MonthApril 2022

Reading of the Week: Tailoring CBT for Black Women – the New JAMA Psych Paper; Also, Meds & Transgender Individuals

From the Editor

The story is too familiar: Black women are more likely to have insomnia, and yet less likely to receive the needed care. What can be done? That question speaks to the larger issue of equity.

In the first selection from JAMA Psychiatry, Eric S. Zhou (of Harvard University) and his co-authors offer a culturally tailored form of CBT-insomnia for Black women. They designed an elegant, three-armed RCT, working with several people, including – yes – a Black woman with insomnia. They find: “Participants were more likely to complete the full intervention if they received the tailored program, with intervention completion associated with greater insomnia improvement.” We consider the paper and its implications.

CBT-I aims to help everyone sleep like lambs

In the second selection, we look at a new paper by Dr. Jack L. Turban (of Stanford University) and his co-authors. In JAMA Psychiatry, they write: “Transgender and gender diverse (TGD) people unfortunately experience high rates of psychiatric morbidity, and their psychopharmacologic needs can be unique when compared with those of cisgender people.” They offer practical suggestions.

DG

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Reading of the Week: Equity & Mental Health Care – Post-Partum Follow Up After ED Visits (Lancet Psych) and Race and Prescribing (Psych Services)

From the Editor

We often speak of the challenges patients face in accessing mental health care. But, of course, such challenges may vary greatly, depending on demographics – think rural versus urban, young versus older, White versus non-White. How equitable is care? This week, we look at two new papers; one draws on Canadian data while the other on American. And though the studies are different, they point in a similar direction: unique populations face significant challenges accessing care.

In the first selection, Dr. Lucy C. Barker (of the University of Toronto) and her co-authors consider follow-up after an ED visit for patients in the post-partum period. In a new Lancet Psychiatry paper, they drew on Ontario databases, with more than 12 000 visits analyzed. They write: “Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care.” We consider the paper and its implications.

In the second selection, Jocelyn E. Remmert (of the U.S. Department of Veterans Affairs) and her co-authors consider depression care and race. In a new Psychiatric Services paper, they look at antidepressant prescribing, finding big differences between White and Black veterans. “Among veterans, Black patients were almost two times less likely than White patients to have an antidepressant prescription, even after the analyses controlled for depression symptoms, demographic characteristics, psychosocial variables, and other clinical symptoms.”

DG

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Reading of the Week: Cool but Useful? VR Therapy for Psychosis; Also, Preventing Child Abuse (QT) and Renaming Schizophrenia (Lancet Psych)

From the Editor

Asking for a coffee. Passing strangers on a bus. Making eye contact at a grocery store. These tasks don’t seem particularly daunting but for those with major mental illness, they can be deeply unsettling. Some are left homebound.

In this week’s first selection, we look at a new Lancet Psychiatry paper by Daniel Freeman (of Oxford University) and his co-authors; in it, they detail an intervention where participants work through several tasks, like the ones named above. The coolness factor? It’s done through virtual reality (or VR). They find: “Automated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone.” We consider the paper and the larger implications.

Passing strangers on a bus: one of several tasks in gameChange

In the second selection, we weigh prevention in mental health care. Ainslie Heasman (of the Center for Addiction and Mental Health) joins me for a Quick Takes podcast interview. We discuss Talking for Change, which aims to prevent child sexual abuse with evidence-based interventions focused on high-risk populations – that is, “moving prevention upstream” in the words of the psychologist.

Finally, in the third selection, Dr. Bruce M. Cohen (of Harvard University) and his co-authors consider psychiatric terms, noting that some are outdated. In a Lancet Psychiatry paper, they discuss schizophrenia and personality disorders. They write: “Any label can stigmatise, and there are no perfect terms, but that should not prevent changing to better ones. Words communicate how we conceptualise a disorder.”

DG

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Reading of the Week: Cancer & Suicide – the New Nature Medicine Paper; Also, Dr. Natasha Steele on Her Cancer (NEJM)

From the Editor

The big diagnosis. Even years after the fact and even in cases of good outcomes, so many still remember the exact moment when they were told that they had cancer. A patient once recalled with great detail the floor tiles in his doctor’s office (he couldn’t bear looking at his spouse or his doctor). He also remembered feeling so overwhelmed that suicide seemed like an option.

But what is the risk of suicide? In the first selection, Michael Heinrich (of the University of Regensburg) and his co-authors seek to answer that question, drawing on an impressive number of studies including more than 22 million patients. In a new paper for Nature Medicine, they report on a systematic review and meta-analysis; they found that “patients with cancer have an almost twofold increased risk of dying by suicide compared with the general population.” They write: “Despite immense progress in cancer therapy and prognosis in the past decades, suicide remains an important cause of death in patients with cancer.” We consider the paper and its clinical implications.

In the second selection, Dr. Natasha Z. Rabinowitz Steele (of Stanford University) considers her experiences in a New England Journal of Medicine paper. She writes about her cancer diagnosis and treatment, and the impact on her clinical work. She concludes: “Though all of our journeys will have beginnings and endings, our lives are what we choose to do with the precious, unpredictable, terrifying, and beautiful moments in between.”

DG


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