Month: March 2025

Reading of the Week: Task-sharing in Therapy for Perinatal Depression – the New Nature Med Study; Also, Yoga, and Donelle on Grief After Her Daughter’s Suicide

March 27, 2025 /

From the Editor

She was so excited about the pregnancy; in our sessions, she expressed joy. But, as with some women after childbirth, her mood declined. She couldn’t properly care for her son, which she reported with shame and guilt. Perinatal depression is common – and yet many women in Canada and other high-income countries don’t receive care.

What can be done to help them? Could nonspecialist providers – like nurses, midwives, and doulas – be trained up to deliver psychotherapy effectively? Can telemedicine be used? In a new paper for Nature Medicine, Daisy Singla (of the University of Toronto) and her co-authors attempt to answer these questions. In their study, SUMMIT, they conducted a pragmatic, noninferiority trial comparing specialist and nonspecialist providers, delivering care in person or through telemedicine. Participants received eight treatment sessions of behavioural activation. They found noninferiority with both providers and modality of treatment. “This trial suggests compelling evidence for task-sharing and telemedicine to improve access to psychotherapies for perinatal depressive and anxiety symptoms.” We discuss the paper and its implications.

Daisy Singla

Alternative treatments – think mindfulness, acupuncture, yoga – have been historically popular with patients but generally lacking in evidence. Times have changed: mindfulness as a psychotherapy, for instance, is included in the CANMAT depression guidelines. What about yoga? Does depression care include the downward dog? In the second selection, a new episode of Quick Takes, I speak with Dr. Vanika Chawla (of Stanford University) who is part of that university’s lifestyle medicine team and a registered yoga teacher. “I think yoga is a wonderful way to expand providers’ toolbox of existing treatments.”

And in the third selection, Caroline Donelle writes about the suicide of her daughter. In a deeply personal essay for The Globe and Mail, she notes the loss, her decision to move across the country, and her slow healing. “I’m not the person I was when she died and never will be again. I’ve evolved and grown in unexpected ways.”

DG


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Reading of the Week: Physician Suicide – the New JAMA Psych Paper; Also, Homelessness & Substance (JAMA)

March 6, 2025 /

From the Editor 

It’s a demanding profession that can push us. Not surprisingly, there is some evidence that physicians may be at higher risk of completing suicide than the general population. But are we?

Hirsh Makhija (of the University of California, San Diego) and his co-authors attempt to answer this question in new JAMA Psychiatry study. Drawing on a US national database, they compared suicides among male and female physicians to the nonphysicians, over five years, finding that suicide rates for female physicians were 47% higher than for women in the general population. They also looked at mood, mental health, and other problems. “Comprehensive and multimodal suicide prevention strategies remain warranted for physicians, with proactive consideration for those experiencing mental health issues, job problems, legal issues, and diversion investigations.” We review the paper and its implications, and look at the accompanying Editorial.

In this week’s second selection, Ryan D. Assaf (of the University of California, San Francisco) and his co-authors report on homelessness and substance use. In a new paper for JAMA, they surveyed 3 200 people, finding that 37% reported using any illicit substance regularly (more than three times per week), most commonly crystal methamphetamine. “In a representative study of adults experiencing homelessness in California, there was a high proportion of current drug use, history of overdose, and unmet need for treatment.”

Note that there will be no Readings for the next two weeks.

DG

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