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 CONTENTS
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, July 3, 2006
OBESITY ASSOCIATED WITH PSYCHIATRIC DISORDERS, DECREASED ODDS OF SUBSTANCE ABUSE
MILD SADNESS PROVOKES DEPRESSIVE THINKING IN SOME RECOVERED PATIENTS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, July 3, 2006
EARLY DRINKING LINKED TO RISK FOR ALCOHOL DEPENDENCE
COMMONLY RECOMMENDED SEDATIVE DOES NOT IMPROVE INFANT SLEEP
TEEN SEXUAL ASSAULT SURVIVORS SELDOM COMPLETE HIV PREVENTION THERAPY
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 3, 2006
Media Advisory: To contact Gregory E. Simon, M.D., M.P.H., call Joan DeClaire at 206-287-2653.
OBESITY ASSOCIATED WITH PSYCHIATRIC DISORDERS, DECREASED ODDS OF SUBSTANCE ABUSE
CHICAGO—Obesity is associated with a 25 percent increase in the risk of developing mood and anxiety disorders and a 25 percent decrease in likeliness for substance abuse, according to a paper in the July issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
About 31 percent of all U.S. adults were obese in 2000, an increase from 23 percent in 1990, according to background information in the article. Obese adults are at higher risk of diabetes, cardiovascular disease and other harmful conditions. Previous studies have suggested a link between obesity and depression, but little research has examined the associations between obesity and other psychiatric disorders.
Gregory E. Simon, M.D., M.P.H., of the Group Health Cooperative, Seattle, and colleagues studied 9,125 adults from across the country who were interviewed as part of a large national survey of mental disorders between Feb. 5, 2001, and Feb. 12, 2003. Participants (average age 44.8 years) completed an in-home interview that included questions about demographic characteristics, height, weight and psychiatric disorders. These included mood disorders, such as major depression, dysthymia (persistent mild depression with associated symptoms) and bipolar disorder; anxiety disorders, such as panic disorder and generalized anxiety disorder; and substance abuse disorders, including alcohol or drug dependence.
Of all the participants, 6,795 had a body mass index (BMI) of less than 30 and 2,330 had a BMI of 30 or greater and were therefore considered obese. Those who were obese had a higher prevalence of mood and anxiety disorders and a lower prevalence of substance abuse disorders over their lifetimes. These associations remained similar for men and women. The link between obesity and mood disorders appeared strongest in non-Hispanic whites and in those with higher education levels.
"The estimated prevalence of lifetime mood disorder in those with BMIs below 30 and in those with BMIs 30 or higher translates to a population-attributable risk of 24 percent, which indicates that nearly one-quarter of the cases of obesity in the general population are attributable to the association with mood disorder," the authors write. "This calculation illustrates the public health importance of the association but does not indicate a direction for the causal relationship. It is equally correct to state that more than one-fifth of cases of mood disorder in the general population are attributable to the association with obesity." Increased appetite, weight gain, reduced physical activity and binge eating have all been associated with depression, potentially increasing risk for obesity. However, obesity could also contribute to depression by limiting physical activity, or through the stigma that may be associated with being overweight, especially among some women and other particular sociodemographic groups. An unknown third cause also could be linked to both. The results also do not indicate the mechanisms behind the negative association between obesity and substance abuse.
"We conclude that obesity is meaningfully associated with a range of common mood and anxiety disorders in the general U.S. population," the authors write. "Obesity is associated with a moderately lower risk of substance use disorder. Variation in the obesity-depression relationship by education level and race/ethnicity suggests an important role of social or cultural factors in mediating or moderating the relationship between obesity and mood disorders."
(Arch Gen Psychiatry.
2006;63:824-830. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see full study for complete funding information.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 3, 2006
Media Advisory: To contact Zindel V. Segal, Ph.D., call Mary Thring at 416-946-8369.
MILD SADNESS PROVOKES DEPRESSIVE THINKING IN SOME RECOVERED PATIENTS
CHICAGO—Some individuals with a history of depression may sink back into thinking patterns associated with the condition when faced with mild stresses or sadness, increasing their risk for relapse, according to a report in the July issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
Many patients who recover from depression eventually relapse, according to background information in the article. Management of depression usually focuses on alleviating symptoms rather than reducing the risk for recurrence or identifying patients who might relapse after successful treatment. Previous studies have found that some patients who have recovered from depression still show cognitive processes-patterns in thinking, learning and memory-commonly associated with the condition, while others in remission do not. Such cognitive processes include certain ways of explaining events or particular assumptions about self-worth.
Zindel V. Segal, Ph.D., University of Toronto and Centre for Addiction and Mental Health, Ontario, and colleagues randomly assigned 301 patients with major depressive disorder to receive either antidepressant medications or cognitive behavioral therapy (a kind of psychotherapy designed to modify the cognitive processes that are typically associated with depression). Ninety-nine of those whose depression went into remission participated in a second phase of the trial. These 99 participants rated their current mood on a visual scale from sad to happy and underwent an assessment of their dysfunctional attitudes, signs of the cognitive processes that are associated with depression. The researchers then provoked a sad mood by asking participants to listen to a piece of music and try to recall a time in their lives when they felt sad. After this exercise, the participants rated their mood and underwent the dysfunctional attitude assessment a second time and were observed bimonthly for the next 18 months.
Seventy-eight patients completed the full 18 months of follow-up; 47.5 percent of those who had recovered through antidepressant medication use and 39 percent of those who received cognitive behavioral therapy relapsed during that time period. Regardless of the type of treatment, those who had greater cognitive reactivity-that is, they displayed significantly more dysfunctional beliefs after the sad mood provocation than before it-were more likely to relapse during the 18-month follow-up. This association held true even when researchers considered the number of past episodes of depression each patient had experienced, previously the best known way to predict relapse. In addition, those who took antidepressants were more likely to have greater cognitive reactivity than those in the cognitive behavioral therapy group.
"Our study indicates that even a mild negative mood, when experienced by someone with a history of depression, can reinstate some of the cognitive features observed in depression itself," the authors write. "The presence of such reactivity in recovered patients signals a residual but heightened risk for episode relapse that has not been fully addressed by treatment."
Future depression management approaches might aim to help prevent relapse by teaching patients to reflect on the factors that influence their thinking, the authors suggest. "Such treatments may include components that first help patients deliberately monitor and observe their thinking patterns when they feel sad, and then help patients respond to these thoughts and feelings in a way that allows them to inhibit the cognitive elaboration of their content," they write.
(Arch Gen Psychiatry.
2006;63:749-755. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported in part by the Canadian Institutes for Health Research and by an Ontario Mental Health Foundation Senior Research Fellowship.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 3, 2006
Media Advisory: To contact Ralph W. Hingson, Sc.D., M.P.H., call Lisa Brown at 617-414-1401.
EARLY DRINKING LINKED TO RISK FOR ALCOHOL DEPENDENCE
CHICAGO—Individuals who are younger when they begin drinking alcohol may face a higher risk of alcohol dependence throughout life, at a younger age and consisting of multiple episodes, according to results of a national survey published in the July issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Approximately 1 million U.S. high school students are frequent heavy drinkers, according to background information in the article. Previous surveys have found that 28 percent of high school students begin drinking before age 13 years, and that those who do are more likely to drink until they are intoxicated than those who wait until age 17 years or older to begin drinking. Heavy drinking places these students at risk for dangerous behaviors, including driving while intoxicated; carrying guns; injuring themselves in fights or suicide attempts; having unprotected sex; and earning low grades in school.
Ralph W. Hingson, Sc.D., M.P.H., and colleagues at the Youth Alcohol Prevention Center, Boston University School of Public Health, analyzed results from a national survey of 43,093 adults age 18 years and older conducted in 2001 and 2002. Interviewers asked questions about demographics, behavior, history of depression, drug use, family history of alcohol dependence and the age at which they began drinking. They identified respondents with alcohol dependence based on meeting at least three of seven standard criteria: tolerance for alcohol; withdrawal symptoms; drinking more alcohol or for longer periods of time than intended; willingness but inability to cut down on drinking; spending a great deal of time on alcohol-related behaviors; forgoing important social, work-related or recreational activities in favor of drinking; and continued drinking despite related physical or psychological problems. Individuals who met the criteria for alcohol dependence were asked how old they were when they first began to have several of these experiences at once as well as how many episodes (periods separated by at least one year of not drinking or not having these experiences) they had over their lifetimes.
Overall, 12.5 percent of all the survey respondents and 19 percent of those who had ever drank alcohol met criteria for alcohol dependence at some point in their lives-a figure representing more than 26 million Americans. Forty-seven percent of those who began drinking at a young age (younger than age 14 years) experienced alcohol dependence during their lifetimes, compared with 9 percent of those who began drinking at age 21 years or older. Those who were younger than age 14 when they began drinking were also more likely to be alcohol-dependent within 10 years of beginning drinking (27 percent vs. 4 percent of those starting at age 21 years or older), before age 25 years (33 percent vs. 2 percent) and during the year of the survey (13 percent vs. 2 percent). They also had more than three times the odds of experiencing two or more episodes of alcohol dependence in their lifetimes.
"Usually, each additional year earlier than age 21 years that a respondent began to drink, the greater the odds that he or she would develop the alcohol dependence outcomes examined," the authors write. "This study found that the younger respondents were when they began drinking, the greater their likelihood of experiencing lifetime alcohol dependence after analytically controlling for family history of alcoholism and numerous behavioral and personality characteristics related to the age at drinking onset."
The results highlight the need for pediatricians and other health care professionals to discuss alcohol use with adolescent patients and to implement policies that discourage drinking at younger ages, the authors conclude.
(Arch Pediatr Adolesc Med.
2006;160:739-746. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 3, 2006
Media Advisory: To contact Dan Merenstein, M.D., call Liz McDonald at 202-687-5100.
COMMONLY RECOMMENDED SEDATIVE DOES NOT IMPROVE INFANT SLEEP
CHICAGO—An antihistamine often recommended to parents whose infants do not sleep through the night may not be effective in reducing nighttime awakenings or improving parents' happiness with their children's sleep, according to a report in the July issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Between 20 and 46 percent of parents have reported that their infants have trouble sleeping, according to background information in the article. Some parents let their children cry for extended periods at night-this method, known as crying out, is popular but controversial among parents and health care professionals. Another commonly used method is to give children medications-such as antihistamines, normally used to treat allergies-to sedate them at bedtime. Diphenhydramine hydrochloride, sold as Benadryl, is often used by parents and recommended by physicians despite the fact that it has not been studied in children younger than age 2 years.
Dan Merenstein, M.D., then at The Johns Hopkins School of Medicine, Baltimore, and now at Georgetown University, Washington, D.C., and colleagues conducted a trial of diphenhydramine in 44 children ages 6 to 15 months who slept in cribs. Parents in the study had all reported that their children woke up two or more times per night. The participating infants were randomly assigned to receive 100 mL of diphenhydramine or placebo (inactive medication) in a cherry-flavored liquid 30 minutes before bedtime for one week between May 2004 and May 2005. Parents reported whether the child had fewer awakenings that required parental intervention during that week and also tracked their child's sleep in a diary for the first 28 days. At four points during the first 43 days of the study, parents were asked to rate their happiness with their children's sleep on a scale of one to 10.
Three of 22 participants in the placebo group and one of 22 participants in the diphenhydramine group had fewer nighttime awakenings during the week in which the infants were taking medication. Two additional parents in the placebo group reported improvement in nighttime awakenings four weeks and six weeks later. There was no difference between the two groups in parents' reports of how happy they were with their children's sleep at any point during the study. On June 6, 2005, the trial was stopped because of the apparent lack of effectiveness of diphenhydramine.
"Many in the medical and lay community accept diphenhydramine as effective treatment for sleep problems," the authors write. "Unfortunately, this attitude is based on anecdote and studies of adult physiological interactions." The results of this study "demonstrated that at the most commonly used dose, diphenhydramine may play no role in treating infant sleep problems."
More rigorous studies are needed regarding effective treatment for sleep problems in children, the authors conclude. "Important aspects of a young child's health care, such as proper food intake and sleep routine, often are based on assumptions," they write. "Our study results illustrate that such assumptions may be wrong and should be subjected to study in life laboratories."
(Arch Pediatr Adolesc Med. 2006;160:707-712. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by the Robert Wood Johnson Clinical Scholars Program, Robert Wood Johnson Foundation. All work was independent of funder.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 3, 2006
Media Advisory: To contact Elyse Olshen, M.D., M.P.H., call Elizabeth Streich at 212-305-6535. To contact editorialist Jonathan M. Ellen, M.D., call Katerina Pesheva at 410-516-4996 or Kim Hoppe at 410-516-4934.
TEEN SEXUAL ASSAULT SURVIVORS SELDOM COMPLETE HIV PREVENTION THERAPY
CHICAGO—Fewer than one-half of adolescent sexual assault survivors who are prescribed medications to prevent contraction of human immunodeficiency virus (HIV) may return for follow-up visits and only about 15 percent complete the therapy, according to a report in the July issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
As many as 10 percent of adolescent females experience sexual assault in their lifetimes, according to background information in the article. The risk of contracting HIV after a single exposure is low, but transmission has been reported after sexual assault. National guidelines published in 2005 recommend that physicians consider prescribing a 28-day course of antiviral medications after sexual assault to reduce the risk of contracting HIV, an extension of a practice first used by health care workers exposed to the virus by needle sticks.
Elyse Olshen, M.D., M.P.H., then at Boston University School of Medicine and now at Columbia University Medical Center, New York, and colleagues reviewed the charts of 145 adolescents ages 12 to 22 years who visited one of two pediatric emergency departments in Boston within 72 hours of a sexual assault. During the years of the study-2001 to 2003-both academic medical centers followed protocols directing that medications to prevent HIV be considered on a case-by-case basis following sexual assault and that adolescents prescribed these therapies visit their primary care providers or follow-up clinics for continuing treatment.
Of the 145 adolescents, 129 (89 percent) were offered prophylactic (preventive) therapy and 110 (76 percent) agreed to take it. Of the 86 of those 110 who were referred for follow-up treatment at one of the two hospitals in the study, only 37 (38 percent) returned for at least one follow-up visit and 13 (15 percent) completed the full 28 days of prophylactic therapy.
The results highlight the difficulties associated with prescribing such therapies to adolescent sexual assault survivors, including the challenge of determining which survivors should receive a prescription. "In many cases of adolescent sexual assault, the risks of HIV transmission cannot be determined," the authors write. "Among patients in our study, 21 percent reported having blacked out during the assault, 54 percent were unsure whether ejaculation had occurred and 27 percent were unsure whether a condom had been used." In addition, many teen sexual assault survivors also have psychiatric conditions that may decrease the likelihood that they will adhere to prophylactic therapy.
"We agree with published recommendations that postexposure prophylaxis be offered to adolescent sexual assault survivors for exposures that pose a risk of HIV transmission," the authors conclude. "Patient education and a comprehensive follow-up system with extensive outreach and case management are necessary to encourage postexposure prophylaxis adherence and return for follow-up care among adolescent sexual assault survivors."
(Arch Pediatr Adolesc Med. 2006;160:674-680. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Aerosmith Endowment Fund for the Prevention and Treatment of HIV, Leadership Education in Adolescent Health Project, Maternal and Child Health Bureau, U.S. Department of Health and Human Services, and the Boston University School of Medicine Summer Research Scholarship Program.
EDITORIAL: USE HIV PREVENTIVE THERAPY JUDICIOUSLY
Given the lack of adherence to HIV prophylactic therapy demonstrated in this and other studies, the risks of viral resistance associated with failure to finish the course of treatment may outweigh the benefits of these medications for many adolescent sexual assault victims, writes Jonathan M. Ellen, M.D., The Johns Hopkins School of Medicine, in an accompanying editorial.
"Although the saliency of HIV is great and the desire to offer treatment with any hope of benefit to someone traumatized by sexual assault is high, data support a restrained position," Dr. Ellen concludes.
(Arch Pediatr Adolesc Med. 2006;160:754-755. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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