CategoryReading of the Week

Reading of the Week: Trends in Suicide Mortality in Canada (CJP); also, Suicide Prevention (Quick Takes) and Lawrence on Her Depression (Guardian)

From the Editor

Suicide is often discussed, but what do we know about the overall rate of completions? We hear that there are more suicides in the United States over the past few years – but was does the Canadian data say?

In the first selection, we consider a new paper by Mélanie Varin (of Indigenous Services Canada) and her co-authors. Drawing on a Canadian database, they consider suicide mortality. The good news: the suicide rate in Canada decreased by 24.0% between 1981 and 2017. But, in recent years, there hasn’t been a further decline.So – is the glass half full or half empty?

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In the second selection, we look further at suicide, considering a new podcast discussing suicide and suicide prevention. I talk with Dr. Juveria Zaheer (of the University of Toronto) about COVID-19, the literature, and, yes, her suggestions for clinical interviews. “If you have a room of one hundred people, one hundred people in that room have been affected by suicide.”

Dr. Rebecca Lawrence is a UK psychiatrist and we can assume that she has done many suicide risk assessments. In a Guardian essay – our third selection – she tells her story: as a person who struggled with mental illness, then made the decision to become a psychiatrist. “If my story helps anyone unsure of their capacity to take on the job, or worried about the ‘dark secret’ of their own psychological troubles, then I think it’s worth telling.”

DG

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Reading of the Week: Cannabis for Mental Illness (CJP)? Also, Cannabidiol for the Cannabis Use Disorder (Lancet Psych) & Love on the Police (Globe)

From the Editor

“Should I take cannabis for my mental illness?”

Our patients ask this question – in our EDs, inpatient wards, and outpatient clinics. We shouldn’t be surprised. Cannabis is now legal, and private industry pushes the medicinal benefits of cannabis. But what does the literature say?

This week, we have three selections.

The first is a new Canadian Psychiatric Association position statement that considers cannabis and mental illness. Dr. Philip G. Tibbo (of Dalhousie University) and his co-authors systematically reviewed the literature. They found 29 RCTs, including for anxiety and psychotic disorders. “Use of cannabis or a cannabinoid product should never delay (or replace) more evidence-based forms of treatment.”

marijuana-candy-sizedMany products, little evidence?

But is there emerging evidence for cannabis? Tom P. Freeman (of the University College London) and his co-authors did a phase 2a trial using CBD to address cannabis use disorder, which is written up in The Lancet Psychiatry. “In the first randomised clinical trial of cannabidiol for cannabis use disorder, cannabidiol 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use.”

Finally, on a pivot, in the third selection, we consider an essay from The Globe and Mail. Rebeccah Love writes about her own experiences with psychosis and her recovery. She also considers whether police should be involved in mental health crises. “The image of a police officer – often a big white man with a gun – is interpreted as a threat, an agent of death, an oppressor.”

DG

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Reading of the Week: Apps for the Treatment of Depression (JAMA Psych)? Also, Cannabis & Driving (CJP); Oleynikova on Returning to School (Globe)

From the Editor

The world changed on March 11, the day that the pandemic was declared by the WHO. So did mental health care, with so many of our services becoming virtually delivered. But what’s effective and what should be incorporated into care moving forward?

This week, we have three selections.

The first is a new JAMA Psychiatry paper. With COVID-19, apps are becoming increasingly popular (one therapy app reports a 65% increase in clients over the spring). Can the apps be incorporated into primary care? Andrea K. Graham (of Northwestern University) and her co-authors do a RCT using apps for patients with depression and anxiety. They conclude: “In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients.” But should we be so enthusiastic? And how could apps be used in care?

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Canada legalized cannabis for non-medical purposes in 2018. In a short research letter – our second selection – medical student Laura A. Rivera and Dr. Scott B. Patten (both of the University of Calgary) consider driving under the influence of cannabis, drawing on national survey data. “Public policy actions toward prevention of DUIC [driving under the influence of cannabis] appear necessary and will have the greatest impact if they are effective in the 15 to 24 age range and in males.”

Finally, in the third selection, we consider an essay from The Globe and Mail. Like many, Vera Oleynikova thinks about the return to school. She writes about her own experiences, noting a complication: she has struggled with depression. “To be sick for a long time and then to feel well again is a magical thing. You feel brand new and capable of anything. You marvel at your own capacity to do the things that for a long time were unavailable to you because of your illness. Which is why going back to school at 31 felt so right.”

DG

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Reading of the Week: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

4anvfzqDepression treatment: helpful, like a lift from a friend?

In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

DG
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Reading of the Week: Burnout & North American Psychiatrists – the Big AJP Paper; Also, Satel on Kanye West’s Mental Illness (USA Today)

From the Editor

“Burnout is notoriously difficult to characterize.”

So comment the authors of a new American Journal of Psychiatry paper.

In recent years, we have been collectively speaking much more about physician burnout, but we often lack basic data. Using an online survey, Dr. Richard F. Summers (of the University of Pennsylvania) and his co-authors attempt to find out how common it is among North American psychiatrists. While there are many surveys of physicians, this one focuses on our specialty. What do they find? “Psychiatrists, like other physicians, have substantial burnout.”

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In the second selection, we look at a new essay by Dr. Sally Satel (of Yale University). Writing in USA Today, she discusses the presidential campaign of Kanye West and the unusual comments that he has made. “None of this is funny.” She notes that he has a history of mental illness, and wonders how journalists should have covered the story.

Please note that there will be no Reading next week.

DG

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Reading of the Week: Depression Outcomes: What Matters to Patients (Lancet Psych)? Also, NYT on Mental Health Apps and Startup Culture

From the Editor

“US Food and Drug Administration accepts only three outcome measures as primary endpoints in phase 3 studies to support an indication for major depressive disorder: the Hamilton Depression Rating Scale, the Montgomery-Åsberg Depression Rating Scale, or the Children’s Depression Rating Scale.”

The editors of The Lancet Psychiatry make this point in in the August issue of that journal. Their concern: the FDA view is very narrow and confined to these three scales.

In the first selection, we look at a new paper from The Lancet Psychiatry. Dr. Astrid Chevance (of the Center for Epidemiology and Statistics Paris Sorbonne) and her co-authors consider depression outcomes. To understand different perspectives, they draw on three groups: providers, patients, and caregivers. For the record, the resulting paper is fascinating and includes outcome measures that aren’t captured by these three scales. We consider the paper and the editorial that runs with it.

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In the second selection – also on the topic of depression – Kashmir Hill and Aaron Krolik report for The New York Times on a popular therapy app. They note that Talkspace has good marketing and a growing client base. But should you recommend the app to your patients?

DG

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Reading of the Week: Is Yoga Useful for Depression (CJP)? Also, Women & COVID (JAMA) and Stergiopoulos on Masks & Medicine (UofTMed)

From the Editor

Complementary and alternative medicines are trendy – but are they helpful?

“Depressed patients… often perceive CAMs [complementary and alternative medicines] as safer, accessible, more tolerable, and easily acceptable compared to pharmaceuticals. It has been estimated that 10% to 30% of depressed patients use CAM therapies, often in tandem with conventional treatments and frequently without the knowledge of their physician. This percentage is even higher amongst those with bipolar disorder (up to 50%) and in clinic populations (up to 86%).”

So writes Dr. Arun V. Ravindran (of the University of Toronto) and his co-authors in a new Canadian Journal of Psychiatry paper. That study – our first selection this week –considers the use of one type of CAM: yoga. They find that it “may be helpful as an adjunctive intervention.”

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In the second selection, writing in JAMA, Dr. Linda Brubaker (of the University of California, San Diego) considers gender and roles in medicine. While she is careful not to over-generalize, she notes that: “As a group, women physicians spend proportionately more time on home and family care activities.” With the disruptions of COVID-19, she wonders what must be done to support all physicians. “Women and men physicians should be able to share the joy and the work of their lives equally.”

And, in the third selection, University of Toronto psychiatry resident Dr. Erene Stergiopoulos considers masks – and humility – in a time of COVID-19. In a personal essay that turns on a split-second decision, she notes: “These days it’s hard to remember a time before masks. And some days, it’s just as hard to imagine a future without them.”

DG

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Reading of the Week: ECT & Equity (CJP); also, COVID and Mental Health Surveys (Policy Options) and Farrell on Witnessing the Pandemic (Nation)

From the Editor

Who has better access to care?

This week, we have three selections. The first is a paper about inpatient ECT – an important topic. And the study – just published in The Canadian Journal of Psychiatry – has interesting findings, including that ECT is not particularly commonly performed (for just 1 out of 10 inpatients with depression). But this new paper by Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors also touches on the larger issue of equity. We consider it – and the questions the study raises.

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The second selection is an essay from Policy Options. Drs. Scott Patten (of the University of Calgary) and Stan Kutcher (of Dalhousie University) bemoan the state of mental health data during the pandemic. “There has been a disturbing acceptance of trivial and often misrepresented information, delivered from sub-optimal surveys and problematic interpretation of results.”

Finally, we consider an essay by Dr. Colleen M. Farrell (of Cornell University). She discusses COVID-19 – she is working in the ICU of a major New York City hospital during the pandemic – but also ties to the larger issues of public health, advocacy, and the role of medicine. “As I tend to my patients in the Covid ICU, I struggle to process reality. The attending physicians who are my teachers have few answers; this disease is new to all of us.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Physician Suicide – the New JAMA Psychiatry Paper and Editorial

From the Editor

“‘I Couldn’t Do Anything’: The Virus and an E.R. Doctor’s Suicide.”

So headlines a long article on the life and death of a New York doctor who had excelled at medicine – Dr. Lorna Breen oversaw an ER department, and was studying in a dual degree master’s program at Cornell University – but died during the COVID-19 pandemic. The front-page story ran last weekend in The New York Times.

Physician suicide. It’s a weighty topic, one that typically wasn’t discussed much in the past, in part because of the reluctance of physicians to acknowledge their own problems. But how often does it occur and is there a gender gap?

This week, we consider a new paper by Dr. Dante Duarte (of Harvard Medical School) and his co-authors. While previous papers have been published in this area, Duarte et al. are ambitious: they do a systematic review and meta-analysis of studies published over the last four decades. In the JAMA Psychiatry paper, they find: “suicide standardized morality ratios were high in female physicians and low in male physicians after 1980…”

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The paper runs with an editorial by Drs. Katherine J. Gold (of the University of Michigan) and Thomas L. Schwenk (of the University of Nevada). Putting the paper in a larger context, they write: “Suicide prevention is a moral responsibility of the entire medical profession.”

And a quick word of welcome to PGY1 residents who are joining us this week as part of our continued partnership with 12 Canadian residency programs from coast to coast to coast.

DG

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Reading of the Week: Rurality and Suicide (CJP); Also, COVID and Digital Practice (Quick Takes) and Haughton & Bromberg on Policing (Tor Star)

From the Editor

At times, it seems that we understand little about suicide.

That statement is vast, sweeping – and painfully true for us clinicians who aspire to do better with very blunt instruments. This week, we have three selections; the first is a systematic review and meta-analysis focused on suicide. In a new Canadian Journal of Psychiatry paper, Rebecca Barry (of the University of Toronto) and her co-authors consider the potential link between suicide and rurality. Spoiler alert: they find a connection, at least for men. What are the implications for practice and policy?

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In the second selection, we consider a new podcast discussing our digital future. I talk with Dr. Jay Shore (of the University of Colorado), who chairs the APA’s Telepsychiatry Committee. We discuss the virtualization of mental health services, and contemplate a future of hybrid care. And, yes, he has tips on how to avoid “Zoom fatigue.”

In the third selection, activists Asante Haughton and Rachel Bromberg discuss alternatives to police responding to mental health crises, seeing a dedicated team tasked with “on-the-spot risk assessments, de-escalation, and safety planning for clients in crisis” and more. “By taking on these important tasks, this team will enable Toronto policing resources to be more effectively directed toward solving crimes, rather than providing social services.”

DG

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