MonthMay 2015

Reading of the Week: The Kids are Alright – The New England Journal of Medicine and Childhood Mental Health Disorders

The rate of severe mental illness among children and adolescents has dropped substantially in the past generation, researchers reported Wednesday, in an analysis that defies public perceptions of trends in youngsters’ mental health.

So begins The New York Times’ front-section coverage of a big paper in a big journal with a big result.

This paper, just published by The New England Journal of Medicine, considers the rate and treatment of childhood mental health impairment. In contrast to other surveys, this paper didn’t find a rise in the rate of mental illness. (Contrast this finding with the comment of a former president of the American Psychiatric Association that such illnesses are “an epidemic hidden in plain view” – that is, obviously there but underreported historically.)

Explains the lead author, Dr. Mark Olfson:

The finding is robust and real and challenges the prevailing stereotype that young people are somehow more vulnerable to mental problems.

Dr. Mark Olfson

How common is mental impairment among children and adolescents? How has this changed in recent years? How are patients being treated? Are we prescribing more than in the past? Olfson et al. seek answers to these important questions in “Trends in Mental Health Care among Children and Adolescents” – this week’s Reading. Continue reading

Reading of the Week: Dr. Gawande and ‘Low-Value Care’

It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful.

So begins Dr. Atul Gawande’s recent essay in The New Yorker, which I have chosen as this week’s Reading.

It asks a simple question: what can we do about this?

Dr. Atul Gawande

Dr. Gawande, a general surgeon at Brigham and Women’s Hospital, is a prolific writer; he is a frequent contributor to The New Yorker and has penned several bestselling books, including Being Mortal and The Checklist Manifesto.

In this piece, Dr. Gawande focuses on overtreatment. Indeed, the title is a good summary: “Overkill.” Continue reading

Reading of the Week: Depression and Employment

I want to get back to work… I want to get back to my life.

A patient recently made this comment to me. Before his depression, he had thrived at a government job and taken great pride in his work. (He showed me iPhone pictures of an event he had helped organize which was keynoted by the premier.) But in the cloud of depression, he left his job, and worried that he would never have another one.

This raises a simple question: how do you get patients like this back to work?

It seems like an obvious question to ask – and very relevant one. After all, many people with depression are off work, or have left the workforce altogether. A Towers Watson report considered disability in North America; mental health issues (typically “depression, anxiety and stress”) contribute to 78% of short-term and 67% of long-term disability claims in Canada. Let’s put that in perspective: for short-term disability, cancer was well under half that.

Yet if the burden of illness is great, little has been written about interventions to get patients with depression back to work. A 2008 Cochrane review identified only 11 randomized controlled trials (RCTs) on interventions aimed at reducing work disability in workers with major depressive disorder (and just four studies including work functioning as an outcome measure). A more recent Cochrane review considered 13 randomized controlled trials; only three studies, for example, looked at antidepressant therapy.

That’s why this week’s Reading is so interesting. “Gains in employment status following antidepressant medication or cognitive therapy for depression” by Jay C. Fournier et al. compares drug management with psychological interventions (CBT). Continue reading

Reading of the Week: Economics and Mental Illness

For John Mooney, it was a career highlight. In March the Irish cricketer took a crucial catch that gave his team the victory in a World Cup match and eliminated the higher-ranked Zimbabwe. But afterwards the Zimbabwe Herald, a daily paper with links to Zanu-PF, the thuggish ruling party, claimed that Mr. Mooney had lied when he said that his foot had not been touching the boundary, meaning the catch should have been disallowed. The article cited previous interviews in which the sportsman had spoken frankly about his long battles with drink, depression and suicidal thoughts. Under pressure, it claimed, a “man of such a character” could not be trusted to have “the honesty, let alone the decency” to tell the truth.

John Mooney, cricketer, Ireland “player of the year” (2010), and a man with depression

So begins this week’s Reading.

The essay provides an excellent summary of the impact of mental health on our society and our economy. It also notes reasons for hope. Indeed, Mr. Mooney’s story is moving: after the Zimbabwe Herald attack, fearing that others may be reluctant to talk about their mental illness in light of his harassment, Mr. Mooney chose to publicly speak about his battle with depression. The article notes:

The reaction was heartening. Messages and thanks are still coming in.

This essay is readable and concise. “Out of the shadows: The stigma of mental illness is fading. But it will take time for sufferers to get the treatment they need” is a must read. Here’s the surprise: it was published in an economics magazine.

Welcome to 2015, where thoughtful analysis on mental health issues isn’t just for the psychiatry journals anymore. Continue reading