Tag: United States

Reading of the Week: Novel Depression Care – the New JAMA Psychiatry Study; Also, Psych Beds in the US and ChatGPT & Sensitive Conversations

November 6, 2025 /

From the Editor

He had several antidepressant trials. rTMS was helpful but the improvement faded quickly. Should he try ketamine? My patient had read good things and asked.

In a new paper for JAMA Psychiatry, Ana Jelovac (of Trinity College Dublin) and her co-authors attempt to answer that question. 62 hospitalized patients with depression were randomly assigned to receive either repeated ketamine or midazolam treatment and were followed for 24 weeks afterwards. “Serial adjunctive ketamine infusions were not more effective than serial midazolam infusions in reducing depressive symptoms in inpatients receiving usual psychiatric care.” We consider the paper and its implications.

How has the supply of US psychiatric beds changed with time? In the second selection, from JAMA Psychiatry, Karen Shen (of Johns Hopkins University) and her co-authors drew on US databases, finding a slight reduction in overall beds but perhaps an increase in acute care supply, albeit with an increase in beds from large for-profit hospital chains. “Given reports of safety concerns at large for-profit chains, our findings also underscore the need for research on the effects of growing corporatization of inpatient mental health care on patient outcomes.”

And in the third selection, published on their website, ChatGPT staff write about recent controversies involving those with mental health problems, suggesting that the organization has been moved to action. The essay describes their efforts to make advice safer and more appropriate for users who are psychotic, suicidal, or becoming emotionally reliant on AI. “We worked with more than 170 mental health experts to help ChatGPT more reliably recognize signs of distress, respond with care, and guide people toward real-world support – reducing responses that fall short of our desired behavior by 65-80%.”

DG

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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: On Spade, Suicide, and the New CDC Report

June 14, 2018 /

From the Editor

“I didn’t know Kate Spade, who hanged herself with a red scarf in her bedroom on Tuesday at the age of 55, other than through the prism of her insistently cheerful and whimsical accessories. But everything about Ms. Spade and her designs suggested a sunny temperament, from her candy-colored aesthetic to the perky image she projected. We have a hard time squaring a seemingly successful woman — one with a highflying career, a family and heaps of money — with a despondency so insinuating that it led her to end it all. All this helps explain why Fern Mallis, the former director of the Council of Fashion Designers of America and a friend of Ms. Spade’s, called her death ‘so out of character.’ In fact, it turned out that the bubbly girl from Kansas City ‘suffered from depression and anxiety for many years,’ as her husband, Andy, said.”

So writes novelist Daphne Merkin The New York Times. In the essay, Merkin writes about her depression and her own suicidal thoughts.

Kate Spade. Then Anthony Bourdain.

It’s been a remarkable few days.

bourdain-obama-429e2fd0-b412-4a22-804a-acb7a25d8d43Anthony Bourdain with President Barack Obama

In this Reading, we look at the new CDC report on suicide in the United States. Suicide rates south of the 49thparallel have risen nearly 30% since 1999. We consider the paper and its implications.

DG

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Reading of the Week: ECT in America – Uncommon, Uneven, and Underappreciated? The New Wilkinson Paper; Also, Cope’s Challenge to Corporate Canada

February 8, 2018 /

From the Editor

It’s difficult not to be excited about Bell Let’s Talk. Last week’s event set a fundraising record. Pause for a moment and appreciate how far we have traveled: a major Canadian corporation is promoting mental health awareness, raising millions of dollars in the process, and gathering praise from many, including the Prime Minister. The decline of stigma is seen across the west, with talk of tackling the opioid epidemic in New Hampshire, US, and of bettering psychological interventions in Hampshire, UK.

But how accessible is evidence-based care?

In the first selection, we consider a paper just published on ECT in the United States. Drawing on a massive database, the authors of this Psychiatric Services paper find ECT is used rarely and unevenly. In this Reading, we compare the American data to Canada’s – and draw a similar conclusion.

flag_map_of_the_contiguous_united_states_1912-1959A large country with many people – but not much ECT

And speaking of Bell Canada, in our second selection, we consider a Globe article on CEO George Cope’s recent Canada Club speech. In it, Cope challenges other businesses to implement a mental health strategy. “For business leaders… here’s the call-out: The numbers are self-funding. There’s no reason not to adopt a program in your company.”

DG

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