohort entry were identified in Finnish national databases. Four subcohorts were formed based on cardiometabolic drug use during the follow-up period, 1996–2017, namely statin (n = 14,047), antidiabetic (n = 13,070), antihypertensive (n = 17,227), and beta-blocker (n = 21,464) users. To control for subject-related factors, including likelihood of adherence as a trait characteristic, we conducted a within-subject study comparing the risk of discontinuation of each cardiometabolic drug during periods on vs off antipsychotics within each subject. We also accounted for number of psychiatric and nonpsychiatric visits in sensitivity analyses.ResultsIn 52,607 subjects with schizophrenia, any antipsychotic use vs nonuse was associated with decreased discontinuation risk of antidiabetics (adjusted hazard ratio [aHR] = 0.56, 95% confidence interval [CI] = 0.47–0.66), statins (aHR = 0.61, 95%CI = 0.53–0.70), antihypertensives (aHR = 0.63, 95%CI = 0.56–0.71), and beta-blockers (aHR = 0.79, 95%CI = 0.73–0.87). Antipsychotics ranking best for discontinuation of all cardiometabolic drug categories were clozapine (aHR range = 0.34–0.55), followed by olanzapine (aHR = 0.43–0.71). For statins, aHRs ranged from aHR = 0.30 (95%CI = 0.09–0.98) (flupentixol-long-acting injectable (LAI) to aHR = 0.71 (95%CI = 0.52–0.97) (risperidone-LAI), for anti-diabetic medications from aHR = 0.37 (95%CI = 0.28–0.50) (clozapine) to aHR = 0.70 (95%CI = 0.53–0.92) (quetiapine), for antihypertensives from aHR = 0.14 (95%CI = 0.04–0.46) (paliperidone-LAI) to aHR = 0.69 (95%CI = 0.54–0.88) (perphenazine), for beta-blockers from aHR = 0.55 (95%CI = 0.48–0.63) (clozapine) to aHR = 0.76 (95%CI = 0.59–0.99) (perphenazine-LAI). The decreased risk of discontinuation associated with antipsychotic use somewhat varied between age strata. Sensitivity analyses confirmed main findings.DiscussionIn this national database within-subject design study, current antipsychotic use was associated with substantially decreased risk of discontinuation of statins, anti-diabetics, antihypertensives, and beta-blockers, which might explain reduced cardiovascular mortality observed with antipsychotics in people with schizophrenia.     

The associations between health risk behaviours and suicidal ideation and attempts in a nationally representative sample of young adolescents.

OBJECTIVE: To examine associations between health risk behaviours and suicidal ideation and attempts in Canadian adolescents aged 12 to 13 years. Young adolescents think about and attempt suicide. However, most existing research on suicide has been conducted on individuals aged 15 years and older. METHOD: The present study examined a nationally representative Canadian sample of adolescents aged 12 to 13 years (n=2090). Health risk behaviours included disruptive (shoplifting, physical fighting, damaging property, fighting with a weapon, carrying a knife, and gambling), sexual (petting below the waist and sexual intercourse), and substance use behaviours (smoking cigarettes, consuming alcohol, marijuana or hash, and glue or solvents). Unadjusted and adjusted (for all significant health risk behaviour and psychiatric symptoms) models were tested. RESULTS: All health risk behaviours were common among male and female adolescents. In unadjusted models, almost all health risk behaviours were associated with suicidal ideation and attempts among adolescent boys. In adjusted models, only damaging property, sexual intercourse, and smoking cigarettes remained statistically associated with suicidal ideation, while smoking cigarettes and using marijuana or hash remained statistically associated with suicide attempts among adolescent boys. All health risk behaviours were statistically associated with suicidal ideation and attempts among female adolescents in unadjusted models. In adjusted models, only carrying a knife remained statistically associated with suicidal ideation, while shoplifting and gambling remained statistically associated with suicide attempts among adolescent girls. CONCLUSIONS: Health risk behaviours among young adolescents are associated with suicidal ideation and attempts among young adolescents. Recognizing health risk behaviours among young adolescents may be one means of understanding who among them is at increased risk of suicidality.     

Activity spaces and urban adolescent substance use and emotional health

This study analyzed routine locations (activity spaces) of urban adolescents enrolled in a substance abuse treatment program to understand the relationship between their spatial lives and health outcomes such as substance use and mental health. Sixty-eight adolescents were interviewed and produced a list of 199 locations identified as most important, safe, and risky. A TwoStep Cluster analysis resulted in two mutually exclusive groups of adolescents (n = 58). Clusterwise importance analyses showed that sex, distress, anxiety, emotional problems, and drug use significantly distinguish clusters from each other. An important finding was that activity spaces vary according to the frequency of substance use and the amount of emotional problems. School was frequently perceived as a risky place – followed by friend's house and nature – for those who used alcohol and marijuana more frequently and had more emotional distress. The intersection between environment, emotion regulation, and health outcomes is discussed.     

Gender and other risk factors associated with risky behaviours among Nigerian adolescents

Risky behaviours in adolescents, apart from substance use, and their associate factors, have not been thoroughly investigated in Nigeria. Hence, there is a need to study the prevalence of risky behaviours and their relationship with gender and other potential risk factors. Data comprising socio-demographic, risky behaviours, personality traits, religious orientation and substance use were obtained from 300 randomly selected secondary school students. Two risk groups (low and high) based on the number of risky behaviours were determined. Male was a risk factor for theft (OR = 2.1; 95%CI = 1.17–3.95), bullying (OR = 2.76; 95%CI = 1.37–5.56) and fighting (OR = 2.14; 95%CI = 1.35–3.40). Fifty-two (17.3%) of the students were of high-risk behaviour group. Furthermore, private school (β = 1.05; P = 0.010), poor perceived relationship with teachers (β = 1.21; P = 0.002), polygamy (β = 1.20; P = 0.002) and lifetime cigarette use (β = 1.07; P = 0.027) were predictors of high-risk behaviour group. Substantial proportion of adolescents in Nigeria exhibit risky behaviours of which gender and other factors play a significant role.     

Factors associated with low cognitive performance in general practice

Summary In the preparatory phase of a randomised controlled trial data were collected to assess the magnitude of changes on cognitive functions in 1628 volunteers (age range 45–75 years) that were recruited from general practitioners' patient population. Subjects were administered a short neuropsychological battery of tests including three paper-and-pencil tests, which assessed immediate recall, delayed memory, and attention. Being on antihypertensive medication was associated with low results for all three tests in every age group, and in all strata according to blood pressure levels. Psychotropic drug use was correlated with low results for all three tests. Differences between psychotropic drug users and nonusers increased with age. Antihypertensive treatment and psychotropic drug use seem to be important to consider in longitudinal studies of cognitive decline in aging.     

Prevalence and predictors of health service use among Iraqi asylum seekers in the Netherlands

Background A long asylum procedure is associated with higher prevalence rates of psychiatric disorders, lower quality of life, higher disability and more physical health problems. Additional knowledge about health seeking behavior is necessary to guide governments and health professionals in their policies. Objective To measure service use among one of the biggest asylum seekers population in the Netherlands and to assess its relationships with predisposing and need variables (including post-migration living problems). Method Two groups were randomly selected: Group 1 (n = 143), less than 6 months and Group 2 (n = 151), more than 2 years in the Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires, which contained instruments to measure psychiatric disorders, quality of life, disability, physical health and post-migration living problems. Use of preventive and curative (physical and mental) health services was measured and the relationship with predisposing and need risk factors was estimated with univariate and multivariate logistic regression analyses. Results A long asylum procedure is not associated with higher service use, except for mental health service use and drug use. Use of mental health services is, however, low compared to the prevalence of psychiatric disorders. Low quality of perceived general health and functional disability are the most important predictors of services use. Psychopathology predicts use of a medical specialist (non-psychiatrist), but does not predict mental health service use. Conclusion A high percentage of asylum seekers with a psychiatric disorder is not getting adequate treatment. There is a mismatch between the type of health problem and the type of health service use. The various health services should work together in education, detection, referral and care in order to provide help to this group of patients.     

Associations of health insurance coverage,mental health problems,and drug use with mental health service use in US adults: an analysis of 2013 National Survey on Drug Use and Health

Objective: To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities.

Methods: This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use.

Results: The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use . Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use.

Conclusions: Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.     

Clinical implications of drug abuse epidemiology

Research on the epidemiology of illicit drug use disorders provides continued critical insights into the distribution and determinants of drug use and drug use disorders in the United States. This research serves as a foundation for understanding the etiology of these disorders, helping to disentangle the complex interrelationship of developmental, genetic, and environmental risk and protective factors. Building on an understanding of this research in substance abuse epidemiology, it is important for clinicians to understand the unique trends in drug use in the overall communities that they serve and the unique risk factors for given individuals. The generally high prevalence of substance use disorders, along with their high comorbidity with other psychiatric disorders and with the HIV epidemic, make prevention, evaluation, and referral for treatment for drug abuse an important part of routine clinical practice in a range of clinical settings, including primary care, psychiatric, and emergency department settings. Ongoing efforts to ensure insurance coverage parity for the treatment of mental health and substance use disorders offer the promise of continued improvements in the integration and availability of such services in the broader US health care system.     

Looking at “thunderclap headache” differently? Circa 2016

The term “thunderclap headache” (TCH) was first coined in 1986 by Day and Raskin to describe headache that was the presenting feature of an underlying unruptured cerebral aneurysm. The term is now well established to describe the abrupt onset headache seen with many other conditions and is also now included in The International Classification of Headache Disorders 3^rd edition beta version rubric 4.4. An essential to label an acute headache as “TCH” and differentiate it from other “sudden onset, severe headaches” is the arbitrary time frame of 1 min from onset to peak intensity for “TCH.” What happens in practice, however, is that even those “sudden onset, severe headaches” that do not strictly fulfill the definition criteria are also labeled as “TCH” and investigated with the same speed and in the same sequence and managed based on the underlying cause. This article begins by questioning the validity and usefulness of this “one minute” arbitrary time frame to define “TCH,” particularly since this time frame is very difficult to assess in practice and is usually done on a presumptive subjective basis. The article concludes with suggestions for modification of the current investigation protocol for this emergency headache scenario. This proposal for “a change in practice methodology” is essentially based on (1) the fact that in the last two decades, we now have evidence for many more entities other than just subarachnoid hemorrhage that can present as “TCH” or “sudden onset, severe headache” and (2) the evidence from literature which shows that advances in imaging technology using higher magnet strength, better contrast, and newer acquisition sequences will result in a better diagnostic yield. It is therefore time now, in our opinion, to discard current theoretical time frames, use self-explanatory terminologies with practical implications, and move from “lumbar puncture (LP) first” to “LP last!”