JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, August 2, 2005)
JAMA NEWS RELEASES — Theme Issue on Violence and Human Rights
PRENATAL EXPOSURE TO FAMINE INCREASES RISK OF SCHIZOPHRENIA
COGNITIVE THERAPY EFFECTIVE IN PREVENTING REPEAT SUICIDE ATTEMPTS
CAMBODIAN WAR REFUGEES EXPERIENCE PSYCHIATRIC DISORDERS MANY YEARS AFTER RESETTLEMENT
MENTAL HEALTH OF WAR SURVIVORS
PRACTICAL SCREENING TOOLS FOR SEVERELY MALNOURISHED CHILDREN IN SUB-SAHARAN AFRICA
STUDY EXAMINES CRIMINAL RECORDS OF HOMICIDE OFFENDERS
REFUGEE MENTAL HEALTH INFLUENCED BY SOCIAL AND POLITICAL FACTORS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
COGNITIVE THERAPY REDUCED RISK OF REPEAT SUICIDE ATTEMPT IN NEW STUDY
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on the effectiveness of cognitive therapy for preventing repeat suicide attempts. The release will be fed Tuesday, August 2, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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Embargoed for Release: 3 p.m. CT, Tuesday, August 2, 2005
Media Advisory: To contact David St. Clair, M.D., Ph.D., email Jennifer Phillips at j.phillips{at}abdn.ac.uk or call 44-0-1224-273174. To contact co-author Lin He, Ph.D., email: helin{at}nhgg.org. To contact editorial author Richard Neugebauer, Ph.D., M.P.H., call Dacia Morris at 212-543-5421.
PRENATAL EXPOSURE TO FAMINE INCREASES RISK OF SCHIZOPHRENIA
CHICAGO—People born during a famine in China have an increased risk of schizophrenia, consistent with previous research suggesting a link between fetal nutritional deficiency and schizophrenia, according to a study in the August 3 issue of JAMA, a theme issue on violence and human rights.
Schizophrenia is a common form of severe mental illness characterized by thought disorder, hallucinations, and delusions, as well a as deterioration of social functioning and social withdrawal, according to background information in the article. It is distributed worldwide with a lifetime risk of approximately 1 percent. Schizophrenia is increasingly viewed as a neurodevelopmental disorder with environmental influences during early brain development modifying risk of schizophrenia. These influences, none of which are yet firmly established, include fetal nutritional deficiency. A previous study found that there was twice the risk of schizophrenia among children conceived during a food shortage in Holland in 1944-1945. However, the number of cases in this study was small, and the findings were only modestly statistically significant.
David St. Clair, M.D., Ph.D., of Shanghai Jiao Tong University, Shanghai, China, and colleagues conducted a study to test the hypothesis that prenatal exposure to famine would increase the rate of schizophrenia in adult life by examining people who lived through a massive famine in China from 1959-1961. The risk of schizophrenia was examined in the Wuhu region of Anhui, one of the most affected provinces. Rates were compared among those born before, during, and after the famine years. All psychiatric case records for the years 1971 through 2001 were examined, and clinical and sociodemographic information on patients with schizophrenia was extracted by researchers.
The researchers found that birth rates (per 1,000) in Anhui decreased approximately 80 percent during the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and 11.06 in 1961. Among births that occurred during the famine years, the risk of developing schizophrenia in later life increased from 0.84 percent in 1959 to 2.15 percent in 1960 and 1.81 percent in 1961. The death-adjusted risk was 2.3 times higher for those born in 1960 and 1.9 times higher for those born in 1961.
"Our study strongly supports the view that prenatal exposure to famine increases the risk of schizophrenia in later life. Using a much larger sample size with clear evidence of exposure, our findings are internally consistent and almost exactly replicate the Dutch findings. Since the two populations are ethnically and culturally distinct, the processes involved may apply in all populations undergoing famine," the authors conclude.
(JAMA. 2005;294:557-562. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For information on funding/support, please see the JAMA article.
EDITORIAL: ACCUMULATING EVIDENCE FOR PRENATAL NUTRITIONAL ORIGINS OF MENTAL DISORDERS
In an accompanying editorial, Richard Neugebauer, Ph.D., M.P.H., of the New York State Psychiatric Institute and Columbia University, New York, examines the study by St. Clair et al.
"The Chinese study, while providing invaluable confirmation of the earlier Dutch work, unfortunately is not able to directly advance understanding of how nutrition may perturb prenatal neural development so as to influence risk for schizophrenia. The most pressing question from a public health and interventionist perspective is whether the relevant nutritional restriction of interest constitutes a global nutritional deficiency or a specific micronutrient deficiency. If the former, the implications of this work are confined largely to developing countries where severe protein-calorie malnutrition is common - certainly a matter of enormous public health and humanitarian concern in its own right. If the latter, the implications extend to developed and developing countries alike," writes Dr. Neugebauer.
(JAMA. 2005;294:621-623. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, August 2, 2005
Media Advisory: To contact Gregory K. Brown, Ph.D., call Susan Winston at 215-349-8368. To contact editorial authors Thomas B. Cole, M.D., M.P.H., or Richard M. Glass, M.D., call Jann Ingmire at 312-464-2499.
COGNITIVE THERAPY EFFECTIVE IN PREVENTING REPEAT SUICIDE ATTEMPTS
CHICAGO—Adults who had attempted suicide reduced their risk of a repeat attempt by participating in a cognitive therapy program, compared to adults who received the usual care, according to a study in the August 3 issue of JAMA, a theme issue on violence and human rights.
In 2002, suicide was the fourth leading cause of death for adults between the ages of 18 and 65 years with approximately 25,000 suicides for this age group in the United States, according to background information in the article. Attempted suicide is one of the strongest risk factors for completed suicide in adults. Previous studies have indicated that individuals who attempted suicide were about 40 times more likely to commit suicide than those who had not attempted suicide. Evidence for treatments that effectively prevent repetition of suicide attempts has been limited.
Gregory K. Brown, Ph.D., of the University of Pennsylvania, Philadelphia, and colleagues conducted a randomized controlled trial to determine whether a brief psychosocial intervention could reduce the rate of repeat suicide attempts over an 18-month interval. The study included 120 adults who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Sixty participants were randomized to receive 10 sessions of cognitive therapy and 60 to receive enhanced usual care with tracking and referral services.
The central feature of cognitive therapy was the identification of thoughts, images, and core beliefs that were activated prior to the suicide attempt. Strategies were applied to address the identified thoughts and beliefs and participants were helped to develop adaptive ways of coping with stressors. Usual care included outpatient therapy and medication.
From baseline to the 18-month assessment, 13 participants (24.1 percent) in the cognitive therapy group and 23 participants (41.6 percent) in the usual care group made at least one subsequent suicide attempt.
"The results of this randomized controlled trial indicated that a relatively brief cognitive therapy intervention was effective in preventing suicide attempts for adults who recently attempted suicide. Specifically, participants in the cognitive therapy group were approximately 50 percent less likely to attempt suicide during the follow-up period than participants in the usual care group," the authors write.
The researchers also found that the severity of depression by one measurement was significantly lower for the cognitive therapy group than for the usual care group at the 6-month, 12-month, and 18-month assessments. The cognitive therapy group also had significantly less hopelessness than the usual care group at six months.
"An important goal of the National Strategy for Suicide Prevention is to improve community linkages with primary care and mental health/substance abuse health systems for translating evidence-based treatments into community-based settings. The short-term feature of cognitive therapy would make it particularly applicable for the treatment of suicide attempters at community mental health centers, which typically provide relatively short-term therapy. Additional studies are warranted to examine the feasibility, effectiveness, and cost-effectiveness of this intervention in community-based mental health and substance use treatment settings," the authors conclude.
(JAMA. 2005;294:563-570. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was supported by grants from the National Institute of Mental Health and the CDC.
EDITORIAL: MENTAL ILLNESS AND VIOLENT DEATH — MAJOR ISSUES FOR PUBLIC HEALTH
In an accompanying editorial, Thomas B. Cole, M.D., M.P.H., and Richard M. Glass, M.D., of JAMA, Chicago, comment on the studies in this week's JAMA on suicide and violence.
"Identifying persons at risk of violence to themselves or others and offering or compelling them to receive mental health treatment services is warranted. Barriers to delivery of these services may be financial, such as lack of access to health care; structural, such as the lack of mental heath programs and practitioners; or personal, such as concerns about confidentiality or discrimination. Another barrier is scientific - lack of randomized controlled trials of therapeutic interventions for suicide and interpersonal violence prevention to guide clinical and systems management."
"Other strategies for violence prevention address the lethality of weapons or social, pharmacological, and other situational factors that may lower the threshold for violent ideation to progress to violent action. Although these factors are late in the causal pathway from mental illness to violence, they are no less important for the prevention of violent death. A severely anxious, depressed, impulsive, or hopeless person whose violent actions are interrupted before he or she harms himself or herself or someone else would be considered a good outcome from the perspective of violence prevention. But without effective psychiatric treatment, such a person will still be in distress and is likely to remain at risk for violence. From this public health perspective, society should devote adequate resources to developing and evaluating psychiatric treatments and lowering barriers to their delivery," they conclude.
(JAMA. 2005;294:623-624. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, August 2, 2005
Media Advisory: To contact Grant N. Marshall, Ph.D., call Crystal Davis at 703-413-1100, ext. 5117.
CAMBODIAN WAR REFUGEES EXPERIENCE PSYCHIATRIC DISORDERS MANY YEARS AFTER RESETTLEMENT
CHICAGO—Cambodian refugees who resettled in the U.S. more than 20 years ago still experience high rates of psychiatric disorders related to their trauma such as posttraumatic stress disorder or depression, according to a study in the August 3 issue of JAMA, a theme issue on violence and human rights.
The United Nations reports there were approximately 19.2 million refugees, internally displaced persons, and asylum seekers worldwide in 2004, according to background information in the article. Researchers studying these populations have found high levels of violence exposure, often involving multiple traumas, as well as significant mental health problems. Previous investigations generally conclude that depression and posttraumatic stress disorder (PTSD) constitute the most common psychiatric disorders in refugee populations. Little is known about the long-term mental health of trauma-exposed refugees years after permanent resettlement in resource-rich countries like the United States.
Cambodians constitute one of the largest refugee groups in the United States, with approximately 150,000 refugees admitted since 1975. After a coup in 1970, a civil war began that led to a Khmer Rouge takeover from 1975 to 1979. Of an estimated population of 7.1 million in 1975, as many as 2 million Cambodians were killed during the 4-year Khmer Rouge reign. Approximately 1 million more were killed in the civil wars before and after this period.
Grant N. Marshall, Ph.D., of RAND, Santa Monica, Calif., and colleagues assessed the population prevalence, related illnesses and correlates of psychiatric disorders in the U.S. Cambodian refugee community 25 years after the Khmer Rouge era. The study included face-to-face interviews, conducted in Khmer language, with a random sample of households from the Cambodian community in Long Beach, Calif., the largest such community in the United States. The interviews, conducted between October 2003 and February 2005, included a total of 490 adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign and immigrated to the United States prior to 1993.
All participants had been exposed to trauma before immigration. Ninety-nine percent (n = 483) experienced near-death due to starvation and 90 percent (n = 437) had a family member or friend murdered. Seventy percent (n = 338) also reported exposure to violence after settlement in the United States. High rates of PTSD (62 percent) and major depression (51 percent) were found. PTSD and major depression often existed simultaneously in this population (n=209; 42 percent) and each showed a strong dose-response relationship with measures of traumatic exposure. In further analyses, PTSD and major depression were associated with premigration and postmigration trauma exposure and older age.
"We found evidence of pronounced mental health problems in previously traumatized refugees. Indeed, only approximately 30 percent of the sample was free of any of the 3 disorders [PTSD, major depression, alcohol use disorder] assessed. These results indicate that members of refugee communities can have substantial need for mental health services even years removed from their tribulations," the authors write.
"The pervasiveness of these disorders raises questions about the adequacy of existing mental health resources in this community. Addressing this high level of need may require additional research to identify barriers to seeking services as well as efforts at improving treatment for this population," the researchers conclude.
(JAMA. 2005;294:571-579. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institute of Mental Health and from the National Institute on Alcohol Abuse and Alcoholism.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, August 2, 2005
Media Advisory: For copies of the studies, please go to www.jamamedia.org or call 312-464-JAMA (5262).
OTHER STUDIES APPEARING IN THE VIOLENCE AND HUMAN RIGHTS JAMA THEME ISSUE:
MENTAL HEALTH OF WAR SURVIVORS
In a survey of people who had experienced war-related events and traumas in the former Yugoslavia, researchers found that most survivors (79 percent) reported a sense of injustice in relation to perceived lack of redress for their trauma. Thirty-three percent reported experiencing lifetime posttraumatic stress disorder and 10 percent reported current major depression. Perceived impunity for those responsible for the trauma was one of the factors associated with the sense of injustice. Fear of threat to safety and loss of control over life appeared to be the most important factors associated with posttraumatic stress disorder and depression.
(JAMA. 2005;294:580-590.
Editor's Note: To contact lead author Metin Basoglu, M.D., Ph.D., email: spjumeb{at}iop.kcl.ac.uk.
PRACTICAL SCREENING TOOLS FOR SEVERELY MALNOURISHED CHILDREN IN SUB-SAHARAN AFRICA
Even though severe malnutrition is a major cause of death among many hospitalized children in sub-Saharan Africa, the current recommended assessment method using weight for height to determine if a child is malnourished is not always feasible in these clinical settings. In this study, researchers evaluated an assessment using mid upper arm circumference (MUAC) and the clinical sign "visible severe wasting" to predict the probability of death among malnourished children at a district hospital as compared to the currently recommended weight-for-height z score (WHZ). The researchers found that MUAC and visible severe wasting performed as well as the recommended WHZ method in predicting inpatient death. They suggest that when also considering cost and practicality, MUAC may be more appropriate than WHZ for identifying severe malnutrition in children aged between one and five years who are admitted to African district hospital.
(JAMA. 2005;294:591-597.
Editor's Note: To contact lead author James Berkley, M.D., email: jberkley{at}kilifi.mimcom.net.
STUDY EXAMINES CRIMINAL RECORDS OF HOMICIDE OFFENDERS
The prevalence of having a serious criminal record is far higher among persons arrested for homicide than for the general population, according to researchers analyzing data of all arrests and felony convictions in Illinois for 1990 - 2000. The researchers write that homicide is a serious public health problem in the U.S. with 17,638 victims in 2002. The researchers found that homicide arrests in Illinois are concentrated among individuals with a criminal record. However, only 32.5 percent of homicide arrestees were convicted of a felony in the previous 5 years suggesting that "an intervention that reduced the homicide risk of felons to that of the general population would reduce the homicide rate by just 31 percent." The researchers note that a large part of the homicide problem lies beyond the reach of any preventive treatment that is limited to individuals who have been arrested or convicted. The researchers suggest that broader prevention strategies, including general deterrence and the regulation of markets for "criminogenic" commodities (firearms, alcohol, and drugs), may be needed in addition to the already existing interventions after arrest or convictions, such as mandatory drug treatment, supervised release, imprisonment, correctional programs, and bans of firearm possession.
(JAMA. 2005; 294:598-601.
Editor's Note: To contact lead author Philip J. Cook, Ph.D., call Karen Kemp at 919-613-7394.
REFUGEE MENTAL HEALTH INFLUENCED BY SOCIAL AND POLITICAL FACTORS
Economic, social and cultural conditions before and after displacement influence the mental health of refugees, according to a meta-analysis published in this JAMA theme issue. Researchers analyzed the medical literature to find studies about the mental health of refugees (including internally displaced persons, asylum seekers, and stateless persons). The researchers write that existing data from several international agencies indicate that over 42 million people can be considered refugees and displaced from their homes because of war, political violence or related threats. The researchers found worse mental health outcomes were observed for refugees who are living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes.
(JAMA. 2005;294:602-612. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: To contact lead author Matthew Porter, Ph.D., call Craig LeMoult at 212-305-0820.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
COGNITIVE THERAPY REDUCED RISK OF REPEAT SUICIDE ATTEMPT IN NEW STUDY
VIDEO:
B-ROLL
Black people and white people walking on city street – no faces showing
AUDIO:
RESEARCHERS IN PHILADELPHIA ENROLLED 120 PATIENTS IN A STUDY. MANY OF THE PATIENTS HAD A VARIETY OF PROBLEMS. ALL OF THE PATIENTS HAD ATTEMPTED SUICIDE.
VIDEO:
SOT/FULL
@ :10
Super: Gregory Brown, Ph.D.
University of Pennsylvania
Runs :14
AUDIO:
"When you’re faced with multiple major problems like medical problems, unemployment problems, major psychiatric illnesses and other social problems, it can be very overwhelming and you can find yourself very, very hopeless."
VIDEO:
B-ROLL
Dr. Brown and colleagues around conference table
AUDIO:
DR. GREGORY BROWN AND HIS COLLEAGUES AT UNIVERSITY OF PENNSYLVANIA STUDIED WHETHER A KIND OF COUNSELING CALLED COGNITIVE THERAPY COULD HELP REDUCE THE RISK OF REPEAT SUICIDE ATTEMPTS.
VIDEO:
SOT/FULL
Gregory Brown, Ph.D.
University of Pennsylvania
Runs :13
AUDIO:
"The point of the therapy is to see if we could address the patients’ hopelessness which occurs prior to a suicide attempt and help them to be better problem solvers so that they won’t make another suicide attempt."
VIDEO:
B-ROLL
Black people and white people walking on city street – no faces showing
Dr. Brown in mock counseling session with colleague
AUDIO:
IN THE 18-MONTH STUDY, ABOUT HALF THE PATIENTS RECEIVED USUAL CARE, INCLUDING OUTPATIENT THERAPY, MEDICATION, OR ADDICITION TREATMENT. THE OTHER HALF MAY ALSO HAVE RECEIVED THOSE TREATMENTS, BUT THEY RECEIVED ABOUT TEN COGNITIVE THERAPY SESSIONS AS WELL.
VIDEO:
SOT/FULL
Gregory Brown, Ph.D.
University of Pennsylvania
Runs :09
AUDIO:
"So this treatment, this cognitive therapy treatment, really is an add-on treatment that directly focuses on reducing suicide behavior."
VIDEO:
B-ROLL
Dr. Brown and colleagues around conference table
GFX/JAMA COVER
AUDIO:
THE STUDY, SPONSORED BY THE NATIONAL INSTITUTE OF MENTAL HEALTH AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION, IS PUBLISHED IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Gregory Brown, Ph.D.
University of Pennsylvania
Runs :09
AUDIO:
"The most important finding was that the patients who received the cognitive therapy were 50% less likely to make a repeat suicide attempt."
VIDEO:
FULL SCREEN GRAPHIC
Title: Repeat Suicide Attempts
Usual care = 42% (23 people)
Cognitive Therapy = 24% (13 people)
AUDIO:
FORTY-TWO PERCENT OF THE PATIENTS WHO RECEIVED USUAL CARE MADE A REPEAT SUICIDE ATTEMPT... AS COMPARED TO TWENTY-FOUR PERCENT OF THE PATIENTS WHO RECEIVED COGNITIVE THERAPY.
VIDEO:
SOT/FULL
Gregory Brown, Ph.D.
University of Pennsylvania
Runs :11
AUDIO:
"When they felt really hopeless and desperate, to have them take a step back and look at their problems and try to come up with ways to solve them, that’s really what the therapy was about."
VIDEO:
B-ROLL
Black people and white people walking on city street – no faces showing
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
