Tag: lived experience

Reading of the Week: Homelessness with Papers from Lancet and JAMA; Also, Kinsella on His Recovery

October 30, 2025 /

From the Editor

The loss of her job. A couple of poorly timed moves, motivated by her need to help care for an ailing parent. Financial woes. These problems converged, and my patient found herself ill and homeless. What were the potential implications for mortality?

In a new paper published by The Lancet Public Health, Sandra Feodor Nilsson (of Copenhagen University) and her co-authors attempt to answer that question. Drawing on Danish data involving more than six million adults, they found that men and women live far fewer years when experiencing homelessness, 15.9 years and 15.3 years, respectively. Though past work has examined the topic, Nilsson et al. offer a more comprehensive look. “Life-years lost exceeded those observed in individuals with schizophrenia, alcohol use disorder (for males), and drug use disorder.” We consider the paper and its implications.

In the second selection, from JAMA, Drs. Kirk B. Fetters and Joshua A. Barocas (both of the University of Colorado) describe recent cuts to Housing First programs in the United States and weigh its impact. They note the evidence for this approach. “Because the health care system is already overburdened and the homelessness crisis is worsening, maintaining and expanding Housing First is not only compassionate but also imperative.”

And in the third selection, Sean Kinsella writes personally about homelessness and addiction. In an essay for the Irish Examiner, he discusses his deep problems – and his recovery. He advocates that we do more for those who are homeless. “I wasn’t seen. I wasn’t heard. I was a file. A risk to be managed.”

DG



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Reading of the Week: Contingency Management for Stimulant Use – the New AJP Paper; Also, LLMs as Mental Health Providers and Kumpf on Her ED Visit

October 9, 2025 /

From the Editor

Her housing is unstable; major relationships have ended; she is deeply in debt. She presented to the emergency department hoping for help with her crystal methamphetamine addiction. “That drug just grabs you and holds you.” No medications have demonstrated efficacy for stimulant use disorder. But could contingency management be part of a meaningful plan for her recovery?

In the first selection, a paper published last month in The American Journal of Psychiatry, Lara N. Coughlin (of the University of Michigan) and her co-authors attempt to answer that question. They did a retrospective cohort study, comparing those who received contingency management with those who didn’t, looking at outcomes and 12 months of data, and involving 1 481 patients and an equal number of people in the control group. “This study provides the first evidence that contingency management use in real-world health care settings is associated with reduced risk of mortality among patients with stimulant use disorder.” We consider the paper and its implications.

In the second selection, Tony Rousmaniere (of Sentio University) and his co-authors examine large language models as health providers. In a timely paper for The Lancet Psychiatry, they weigh the regulatory and legal contexts. “LLMs have entered everyday use for mental health. Developers who embrace transparency and collaborative research can transform the mental health landscape and define the future of digital care for the better.”

And in the third selection, Emily A. Kumpf (of Johns Hopkins University) writes personally about her first-episode psychosis in Psychiatric Services. While she is grateful for the care she received in the emergency room, she was traumatized by the experience. “When I was restrained, every part of me genuinely believed the medications they were injecting into me were chemicals intended to kill me. My scream pierced through the hospital walls; I thought I was dying. To my surprise, I woke up the next morning.”

DG

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Reading of the Week: Less Social Media, Better Mental Health? The New NBER Paper; Also, Harm & School-based Interventions, and Jones on Her Psychosis

September 25, 2025 /

From the Editor

11.

This month, Reading of the Week celebrates its 11th birthday. Thanks for continuing to read.

Does quitting social media enhance emotional wellbeing? In the first selection, Hunt Allcott (of Stanford University) and his co-authors attempt to answer this question in a paper for NBER. In a randomized trial, they assigned more than 35 000 social media users to either a social media-free group or one where people continued to use Facebook and Instagram. “Our estimates suggest that deactivating Facebook or Instagram before the 2020 election improved people’s emotional state…” We consider the paper and its implications.

In the second selection, Carolina Guzman Holst (of Oxford University) and her co-authors look at school-based mental health interventions and potential harms in a new Child and Adolescent Mental Health paper. In their scoping review, they drew on 120 studies involving CBT and mindfulness. “Overall, our study suggests that a minority (8.93%) of these interventions finds at least one negative outcome and that, to date, no adverse events linked to the intervention itself have been reported.”

And in the third selection, Alexandra Jones writes about her postpartum psychosis in a paper for The Lancet Psychiatry. After a quick labour and delivery, she notes changes with her mental health. She tries to seek care – but only becomes more ill. Eventually, she is hospitalized. “Postpartum psychosis is a psychiatric emergency, and women with postpartum psychosis deserve greater compassion and support underpinned by increased education, research and resources.”

DG



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Reading of the Week: Some Reading Before Labour Day

August 28, 2025 /

From the Editor

How does ChatGPT compare to a human therapist for CBT? How often is lithium – arguably the gold standard medication for bipolar disorder – prescribed in Canada? Do young patients do as well as adults with psychotherapy?

In the coming weeks, we will look at papers that attempt to answer these important questions. But today’s Reading is the last one before the Labour Day weekend. 

Instead, in a break from our usual format, I offer a few things you may choose to read from a comfortable chair by a lake or, perhaps, in the quiet of a call room if you are working (and a quick thanks to my colleagues for covering my inpatients this long weekend).

This week, there are no detailed descriptions nor commentary. I provide short summaries and an invitation to read one, two, or three of these longer pieces.

DG

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Reading of the Week: Suicide – with Papers from AJP and BJPsych Int; Also, O’Brien on His Brother’s Suicide & His Family

June 12, 2025 /

From the Editor

She came into our ED feeling overwhelmed. After a recent breakup, she felt suicidal; the academic demands of grade 12 further stressed her. As a clinician, this type of adolescent presentation seems to be increasingly common.

But is it? Many people have opinions. Dr. Tanner J. Bommersbach (of the University of Wisconsin) and his co-authors attempt to shed light on the state of teen mental health with a new and important paper focused on suicidal ideation, plans, and attempts. In the first selection, we examine their American Journal of Psychiatry paper, involving almost 120 000 high school students, drawing on US survey data, and covering a decade and a half. “In this nationally representative sample… significant increases occurred in the percentage reporting past-year suicidal thoughts, suicide plans, and suicide attempts from 2007 to 2021.” We consider the paper and its implications.

In the second selection from BJPsych International, Dr. Rachel Gibbons (of the Royal College of Psychiatrists) writes about suicide. In a controversial paper, she argues that we make too many assumptions about suicide, which colour our research and undermine our understanding of patients. “Embracing the complexity of suicide may not only refine prevention but also deepen our understanding of suffering, resilience, and meaning.”

And in the third selection, playwright Dan O’Brien writes about his brother’s suicide for Esquire. In a deeply personal essay, he discusses his brother’s mental health problems and his parents’ desire to hide them. He wonders what could have been. “I would like to be helpful to some who might read this, if only to deny that the suffering of mental illness is a disgrace, and to assert that such suffering is common and survivable.”

DG

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Reading of the Week: Glucagon-Like Peptide 1 Receptor Agonists & Mental Health – the New JAMA Psych Study; Also, Innovation and Lee on His Depression

May 29, 2025 /

From the Editor

These medications are widely discussed – and, yes, our patients ask about them. But how do glucagon-like peptide 1 receptor agonists impact mental health and overall wellness? Should we hesitate before reaching for the prescription pad?

Aureliane C. S. Pierret (of King’s College London) and her co-authors attempt to answer these questions in a new paper just published in JAMA Psychiatry. In their systematic review and meta-analysis, they included more than 107 000 patients, comparing treatment with GLP1-RAs to placebo, looking at psychiatric, cognitive, and quality of life outcomes in those who are overweight, obese, or have diabetes. “Our results provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment is associated with improved mental well-being, in addition to the known physical health improvements.” We consider the paper and its implications.

When we hear innovations in mental healthcare, we tend to think of apps or wearables. In the second selection from Quick Takes, Daisy Singla (of the University of Toronto) discusses her recent study that expanded access to psychotherapy for perinatal women, reducing symptoms of depression and anxiety by drawing a page from work done in low-income countries. The key concept: training up laypeople to deliver therapy (task sharing). “It’s one of the largest psychotherapy trials in the world.”

And in the third selection, from The Globe and Mail, Joe Lee writes about his realization that he has depression and that it has affected his life for years. In a personal essay, he talks about his illness and the impact on his life. “Depression is weird like that. For some people, it sneaks in. For me, it’s always been there – like blood in my body.”

DG

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Reading of the Week: Lived Experience of Postpartum Depression & Psychosis – the New World Psych Paper; Also, Involuntary Treatment and Family Stress

May 15, 2025 /

From the Editor

“You are normal and then the next thing, you know, you’re crazy.”

So comments a woman about her postpartum depression. Typically, we describe this illness with a list of symptoms. But how do patients experience it? In a new World Psychiatry paper, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer this question with a “bottom-up” approach, looking at both postpartum depression and psychosis. “To the best of our knowledge, this is the first bottom-up review of the lived experience of postpartum depression and psychosis. Experts by experience co-designed, co-conducted and co-wrote the study, leveraging an established methodological template developed by our group to investigate the lived experience of psychosis [and] depression…” We look at the paper and its implications.

Should people with substance problems be forced into treatment? Across North America, some are proposing this idea, including governments in British Columbia and Alberta. In a new Canadian Journal of Psychiatry paper, Benedikt Fischer (of the University of Toronto) and his co-authors look at the issue and the evidence. “Involuntary treatment for severe SUD is a complex and contentious concept that requires careful in-depth consideration before its adoption.”

In the third selection, a paper written anonymously for The BMJ, the author describes the challenges for families of those with severe mental disorders. He notes his deep frustration with visits to the ward, often leaving him in tears. “Perhaps family support needs to become part of the culture on mental health wards, and we should recognise the need for help in communicating.”

DG


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Reading of the Week: When Does Grief Become a Disorder? The Lancet Review; Also, Time to End Daylight Saving Time? And Dr. Hickey on Her Anxiety

May 8, 2025 /

From the Editor

After the unexpected loss of his spouse, my patient sank deeply into grief. He was tearful during our sessions, explaining that a part of him had died, too. Weeks turned to months. Was this a normal response to a profound loss? Or something more problematic? DSM-5 seeks to clarify the issue by recognizing prolonged grief disorder – though the disorder is controversial and has attracted much criticism. When The New York Times covered the topic in 2022, Joanne Cacciatore (of Arizona State University) commented: “I completely, utterly disagree that grief is a mental illness.”

Clare Killikelly (of the University of Zurich) and her co-authors shed light on prolonged grief disorder with a new review, just published in The Lancet. They write about the disorder, the differences from grief, its treatment, and more, drawing on 142 citations. “Grief is a universal experience. However, for a minority of individuals, grief becomes a debilitating, devastating mental health disorder with serious implications on a personal and societal level.” We examine the review, highlight four take-aways, and reflect on the broader debate.

Spring forward, fall back. Twice a year, we adjust our clocks (and our brains) to and from daylight saving time. In the second selection, Dr. David Dongkyung Kim (of the University of Toronto) and his co-authors argue that daylight saving time should be eliminated. In their JAMA Commentary, they draw on the literature. “Daylight saving time transitions cause acute disruptions in human circadian rhythm, and the medical literature shows detrimental effects for public health.”

Finally, in the third selection, Dr. Joanne Hickey (of Memorial University) discusses anxiety and her expectations. In a personal CMAJ paper, the hematologist reflects on her work – and on her own journey, including her anxiety, the decision to take medications, and her need to come to terms with her perfectionism. “Anxiety has been my life companion, though I often didn’t recognize it. It masqueraded as that internalized need to control.”

DG

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Reading of the Week: ADHD – with Papers from JAMA Psych, PLOS One & Psych Services

April 3, 2025 /

From the Editor

He had struggled for years with mood and ADHD. While we discussed different medication options, my patient was very focused on psychedelics; he explained that his friends had found microdosing to be helpful, especially for their attentional problems.

Psychedelics have entered the mainstream: research is active; patients seem increasingly interested; and, yes, investors offer up billions in the rush to find potential treatments (and profit). But is there evidence for psychedelics for those with ADHD?  Dr. Lorenz Mueller (of the University of Basel) and his colleagues attempt to answer that question with a new paper, just published in JAMA Psychiatry. They describe the first double-blind, placebo-controlled phase 2A randomized clinical trial. 52 participants received repeated doses of LSD (twice weekly) or placebo over six weeks. “In this randomized clinical trial, repeated low-dose LSD administration was safe in an outpatient setting, but it was not more efficacious than placebo in reducing ADHD symptoms.” We consider the paper and its implications.

The molecular structure of LSD – pretty but useful for ADHD?

In the second selection, Vasileia Karasavva (of the University of British Columbia) and her co-authors look at ADHD and social media in a new paper for PLOS One. In a two-part study, they analyzed 100 popular videos on ADHD, finding many views but uneven quality. While they note the “democratizing” of mental health information, they warn: “TikTok’s anecdotal content could lead some viewers to misattribute normal behaviors or those better explained by other conditions to be signs of ADHD…”

In the third selection, Dr. Zilin Cui (of Boston University) writes about ADHD – as a provider and also as a patient. In a personal Psychiatric Services paper, the physician discloses long-standing problems and a diagnosis. She also writes about cultural considerations. “Instead of continuing to dwell on what I cannot do, I now have different tools and strategies to chart my path forward. Now, I can finally tell myself that I am enough.”

DG


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Reading of the Week: Psychiatric Care in 21 Countries – The JAMA Psych Study; Also, Industry Payments to Psychiatrists and Batterman on Relating

February 13, 2025 /

From the Editor

Our patients often struggle to access care. But what is the global experience? What percentage of patients in other countries receive care that meets basic standards?

In the first selection, Dr. Daniel V. Vigo (of the University of British Columbia) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. They analyzed effective treatment and its key components for nine mental disorders drawing on the World Mental Health surveys which included structured interviews. Vigo et al. cover familiar ground, but the study stands out due to its unusually robust dataset which includes almost 57 000 people in 21 countries. “The proportion of 12-month person-disorders receiving effective treatment was 6.9%.” We consider the paper and its implications.

In the second selection, Dr. John L. Havlik (of Stanford University) and his co-authors weigh in on industry payment to US psychiatrists. In this Psychiatric Services paper, they analyzed six years of data covering nearly 60 000 physicians, drawing on government databases, finding: “a small number of psychiatrists (<600 psychiatrists per year) received approximately 75% of industry’s compensation to psychiatrists each year.”

And, in the third selection, medical student Alexander I. Batterman (of Rowan University) writes about a patient encounter for Academic Psychiatry. He notes the challenges of connecting with a patient who has psychosis and is dismissive. Batterman persists – and understands. “As a former epilepsy patient who is intimately aware of what it is like to be questioned and observed by clinicians and students in the emergency department, as if I were an animal at the zoo on display, I could relate to the human experience of being judged.”

DG

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