Ever wonder where funding for mental health research goes? Or how research evidence informs medicine and practice?

The scientific evidence used in medicine comes from a pool of tens of thousands of published research studies. There are many types of studies, and the design of any given study usually depends on the question that the researchers want answered. Studies can differ considerably in the way they are designed and conducted, and can therefore differ considerably in quality.

Often the scientific community behind mental health research, studies and reports don’t get a lot of attention or gratitude, but without them our knowledge of mental health and mental illness would develop pretty slowly.

Evidence-based medicine is extremely important in the treatment of mental illness in general, and is particularly important in the treatment of mental illness in children and adolescents.

Here are some recent examples of research related to adolescents conducted by the National Institute of Mental Health.

(Our group is not affiliated with any of these studies, their results or NIMH)

Anxious and Depressed Teens and Adults: Same Version of Mood Gene, Different Brain Reactions

An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the journal Biological Psychiatry.

Depression Relapse Less Likely Among Teens Who Receive CBT After Medication Therapy

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Suicidal Thinking May Be Predicted Among Certain Teens with Depression

Certain circumstances may predict suicidal thinking or behavior among teens with treatment-resistant major depression who are undergoing second-step treatment, according to an analysis of data from an NIMH-funded study. The study was published online ahead of print February 17, 2009, in the American Journal of Psychiatry.

Getting Closer to Personalized Treatment for Teens with Treatment-resistant Depression

Some teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

The American Journal of Nursing (AJN) recognized the best nursing and healthcare publications of 2008 with an announcement today of its Book of the Year Award recipients. Winners in 15 separate categories appear in the journal’s January issue. Many of the winning publications address a variety of controversial consumer health topics and nursing industry issues that span medical-surgical nursing, psychiatric-mental health nursing, maternal and child health, and other areas.

Two of the top three consumer health books awarded by the AJN were about mental health issues:

Helping Teens Who Cut: Understanding and Ending Self-Injury, by Michael Hollander, which brings to light the serious and potentially devastating issue of self injury which affects the quality of life of teens and their parents. The author suggests interventions for families to use.

What Works for Bipolar Kids: Help and Hope for Parents, by Mani Pavuluri, takes an optimistic, evidence-based “how to” approach to help parents and children manage a bipolar child’s behavior, understand medications and therapies and reduce family stress.

Evidence-based medicine (EBM) is a term that has become widely used in health care settings. But, what exactly is EBM and what does it mean for you?

EBM is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The “best evidence” comes from the more than 20,000 scientific research studies that are published every year, and “patient care” involves everything from diagnosis to treatment.

EBM is not just a recipe for treatment (e.g. every 15 year-old male with depression is not automatically prescribed the same medication). It is a methodical approach to patient care that is comprised of three components: the scientific evidence, the expertise of your health provider(s), and you.

EBM “integrates the best external evidence with individual clinical expertise and patients’ choice” to ensure that patients receive the treatment that best meets their needs. Evidence-based medicine goes beyond treatments. It also applies to how patients are assessed, diagnosed, monitored, and followed over time.

When we are unwell, it is often difficult to tell what has caused the problem and what can best help. Imagine that you are ill for a few days with a sore throat and cough. When your condition improves, you might wonder what made you feel better. Was it the bedrest, the cold medication, the chicken soup, or was it simply giving your body enough time to fight off the illness? And what if your friend gave you a “secret remedy” made from milk, cognac and grass? Is that why you feel better?

Before you spend time and money on a treatment, you might have a lot of questions. You might want the best information about whether the treatment works, how well it works compared to other treatments and what possible problems can result from the treatment. You should be aware of possible problems (such as the types of side effects that might
happen, the cost of the treatment and the difficulties in taking the treatment) that may occur when you and your health care provider are deciding which treatment you should have.

The ultimate goal of EBM is to help patients receive the treatment that is most appropriate for them. This means finding a balance between the scientific evidence, the patient’s values and the experience of their health provider(s).

Remember, people can respond differently to any given treatment, so it is impossible to know exactly how you may respond. However, at least you can know what the chances are that you might be helped or harmed by a given treatment. This can help you, your doctor and other health providers come to a better decision about what treatment is right for you.

To help understand evidence-based medicine the Chair has developed a guide for patients. Feel free to download it from our website and use it to help you make the best decisions about your health care.

A teen version of this guide will be available sometime soon!

~ Dr. Stan Kutcher

There is no health without brain health. A healthy functioning brain is the foundation for all successful learning, social, civic and economic development. The school environment is an important component of healthy brain development. Just as schools are locations in which physical health can be encouraged and improved, so are they locations in which brain health can be encouraged and improved.

How and when a young person’s brain develops affects how they learn. An understanding of how a young person’s brain functions may help us better create brain-healthy environments and educational approaches that can enhance learning outcomes.

The human brain is the most complex entity in the universe. It has more connections than there are stars in the Milky Way. It is the organ of adaptation and of civilization. What we are, what we think and what we do, as individuals and as a human species are the outcomes of how our brains work. That in turn is influenced by a variety of other factors including our genetic endowment, the way our brains naturally develop over time, and the impact of the environment on the way our brains develop and on how they work.

The adolescent years (puberty to about age 25) are characterized by a second major period of brain development (the first is during the early years of development). New brain connections are developed, old connections are pruned, and complex systems that guide emotional integration, motivation, craving-induced behaviors and the capacity for good executive functioning (impulse control; problem solving; empathic/cognitive integration; etc.) come online.

(more…)

Knowledge translation (also known as KT) is one of those important things that has been going on since the dawn of time, but has now been given a name and a scientific grounding. Many things that we have learned have been from knowledge translation - someone who “knows” has taken that knowledge and put it into a format that helped us learn. This is great as long as the knowledge is correct.

But what happens if it is not?

We could learn something that will not be of maximal value to us and may even be unhelpful or harmful. So here is where the science of KT comes in. Over the last few years a methodology for doing KT has been developed and extensively tested. It consists of systematic and reproducible techniques of finding and evaluating all the available knowledge on any particular topic or issue. These techniques are necessary because all information out there is not of equal quality - some is better and some is much better than others. Some may be more likely to be correct and some more likely to be wrong. The techniques used to evaluate the information are very stringent and have been developed to try and ensure that when the information is synthesized the syntheses is more likely to be correct than not correct. So knowledge will have been translated from scientific studies into a common and more certain bundle of information.

Then the next step comes in — taking that bundle of information and putting it into a format that meets the needs of various users. Because what good is KT if it is not used by people to improve what they are doing and to better understand the world around them?

The Sun Life Chair group does both kinds of KT. We conduct systematic literature evaluations and critical analysis to provide the best available evidence on a variety of topics. For example, one recent topic was that of school-based programs designed to prevent suicide. Guess what we found — although there are many such programs (and I think that some people are making quite a bit of money by selling them) there is very shaky evidence that any are effective.

Indeed, we could not find one that clearly demonstrated it decreased suicide rates in young people! So this is very important information for people making health and education policy and for people who want to buy some of these programs. We think that it’s better to use those things that work instead of those things that do not work or that we do not know if they work or those things that may be harmful.

I recently filmed a video with Insider Medicine talking about knowledge translation. Check it out for more info.

Cheers - Dr. Stan Kutcher

In the Spotlight - Dr. Stan Kutcher, MD, FRCPC, Professor of Psychiatry at Dalhousie University, Discusses Knowledge Translation