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August 3, 2009JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of 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, August 3, 2009)
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 3, 2009)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
Antidepressant Use Increasing In the United States
CHICAGO—A marked and broad expansion in antidepressant treatment occurred among Americans older than 6 years between 1996 and 2005, although treatment rates remain low among racial and ethnic minorities, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Treatment for mental health conditions is becoming more common in the United States, according to background information in the article. "Several factors may have contributed to this trend, including a broadening in concepts of need for mental health treatment, campaigns to promote mental health care and growing public acceptance of mental health treatments," the authors write. "In parallel with growth in mental health service usage, psychotropic medications have become increasingly prominent in treatment." Antidepressants are now the most commonly prescribed class of medications in the United States. Mark Olfson, M.D., M.P.H., of Columbia University Medical Center and New York State Psychiatric Institute, New York, and Steven C. Marcus, Ph.D., of the University of Pennsylvania, Philadelphia, analyzed data from the 1996 and 2005 Medical Expenditure Panel Surveys, sponsored by the Agency for Healthcare Research and Quality to provide national estimates regarding health care usage and costs. A total of 18,993 individuals age 6 and older were included in the 1996 survey and 28,445 in the 2005 survey. A designated adult in each household responded to questions regarding medical visits, prescriptions, conditions for which they were treated and other variables. Between 1996 and 2005, the rate of antidepressant treatment increased from 5.84 percent to 10.12 percent or from an estimated 13.3 million to 27 million individuals. "Significant increases in antidepressant use were evident across all sociodemographic groups examined, except African Americans, who had comparatively low rates of use in both years (1996, 3.61 percent; 2005, 4.51 percent)," the authors write. "Although antidepressant treatment increased for Hispanics, it remained comparatively low (1996, 3.72 percent; 2005, 5.21 percent)." Among antidepressant users, the percentage who were also prescribed antipsychotic medications increased between 1996 and 2005 (5.46 percent vs. 8.86 percent), but fewer also underwent psychotherapy (31.5 percent vs. 19.87 percent). "Together with an increase in the number of antidepressant prescriptions per antidepressant user [an average of 5.6 vs. 6.93 per year], these broad trends suggest that antidepressant treatment is occurring within a clinical context that places greater emphasis on pharmacologic rather than psychologic dimensions of care," the authors write.
Beyond the general expansion of mental health treatment, several factors may have contributed to the overall increase in prescriptions, they note. First, major depression may have become more common. Several new antidepressants were approved by the U.S. Food and Drug Administration to treat depression and anxiety disorders during the study period. In addition, clinical guidelines were published that supported the use of these medications for a variety of conditions.
Editor's Note: This study was supported by a grant from the Agency for Healthcare Research and Quality and by the National Alliance for Research on Schizophrenia and Depression. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
Preschool Depression May Continue Into Childhood
CHICAGO—Depression among preschoolers appears to be a continuous, chronic condition rather than a transient developmental stage, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals. "The validity of major depressive disorder in childhood has been well established, with the disorder now widely recognized and treated in mental health settings," the authors write as background information in the article. However, previous studies have primarily focused on children age 6 and older. Although a growing body of data suggests that depression does exist among preschoolers, skepticism remains about whether it is clinically meaningful or increases the later risk of psychiatric conditions. Joan L. Luby, M.D., and colleagues at Washington University School of Medicine in St. Louis studied 306 preschoolers age 3 to 6. Of these, 75 met criteria for major depressive disorder, 79 had anxiety or disruptive disorders but not depression and 146 did not meet criteria for any psychiatric disorder. A comprehensive three- to four-hour laboratory assessment was completed at the beginning of the study. While children completed measures of emotional, cognitive and social development, primary caregivers were interviewed separately about the preschoolers' psychiatric symptoms and developmental skills. Similar developmental and behavioral assessments were conducted 12 and 24 months later. "Preschoolers with depression at baseline had the highest likelihood of subsequent depression 12 and/or 24 months later compared with preschoolers with no baseline disorder and with those who had other psychiatric disorders," the authors write. After controlling for other demographic variables and risk factors, preschoolers with depression at the beginning of the study had a four times greater likelihood of having depression one and two years later than preschoolers without depression. The condition also showed a chronic and recurrent course among preschoolers-in a subset of 119 preschoolers with depression or depressive symptoms who were screened by phone at six and 18 months, 57 percent of those with depression had an episode during at least two follow-up points during study and 18 percent followed a chronic course, defined as having an episode in at least four waves of the study.
"These results underscore the clinical and public health importance of identification of depression as early as preschool," the authors conclude. Early intervention during the preschool period has proved effective in other childhood disorders, they note. "Therefore, study findings that demonstrate longitudinal stability and homotypic continuity of preschool major depressive disorder suggest that earlier interventions for major depressive disorder during the preschool period may be an important area for investigation in the search for more effective treatments for childhood major depressive disorder."
Editor's Note: Funding for this study was provided by a grant from the National Institute of Mental Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
Twin Study Examines Associations Between Depression and Coronary Artery Disease
CHICAGO—Major depression and coronary artery disease are only modestly related throughout an individual's lifetime, but studying how the two interact over time and in twin pairs paints a more complex picture of the associations between the conditions, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals. For example, the association between coronary artery disease onset and major depression risk is much stronger over time than vice versa. "While an association between major depression and coronary artery disease has long been noted and recently confirmed, the direction and cause of this association remain unclear," the authors write as background information in the article. High cortisol levels, inflammation and changes in blood platelet function associated with depression may increase risk for coronary artery disease; coronary artery disease is a stressful event that may increase risk for depression; and shared genetic or environmental factors may underlie both conditions. Kenneth S. Kendler, M.D., of Virginia Commonwealth University School of Medicine, Richmond, and colleagues studied 30,374 twins (average age 57) from the Swedish Twin Registry. Information was obtained from telephone interviews conducted between 1998 and 2003 and also from Swedish hospital discharge and death registers. The results of statistical models over time and of twin pairs yielded several findings, the authors note. "First, the lifetime association between major depression and coronary artery disease in this sample was modest and did not differ substantially in men and women," they write. "Second, in more informative time-dependent analyses, coronary artery disease onset was associated with a nearly three-fold increased risk for depressive onset in that year and a nearly two-fold increase in subsequent years. The long-term effect of coronary artery disease on risk for major depression did not attenuate over time." "Third, given an onset of major depression, the risk for coronary artery disease onset was increased 2.5-fold in that year and much more modestly in subsequent years," they continue. "The ongoing increased risk for coronary artery disease after major depression onset did not attenuate over time. Although modest, this future risk for coronary artery disease was strongly related to the severity and recurrence of major depression. Indeed, elevated future coronary artery disease risk was confined to individuals with recurrent episodes of major depression or those who meet more than the minimum number of diagnostic criteria."
In men, the increased risk for major depression was much greater in the year of coronary artery disease onset than in subsequent years. Women experienced a smaller spike in depression risk after diagnosis with coronary artery disease but had nearly the same risk thereafter. "When examined separately, in men, environmental effects, which are often acute, have a large role in major depression-coronary artery disease comorbidity, whereas in women, chronic effects, which are in part genetic, are more important," the authors conclude. "In men, genetic sources of major depression-coronary artery disease comorbidity are more important in younger members of the sample."
Editor's Note: Supported in part by National Institute of Mental Health grants, a National Institute on Aging grant, the Swedish Scientific Council and the Swedish Department of Higher Education. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
School-Based Program Helps Prevent Dating Violence Among Teens, Especially Boys
CHICAGO—A school-based program that integrates information about healthy relationships into the existing ninth-grade curriculum appears to reduce adolescent dating violence and increase condom use two and a half years later, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The effects of the low-cost intervention appear stronger in boys. Approximately one in 10 to one in five high school–aged teens are hit, slapped or beaten by an individual they are dating each year, according to background information in the article. Dating violence among adolescents often leads to intimate partner violence in adulthood and also is associated with injuries, unsafe sex, substance use and suicide attempts. David A. Wolfe, Ph.D., of the Centre for Addiction and Mental Health Centre for Prevention Science, London, Ontario, and the University of Toronto, and colleagues in 2004 to 2007 conducted a randomized trial of a 21-lesson curriculum delivered by teachers with special training in the dynamics of dating violence and healthy relationships. The program, known as the "Fourth R: Skills for Youth Relationships," was taught to 968 students at 10 randomly selected high schools. "Dating violence prevention was integrated with core lessons about healthy relationships, sexual health and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized," they continue. Another 754 students at 10 different schools were assigned to a control group, where similar objectives were targeted but without training or materials. When the adolescents were surveyed two and a half years later-at the end of grade 11-rates of physical dating violence were greater in the control students (9.8 percent) than in the students who participated in the program (7.4 percent). Although both boys and girls typically perpetrate dating violence, the intervention had a stronger effect on boys; 7.1 percent of boys in the control group and 2.7 percent in the intervention group reported physical dating violence, compared with 12.1 percent of girls in the control group and 11.9 percent of those in the intervention group. Sexually active boys in the program also reported a higher rate of condom use (114 of 168 or 67.9 percent vs. 65 of 111 or 58.6 percent). Because the program met mandated education requirements in Ontario, no additional class time, scheduling or human resources assistance was needed. The average cost of training and materials was $16 Canadian per student.
"The present evaluation of the Fourth R: Skills for Youth Relationships suggests that methods developed for single-focused interventions (e.g., skills-based, interactive delivery) can be combined effectively from a core relationship perspective. As in related trials, teachers with supplementary training can implement evidence-based prevention programs with sufficient fidelity and effectiveness to garner significant improvements over status quo classroom methods," the authors conclude. "Similar to efforts made with academic subjects, the best policy may involve earlier introduction of these important topics at a lower grade level, with increasing knowledge and practice introduced in core courses throughout high school."
Editor's Note: This work was supported solely by a grant from the Canadian Institutes of Health Research. We recognize RBC Financial Group for their support of the Chair in Children's Mental Health (Dr. Wolfe) and the Royal Lepage Shelter Foundation for their support in developing the program. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Results Suggest Effective Program Provides Value
"The costs of exposure to relationship violence during adolescence are high, with adolescents who are victimized experiencing higher rates of depression, anxiety and associated social and health problems," write Candice L. Odgers, Ph.D, of the University of California, Irvine, and Michael A. Russell, M.A., in an accompanying editorial. "In this issue of the Archives, Wolfe et al present findings from a rare-and seemingly effective-randomized controlled trial of a schoolwide program designed to reduce dating violence among adolescents." "This study contributes to what we know about the prevention of adolescent dating violence in two important ways. First, randomization of adolescents to an intervention condition provides support for the position that school-based interventions can have causal effects on adolescents' romantic relationships, although this may be true only for boys," they continue. "Second, this study provides proof of principle that effective classroom-based interventions targeting relationship violence can be delivered by leveraging existing resources (e.g., teacher time and modifications to existing curriculum) and for the relatively low cost of $16 per student."
"In short, Wolfe and colleagues provide a compelling case that classroom-based interventions can provide value for money with respect to delivering relatively low-cost early interventions that hold the promise of reducing the long-term health costs associated with partner violence."
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
Violence Against Mothers in Bangladesh Associated With Health Problems in Young Children
CHICAGO—Almost half of Bangladeshi women with young children experience violence from their husbands, and their children appear to have a higher risk of recent respiratory infections and diarrhea, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Despite substantial improvements in childhood survival in the previous decade, 77 per 1,000 children born in Bangladesh die before age 5, according to background information in the article. Diarrhea and acute respiratory infections are the leading causes of early childhood deaths. "Violence against mothers by their husbands is a factor hypothesized to relate directly and indirectly to the poor health of young children via exposure to violence, the incapacitation of mothers and direct mistreatment and neglect of children," the authors write. Jay G. Silverman, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 1,592 married Bangladeshi women with at least one child age 5 years or younger who participated in the 2004 Bangladesh Demographic Health Survey. Intimate partner violence was assessed on surveys given to the men, whereas women reported information about their children's health. More than two of every five (42.4 percent) of the mothers had experienced intimate partner violence from their husband within the past year. Those who did were more likely to report that their children had acute respiratory infections (19.2 percent vs. 13.7 percent) or diarrhea (11.6 percent vs. 7.6 percent) within the past two weeks. "Importantly, because the present analyses were adjusted for potential confounders, these effects persist after consideration of socioeconomic status (e.g., poverty), household characteristics and environmental factors (e.g., sanitation)," the authors write. Both direct and indirect mechanisms may be responsible for the elevated risk of illness among children exposed to intimate partner violence, they note. Trauma and anxiety are more common among children in violent households and could lead to suppression of the immune system over time. The children could also be experiencing direct physical harm from their fathers. "A growing body of work demonstrates that intimate partner violence occurs within a context of male-partner control, which can include interference in the ability of women to meet basic health needs for themselves and their children," the authors write. For example, women who are being abused may be less likely to have their children immunized or to breastfeed, both of which can compromise child health.
"Associations of maternal experiences of intimate partner violence with two leading causes of childhood mortality strongly suggest that such abuse threatens not only the health of women but also that of their children," the authors conclude. "Prevention of intimate partner violence perpetration by men may be critical to the improvement of maternal and child health."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Findings Reinforce Pediatricians' Need to Treat the Family
"Nearly 30 years ago, pediatrician Bayard Allmond and colleagues reminded us that, although pediatrics is fundamentally a medical discipline focused on children and youth, the development and health of children is inextricably tied to the functional well-being of the family system," writes W. Thomas Boyce, M.D., of the University of British Columbia, Vancouver, in an accompanying editorial. "We pediatricians, both practitioners and scientists, would be wise to recall, from time to time, the acuity of this insight, as the article by Silverman et al reminds us to do." "A world away from the exigencies and hardships of a young mother's life in Bangladesh, the findings of Silverman et al apply, as aptly and compellingly, to the North American mother who struggles to shield her child from the assaults of family violence, poverty, loneliness and fear," Dr. Boyce continues.
"One of the most broadly endorsed moral standards of democratic societies is the belief that all children should have equal opportunities for the realization of their innate human potential and for the achievement of a good, safe and gratifying life," he concludes. "When will we whose professional lives are dedicated to care for children's health find the will and temerity to expand our borders and direct what moral authority we can muster against the injustice and violence that are the backdrop of too many children's lives?"
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
TV and Computer Screen Time May Be Associated With High Blood Pressure in Young Children
CHICAGO—Sedentary behaviors such as TV viewing and "screen time" involving computer use, videos and video games appear to be associated with elevated blood pressure in children, independent of body composition, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The recent trend in obesity is a major public health concern and its effect on blood pressure is of particular concern, according to background information in the article. "The clustering of cardiovascular disease risk factors in overweight youth suggests that risks may be immediate and not just indicative of potential future problems," the authors write. Although elevated blood pressure is associated with genetic factors, healthy physical, dietary and sleep habits seem to be relevant contributors to blood pressure levels in children. However, there have not been any clear links between sedentary behavior and elevated blood pressure in children younger than age 9. David Martinez-Gomez, B.Sc., of Iowa State University, Ames, and the Spanish National Research Council, Madrid, Spain, and colleagues examined associations between sedentary behavior and elevated blood pressure in 111 young children (57 boys and 54 girls ages 3 to 8). Sedentary behavior was determined by an accelerometer generally worn over the right hip and by parental reports stating the average time the children spent watching TV, playing video games, painting, sitting or taking part in other activities with low levels of physical activity each day for seven days. Time watching TV was defined as time spent watching TV, videotapes or DVDs. Computer use was defined as the time spent using a home computer or video game. Researchers defined screen time as the total amount of time each child spent using a TV, video, computer or video game. The children's height, weight, fat mass and systolic (top number) and diastolic (bottom number) blood pressure were also measured. The children's average sedentary time and screen time per day were five hours and 1.5 hours, respectively. Boys spent more time using computers than girls, but there were no significant differences in time spent on other sedentary behaviors. "Sedentary activity was not significantly related to systolic blood pressure or diastolic blood pressure after controlling for age, sex, height and percentage of body fat. However, TV viewing and screen time, but not computer use, were positively associated with both systolic blood pressure and diastolic blood pressure after adjusting for potential confounders," the authors write. "Participants in the lowest tertile [one-third] of TV and screen time had significantly lower levels of systolic and diastolic blood pressure than participants in the upper tertile."
"In conclusion, the results of this study showed that TV viewing and screen time were associated with elevated blood pressure independent of body composition in children," the authors write. "Given that total objective sedentary time was not associated with elevated blood pressure, it appears that other factors, which occur during excessive screen time, should also be considered in the context of sedentary behavior and elevated blood pressure development in children."
Editor's Note: This work was supported in part by a York University Faculty of Arts Research Grant, American Heart Association Beginning-Grant-in-Aid, a University of Nebraska at Kearney Grant and a scholarship from the Spanish Ministry of Education and Science. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 3, 2009
Pain Relief Only One Motive for Opioid Use Among High School Seniors
CHICAGO—Taking opioid drugs without a prescription appears relatively common among high school seniors, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The most common reasons survey respondents gave for taking the medications included relaxation, feeling good or getting high, experimentation and pain relief. "Prescription opioids are the foundation for the treatment of acute and chronic pain and these medications are highly efficacious when used properly," the authors write as background information in the article. "However, the non-medical use [without a clinician's orders] of prescription opioids has increased significantly among adolescents and young adults over the past decade in the United States." Sean Esteban McCabe, Ph.D., of the University of Michigan, Ann Arbor, and colleagues assessed survey responses from five consecutive groups of seniors at public and private high schools throughout the United States between 2002 and 2006. The 12,441 students filled out questionnaires reporting whether they had used opioids such as morphine, opium or codeine for medical or non-medical reasons over the past year or ever in their lifetimes. Those who reported non-medical use selected their most important reasons for doing so from a list of 17 potential motives. The students also were asked about methods used for taking the drugs (for example, smoking or in pill form) and any other substance use habits. More than one in every ten participants-a total of 12.3 percent-reported using prescription opioids for non-medical reasons in their lifetimes, including 8 percent who reported having done so in the past year. The leading motives were to relax or relieve tension (56.4 percent), to feel good or get high (53.5 percent), to experiment (52.4 percent), to relieve physical pain (44.8 percent) or to have a good time with friends (29.5 percent). Students who said they used the drugs only for pain relief were less likely to also report heavy drinking or other drug use than were those who took them for other reasons or who reported multiple motivations that included pain relief. "Future clinical and research efforts should attempt to differentiate between motives for non-medical use of prescription opioids because the present study identified subtypes that were significantly associated with medical use of prescription opioids and substance use behaviors," the authors write. "Notably, we found that more than seven in every 10 non-medical users of prescription opioids motivated by pain relief reported a lifetime history of medical use of prescription opioids," they continue. Other studies indicate that many adolescents obtain opioids from their own previous prescriptions. "These results suggest that appropriate pain management and careful therapeutic monitoring could contribute to reductions in the non-medical use of prescription opioids among adolescents."
Screening efforts should be used to differentiate between adolescents who need help with pain management and those who need a more comprehensive assessment for substance use disorders, they conclude.
Editor's Note: The development of the manuscript and the data collection were supported by research grants from the National Institute on Drug Abuse, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. 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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