We have known for a long time that the majority of mental disorders begin before age 25. We have also known for a long time that early onset mental disorders are a risk for many poor short and long term outcomes – indeed that is why we recommend early identification and early effective treatment. So that we can try and prevent poor outcomes and enhance good outcomes.

So a recent study, just published has found that for each person (on average) who has an early onset mental disorder it costs her/him over ten thousand dollars per year when they are an adult – that is correct: PER YEAR. This is compared to what their siblings make. ! OUCH!

So, as you know, I am a strong advocate of early identification and early effective treatment for mental disorders. It is simply not right that we do not meet the mental health needs of children and youth at the time that they need the help most – right after they get sick! We know that not providing care early leads to a host of poor outcomes for the person and for our society. Now we have additional information – this is the personal cost – over ten thousand dollars per year! Think of the effect that has on life and wellbeing. Think of what negative spiral effect that could have – poverty, use of food banks, etc. Think of the loss of tax revenue and the impact of lower incomes on the lives of their families and the wellbeing of their children. Not only is this not economically unacceptable, it is simply not fair.

Hey governments. Hey society. Hey banks and wealthy corporations. Hey citizens. It is time we made the investments early on. We can not afford not to do that!

–Stan

Since it is Christmas and since gift giving is “top of mind” (regardless of your religion – this is a time of year that gift giving is celebrated – OK, not the retail kind, the REAL kind), I thought about what gift I as a mental health professional would like to receive.  And guess what – a number came to mind.

First, I would like to see a Canada and the global society be a place in which people living with mental illness had exactly the same rights, equalities and access to care as people with illnesses that are not disorders of the brain have.  When we can speak of diabetes and colitis and arthritis and schizophrenia all in the same breath and with the same considered and supportive perspective then we will have gone a long way to decreasing stigma and barriers to mental health care.

Second, I would like to see us beginning to talk about finding a cure for various mental illnesses, much as we speak about finding a cure for breast cancer or finding a cure for prostate cancer.  We have finally developed and are rapidly developing our understanding of the brain and its functions – in health and in disease.  And we are getting closer to understanding the social and enviromental impacts that effect brain function and how those may contribute to the development or perpetuation of mental disorders.  So its time we set our sights on a cure for schizophrenia, a cure for major depressive disorder, a cure for bipolar disorder and so on.  We may not find a cure in the next five or ten years, but by gosh the search will take us a long way forward.

Third, I would like to see our mental health community supported and enhanced by coming together of various components instead of those components pulling us apart.  Sometimes I think that if we spent one half of the time and effort that we seem to put into supporting pet ideologies or convincing others of our “truths” in common purpose, we would be so much further ahead.  One foundation that we really need to build our community on is scientific literacy.  We need to use science to advance our cause.  We need to use the best scientific methods and the knowledge that they bring to us to inform our directions.  We need to embrace the science and not rail against it.  Building on this foundation we can work together to ensure that all the interests and different voices of individuals and groups are expressed, heard and included.  A house has many rooms, but if its foundation is not strong it will collapse, regardless of how pretty it may look.

So those are my three Christmas gift wishes.  The best of this gift reminding season to you and yours.  Regardless of your religious beliefs or other defining features.  Be well.

-Stan

Recently I wrote a post on mental health in the palm of your hand - exploring how technology and iPhone applications were being used to share medical and mental health information.

Following that post I contacted Dr. Harvey Castro at Deep Pocket Series to ask him about Sad Scale - a self screening Depression test and iPhone application tool.

Understanding the need for a Depression scale for children, Dr. Castro worked with our team to adapt the Kutcher Adolescent Depression Scale (KADS) for use on the Sad Scale application.

The KADS, along with the Center for Epidemiological Studies Depression Scale for Children (CES-DC), are now available on the Sad Scale. These applications will give you a graph on your progress and will also allow you to email your health care provider the results of the test.

The iPhone application is available now and can be downloaded for $0.99 from iTunes.

We are now adapting the Kutcher Generalized Social Anxiety Disorder Scale for Adolescents (K-GSADS-A) … stay tuned! (literally)

~ David Venn

FOR IMMEDIATE RELEASE July 30, 2009

As millions of college students graduate college this year, mtvU, MTV’s 24-hour college network and The Associated Press today revealed the results of a new poll examining the emotional health of college students as they face a global recession and a receding job market, finding that more than half of college seniors are worried they won’t be able to secure a job after graduation.

The study finds that although financial pressures are a major source of daily stress, they do not surpass worries about academic performance. The economy has definitely taken a toll with concerns about finding a job ranking high among stressors, and intensified struggles reported by the almost one in five students whose parents have experienced job loss. Additionally, an alarming number of college students are struggling with mental health issues, but many are not actively seeking out the help that they need. Despite all of this, young people are generally happier than they were last year, are adapting to their environment by switching their majors, going to graduate school or making other proactive changes in their lives, and maintain positive attitudes about the value of their college experience.

The mtvU and Associated Press study follows a month of on-air and online mtvU programming exploring how college students are impacted by increasing financial pressures as part of mtvU and The Jed Foundation’s ongoing “Half of Us” campaign. A similar study examining the impact of stress, mental health struggles, the economy, and other issues facing college students was conducted in 2008 by mtvU / AP in conjunction with “Half of Us.”

Detailed findings from the 2009 study include:

STRESS ON CAMPUS

With 85 percent of students reporting that they experience stress on a daily basis, up from 80 percent last year, it’s clear that stress is a prevalent factor on college campuses today. However, even in light of larger national issues, academic concerns like school work and grades, with 77 percent and 74 percent respectively, maintain their positions as the top drivers of student stress. Financial woes followed close behind, with 67 percent stating that money matters accounted for a lot or some of their daily stress.

In the face of stress and uncertainty, 82 percent maintain positive attitudes surrounding their college education, feeling that it has been worth the time and financial investment.

At the same time, the study shows that stress is taking a serious toll on the everyday lives of college students, affecting them academically and socially:

• Six out of 10 students report having felt so stressed they couldn’t get their work done on one or more occasions.
• 53 percent of students report feeling so stressed they didn’t want to hang out with friends on one or more occasions.

DEPRESSION, SUICIDAL THOUGHTS AND GENERAL MENTAL HEALTH

The mtvU/AP polls from 2008 and 2009 confirm that mental health struggles are common among the college audience and continued efforts are needed to educate students on avenues for seeking support. When stress becomes excessive and impacts a student’s ability to function, it can have severe consequences, especially for students with a mental health condition. Low energy levels, sleep troubles and appetite issues are among the most common indicators of emotional health problems experienced by students, and nearly one out of every 10 students are reporting signs of moderate to severe depression, and an alarming number of students have reached crisis mode:

• 17 percent of students overall report that their friends have talked about wanting to end their lives.
• 10 percent report having a friend who has made a suicide attempt.
• Seven percent report that they have seriously thought about ending their own lives in the past year.

84 percent of students know where they would go for help if they were coping with emotional distress, with 77 percent turning to friends and 67 percent reaching out to their parents for help. Only half of students report that they are familiar with counseling resources available on their campus, and even fewer students actively seek them out. Among students reporting symptoms of moderate to severe depression, 47 percent of state that they are not familiar with the counseling resources available on their campuses, and only 32 percent received any support or treatment from a counselor or mental health professional since beginning college.

Additional findings from this poll can be found at http://www.halfofus.com/press.aspx.

Came across this good article about stigma and teen depression by Leigh Belz over at Teen Vogue. Check it out!

It all started in the sixth grade,” says Jenny,* a seventeen-year-old from Sacramento, California. “I was heavier than a lot of the other girls in my class, and that made me feel self-conscious. My mom and dad were having problems at the time, too, and I kept it all to myself. That’s how my depression began. And it got worse as I got older–I became more anxious and withdrawn, and it became something I couldn’t control. You never would have known it, though. I always had a smile on my face.” By eighth grade, Jenny says her depression was something she could no longer hide. “That year, when I was fourteen, I tried to commit suicide,” she reveals. “Afterward, I was so ashamed of myself. But I didn’t know how to deal with it. I didn’t want to talk to anyone.”

According to Harvard Medical School, about 8 percent of teens will experience depression before they reach adulthood. In addition, the U.S. Surgeon General reports that between 10 and 15 percent of teenagers have some symptoms of depression at any given time.

What separates depression from regular, everyday sadness? “Time,” says Richard E. Nelson, Ph.D., author of The Power to Prevent Suicide (Free Spirit Publishing). “Depression is something that lasts at least ten days,” he says. “Many students may get to school by 8:00 in the morning and feel sad, then are happy by 10:30, and then get sad again at 1:30. That’s normal.” Depression, he says, is more of a constant. According to experts, many teens experience mood swings simply as a result of surging hormone levels. But the condition of depression is also often characterized by behavioral changes like low energy levels, oversleeping (or, conversely, trouble falling asleep), irritability, changes in appetite, and isolation.

“Teens don’t show symptoms of depression the same way adults do. Generally, I break teen depression into three categories,” Nelson explains. “Ten percent is clinical, 10 percent is chemical, and the largest category in young people is what I call situational–related to something happening in their lives. For this reason, depression can manifest itself in different ways and intensities.” Being depressed doesn’t just mean you’re crying all the time–instead, you also may not want to hang out with your friends or you may have constant stomachaches that land you in the nurse’s office.

Read the full article here.

Came across this effusive post entitled “I, Too, Have a Dream” by Therese J. Borchard whose blog Beyond Blue is one of the top blogs about Depression. Here’s a quick excerpt:

I have a dream that one day I won’t hold my breath every time I tell a person that I suffer from bipolar disorder, that I won’t feel shameful in confessing my mental illness.

I have a dream that people won’t feel the need to applaud me for my courage on writing and speaking publicly about my disease, because the diagnosis of depression and bipolar disorder would be understood no differently than that of diabetes, arthritis, or dementia.

What’s your dream for child and youth mental health???

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.

There’s a lot of misinformation out there about youth suicide. Suicide rates in young people nationally have decreased by about 20% from the mid 1990’s to 2004. Nova Scotia is a good case study. It is difficult to determine trends in youth suicide in Nova Scotia because of the small numbers involved, but total suicide rates as well as total suicide attempts in this province have decreased substantially between 1995 and 2004.

Suicide in Canada, 1950 to 1992

Suicide in Canada, 1979-2003

Why this has occurred is not clear.

One explanation is that effective treatment of depression in young people may be an important factor. Studies have demonstrated a strong relationship between increased use of antidepressant medications and decreased suicide rates in youth. Evidence shows that both medications and psychological therapies decrease rates of suicide attempts in depressed youth. Recent research reports in both Canada and the USA indicate that when anti- depressant medication treatment in young people has decreased, suicide rates have increased. Treatment of depression in young people may effectively reduce suicide rates.

Association between suicide rate and SSRI use in youth 5-14 years old (Gibbons, et al. Am J Psychiatry 163:11, November 2006)

Suicide behaviour is complex. Not all self-harm behaviours are suicide attempts. Self-harm behaviour in young people may not be related to suicide, but rather to deficient problem solving strategies, difficulties with emotional control or impulsivity. It is only recently that we have understood the need to differentiate the two in how we collect data. Treatment for young people who demonstrate self-harm behaviours may be different than treatments for youth who attempt suicide.

Self-harm behaviours reflect many mental disturbances and may be an important vehicle by which young people can access emergency care. Thus, increases in self-harm emergency visits may not reflect an increase in suicide as has been erroneously suggested, but may reflect other phenomenon such as: greater parental awareness of the importance of immediately addressing these behaviors; difficulty in access to specialty mental health services; inadequate delivery of child and adolescent mental health care in primary care; inadequacies in the capability to provide early identification and interventions for youth at risk for mental disorders; or others.

Suicide in young people is a complex problem that requires thoughtful, evidence-driven approaches to appropriately address. It is also an emotional issue raising substantial concern amongst parents, youth, care providers, policy makers and the public alike. There are some interventions that we know work to decrease suicide rates in young people.

One of the most important is improving the early identification and effective treatment of depression in youth. This includes enhancing the competencies of primary health care providers (doctors, nurses, social workers, psychologists, etc) in the diagnosis and treatment of adolescent depression. Training programs for school personnel including “gatekeeper” programs for teachers and linkages between schools and health providers to facilitate identification, rapid assessment and effective treatment may also decrease youth suicide. Restriction of access to lethal means (such as bridge barriers) is helpful as is reasonable and informed media reporting.

Youth suicide is an important public health problem. We must work together to better understand it and to apply what we know works. We need to avoid inciting public anxiety through media reports that are not based on a solid understanding of the issue and we need to support the further development of easily accessible and effective mental health care – not just in hospitals but in schools and community settings. We need to do the right thing – not just do something!

~ Dr. Stan Kutcher

Depression is not just being blue.

Everyone feels low or sad sometimes. Often those feelings are in response to a negative event or life problem. Those feelings are perfectly normal. Indeed the ability to experience these emotions may be an essential part of what it means to be human.

These feelings will frequently lead to changes in our behaviour. That is, they help us adapt to our environment – often by enhancing our use of social supports. That is why we feel better when a friend, parent or family member gives us a hug or spends quality time with us. These feelings can also be helped by us seeking out and participating in activities that we usually enjoy.

Sometimes we feel low or sad for no reason. This is also normal. Our moods fluctuate over the course of a day, monthly and yearly. Spontaneous mood changes may be more pronounced over the teen years but everyone has them. These changes are short-lived, do not lead to pronounced social, interpersonal or job problems and usually go away as mysteriously as they came. When these feelings are there you can help them leave by hanging around with people you care about, exercising, listening to music or doing things you like to do.

Unfortunately, we often refer to these normal feelings as depression. This is a shorthand for a whole host of different emotions, including the following: despondent, distressed, despairing, demoralized, disturbed, frustrated, blue, sad, low, etc. Not only does the use of the shorthand “depression” to mean all of the above detract from our ability to communicate the rich nuances of our feelings, but the word depression used as a substitute for these normal feelings can be confused with the concept of clinical depression – which the word depression could be reserved for.

A clinical depression represents a failure of brain adaptation. Unlike feelings of sadness, distress, despondency, etc. which signal brain adaptation, a clinical depression describes a state of being in which a person’s functioning is impaired – that is, they cannot do what they usually do because of how they are feeling. Fundamental to understanding a clinical depression is the decline in functioning that it causes; such as, poor performance at school or at work, problems in interpersonal interactions, social withdrawal, etc.

Unlike the usual and common feelings of sadness, despondency, distress, etc. which are often alleviated by increased positive social interaction or usual enjoyable activities, a clinical depression will usually require a more specific and sustained intervention – usually a psychological or biological treatment. That does not mean that doing things that usually make you feel better (for example: talking with friends, exercising, etc) are not helpful – on the contrary, they may well be. What this means is that for clinical depression these interventions are unlikely to be helpful by themselves. If someone is living with a clinical depression they usually require professional help – from a therapist or physician. These professional helpers will provide additional specific treatments that have undergone rigorous empirical scientific evaluation and have been generally shown to be effective in promoting recovery from the clinical depression.

In addition to the functional impairment, a clinical depression differs from usual low moods in many ways. The low feelings must be persistent and sustained; there is a marked loss of interest or pleasure; there are substantive and persistent feelings of worthlessness or hopelessness; there is often fatigue, lack of appetite and sleep difficulty and there frequently are persistent ideas about suicide or even suicide attempts. Clearly, this state is not a brief response to environmental adversity or a temporary blip in mood.

So, depression is not the blues. Personally, I would really like to see us get away from using the word depression as a shorthand term. So instead of saying “I feel depressed because my boyfriend broke up with me” say instead “I feel distressed (or unhappy, or pissed off, or hurt, or despondent, or whatever) that my boyfriend broke up with me”.

Let’s start using the rich lexicon of our language to identify the varied and nuanced expressions of our moods.

~ Dr. Stan Kutcher

If I Had - A Teen With Extensive Mood Disorders - Dr. Stan Kutcher, MD, FRCPC, Professor of Psychiatry at Dalhousie University

Ever find one of those websites you just can’t stop going to? A few months ago a friend sent me a link to TED - an annual conference devoted to technology, education and design. Now I’m hooked. Their site contains hundreds of archived talks from some of the world’s premiere thinkers and doers.

One of the most inspiring talks on the site is by Jill Bolte Taylor, a brain scientist who had a massive stroke and was able to watch and experience as her brain functions shut down one by one. It’s a pretty amazing story and gives insight into just how complicated the brain is.

Often it’s not until something goes wrong that we think about brain health, and how it’s just as important to keep our brains healthy as it is to keep our bodies healthy.

When the brain is not working properly or is working in the wrong way, a person may experience difficulty thinking or focusing attention, extreme emotional highs and lows, or sleep problems. When these symptoms significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness.

While we know that mental disorders are brain disorders, Jill Bolte Taylor’s story is an example that brain problems do not always indicate mental illness.

~ D. Venn